Submuscular or subglandular Breast Implants for a small-chested rock climber?

Having done reasearch and knowing about your surgery is an excellent start to breast augmentation. I enjoy when my patients have done their research and ask questions which help in the discussion. Where to place the implant is a question that comes up with every breast implant consultation. There are pluses and minuses to each. I also believe that everyone is diferent and scenarios like yours make a difference. Implants placed under the muscle can have less problems with scar tissue and infections as well as more natural looks and less palpablity. Implant placed above the muscle are not moved with flexing your pec muscles and can improve some droop in the breast. Silicone is a great choice for either. In terms of your scenerio I understand your concern. Only you can decided the major tradeoff between the two. I think for you, becuase you are thin, it comes down to possibly having some rippling or implant palpable versus not having the implants move or be noticed with rock climbing. An exam is important too becuase there are some features which may preclude you from placing the implants above the muscle. Best wishes.

I always recommend small round textured silicone gel
implants placed retro-pectoral since they look and feel more natural, are more
stable, less likely to ripple or have complications needing revision. Unfortunately, you have not told us your bra
size just your cup size. If you are 32
or 34 each 100 cc’s of implant corresponds to 1 cup size change. If you are 36 or 38 each 200 cc’s of implant
corresponds to 1 cup size change. From
this, you can compute the volume required to achieve your desired goal. Best Wishes,Gary Horndeski, M.D.

Thank you for your question.In my own practice I favor Submuscular. Under the muscle looks more natural, Mammography is better, infection rate is lower and the risk of capsular contracture appears lower.When my athletic patients flex their pec's, for that moment in time they may look less natural as the muscle compresses the implant, but for the 97% of the time they are not bench pressing or weightlifting under the muscle gives a more natural result. Above or below technically can distort over time-- IMO under the muscle does a better job of hiding the implant.As a AA cup size you are likely very slender. Aything that helps to hide the implant -common sense size, gel, submuscular is what I generally favor in a slender patient.  Subglandular can also burn some bridges, affecting the blood supply to the breast is you should need a lift in your future.I hope this helps.

Choosing a breast implant placement is very important. In general, I use a subfascial placement. Placing the implant beneath the muscle can often give an unnatural dynamic appearance. By that I mean when the pectoralis muscle flexes (as it does dramatically in rock climbing and other chest dependent exercises) the implant can often be displaced laterally. This is because the implant is really in a dual plane meaning the lateral portion of the implant is generally not covered by muscle in the submuscular implant. One of the detractions from placing an implant in the smaller breasted woman in the subglandular position is that it can show too much roundness at the top of the implant. Placing the implant in a subfascial position helps prevent this. The fascia is the lining of the muscle, much as the gristle that you would see in a piece of meat. It is a stiff lining and minimizes the show at the top of the implant. Rippling is possible with any implant especially in a smaller breasted woman. Saline implants will always have a higher chance of rippling than the cohesive gel silicone implants. Rippling is most common in the lateral portion of the breast and this plane is the same in all placement of implants for breast augmentation. Of course, these are only generalizations and your individual decision must be made in consultation with a well qualified plastic surgeon.

Thank you for the question.To best help you, a physical
examination or picture evaluation is required in order to determine
which procedures and techniques would be best for your case.Dr. Campos

99 percent of the time I place the implants under the muscle for well defined reasons.  However in patients who take place in vigorous activity requiring full strength of the arms I would recommend going on top of the muscle.  I would recommend you consider a teardrop shaped implant to help taper the upper pole.  

There is no perfect solution to this, and either option will be a compromise. The implants required for you to go from AA to a full C will be more obvious (visibly and palpably) and therefore may appear less natural, if place in a subglandular position. However, there will be no concerns over the function of your pectoral muscles and your climbing will not be affected.You will get a more natural look with submuscular implants. The implants will not distort over time with the muscle activity. They will move or displace during muscle contraction, but this is not usually a problem. Muscle strength is not noticeably affected in the vast majority of patients, but the exception would be high-performing athletes such as avid rock climbers like you. You may well notice a reduction in your athletic ability.   

If performance is a concern then you are quite right in that a subglandular implant, either cohesive or highly cohesive of a moderate profile might be best for you.

Subglandular placement gives you an easier recovery but it increases the chance of implant palpability and capsular contracture and it interferes more with mammography. Once healed submuscular placement shouldn't your strength in the long term. Implant displacement may be more of an issue below the muscle though. It is best to discuss your concerns with your plastic surgeon though as he or she has been able to examine you and can give the most accurate advice for your case.

Thank you for the question and pictures.
There are pros and cons to the placement of breast implants and the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.
On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” (movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in the sub muscular position.   
Everything considered, the vast majority of patients in my practice (including athletes) undergo breast augmentation surgery with breast implants placed in the sub muscular ( dual plane) position.
Best wishes.