Have you seen good results with over the muscle implants on athletic builds?

Question

Hello! I’m a 33y, 34A, no kids breast implant candidate seeking advice on over the muscle placement. I have low body fat as I’m an avid weightlifter. In a consultation, the surgeon suggested I go over the muscle given my anatomy + desire to continue my high activity level. My main concern is having the “bolted on” aesthetic. Have you seen good results for over the muscle implants? Any guidance is appreciated! I also have a wide breast bone gap, but nice pecs :) thanks!

David Parizh, DO · Answer

I think that is the best option for you, consider coupling it with fat grafting to liposculpt your result.

Gary M. Horndeski, MD · Answer

Over the muscle implants are good on patients who have a certain amount of breast tissue. Otherwise, they can look very obvious. Also, over the muscle implants have a higher rate for capsular contracture. Unfortunately, you have not provided photographs. At size 34 A, each 100 cc of implant corresponds to 1 cup size change. 200 cc implants would take you to size C. This may be appropriate for your body. If your breasts are widely separated then you may benefit from a simultaneous circumareola lift to move the nipple-areola complex more medial.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Harry T. Haramis, MD, FACS · Answer

In my experience, over the muscle is a good option for avid weight lifters.

Intense lifters may develop animation deformity or displacement from very strong pectoral muscles, which can be avoided by placing breast implants above the muscles.

This is a more anatomic placement and easier recovery. Also gives more natural appearance with gels and help with any laxity. Proper sizing should avoid unnatural look.

Slightly higher risk of scar tissue/capsule and fold support.

Further exam and consultation with your/a plastic surgeon is recommended to discuss your options and expectations.

Miguel Mota, MD · Answer

Hi! There are as just as many good results with implants over the muscle as there are good results with implants under the muscle. The decision is mostly due surgeon preference, patient anatomy and the results the patient is looking for. But, without at least some photos it is impossible to tell of you are a candidate.

Because you wish to continue your high activity level over the muscle is a good idea. Plus if your pecs are strong, there will probably be lots of implant animation whenever you move your arm and this does not look natural. On bodybuilders that do not want to alter their muscle anatomy and do not want a bolted on aesthetic, I always recommend teardrop shaped implants. They will fill out you upper pole in a gradual way while projecting the mid and lower portions of your breasts without altering your the pectoral muscle.

Best of luck,
Dr. Miguel Mota

Christopher Pannucci, MD, MS · Answer

Hi bianca_universe,
I place most of my implants above the muscle--generally in the subfascial plane (over the muscle, under the muscle fascia), or for very thin women in the split muscle position. I attached a link to some pre and postop photos, and you will the subfascial or split muscle augmentation can look great!
Hope this helps!
Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington

Gerald Minniti, MD, FACS · Answer

Although common among pro bodybuilders, over the muscle is the worse place for that body type: small breasts and a very lean build. Three things. 1. There are many pro or hard core athletes who enjoy their subpectoral implants. 2. Think long term. Subpectoral implants put less expansion forces on your soft tissues (the breast tissue and skin). 3. Over the muscle will increase your risk for capsular contracture.

Ronald J. Edelson, MD · Answer

Implants above the muscle in someone with very little breast tissue can be done. But the upper edge of the implant as well as rippling will be more noticeable. I still prefer under the muscle.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery. I have been in practice 28 years and have seen every aspect of breast augmentation surgery and perform breast augmentations commonly on fitness competitors. Over the years, the long term (over 5 years) changes associated with subglandular placement of implants is not near as good as submuscular placement. The common issues are implant wrinkling, slide down, and capsular contracture. in fact, it is rare for me to see breast with subglandular placement that don't have one of these issues. If you don't believe me, look at my gallery under breast revision "correction of long term change associated with implants on top of the muscle".  I strongly recommend subpectoral/dual plane placement of your implants. Best wishes to you

Daniel Barrett, MD · Answer

Dear bianca__universe,
athletic females can also have good BA results. It is important to have good preoperative preparation and the right choice of implants. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

Typically, I still place my implants behind the muscle in athletic women, but do discuss the muscle movement. Behind the muscle gives better upper breast fullness, avoids seeing the implant edge, and give some support to the implant.  Fat transfers can be helpful to add more tissue to help cover the implants if you have donor fat. Not all women have extra fat.