Is There a Significant Difference/risk Between 270cc/310cc and 310cc/340cc, Saline over the Muscle, High Profile?

I am 48, just under 5'5" and about 125. I compete in a division of women's bodybuilding referred to as figure/physique. My surgeon wants to go above muscle . I am a 32A and 32B. I wanted to be a full D like I was before giving birth, nursing, and reducing body fat. My surgeon is suggesting overfill 270cc/310cc to achieve my look and says 310/340cc is higher risk for my skin and leaness. I chose saline because wrinkling seemed easier to fix.

Doctor Answers 8

The Best Fit For You?

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Thank you for your question!  I personally do not put my implants above the muscle only under, especially on thin women.  I suggest you go see a board certified plastic surgeon and discuss your goals with him!  Best of luck!Dr Dhaval PatelDouble Board CertifiedPlastic SurgeonChicago Hoffman EstatesOak Brook

Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 100 reviews

Implant choices in bodybuilders

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I would also disagree with your surgeon, disagree with the choice of saline implants above the muscle, disagree that you will get to a full D, and disagree that wrinkling from saline implants is easy to fix. The only thing that is a real factor is that the same size implant above the pectoralis muscle will look bigger than if it was below the muscle. It will also look very obvious and ripply. 

The pectoralis muscle is needed to pad, protect, and blend in the implant without defunctionalizing the muscle but with a trade-off in more movement of the breast with pec flexing. 

Saline-filled implants below the muscle can be made to look just like silicone gel-filled implants if they are sized, positioned, and filled properly but there is no way to make them feel like silicone-gel filled implants regardless of the fill. 

If you are between an A and a B cup with a 32 inch chest it is not possible to get to a full D size breast in one operation without major distortions and risks. A high profile saline (Allergan) or silicone gel-filled implant (either Mentor or Allergan) that is properly fitted to the width of the breast and under the pectoralis muscle for the upper part of the breast will increase apparent cup size by about 2 cup sizes. Given the current plan, you are a set-up for disappointment and an obvious "boob-job" that will be hard to correct and will likely need to be redone. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Body Building and Breast Implants

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There are a subgroup of body building women who are the least suited but most likely to go over the muscle, and that is the open class body builder who is likely to be using hormones for maximum muscle mass. For figure/physique body builders, I urge to do what is considered best for other lean women, which is submuscular placement.  The trade off is some animation deformity, which is usually separation of implants/breasts with pectoralis contraction.

If you do not want to risk this but are willing to risk some wrinkling, there is a new option that has recently become available: Sientra Corporation's shaped, highly cohesive 'gummy bear' breast implants.  These are FDA approved and currently available only to surgeons certified by the American Board of Plastic Surgery.  I have been happy using these in the unusual situation of placing implants over the muscle for bodybuilders.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Implant and choice

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It really is a tough call without an exam and proper evaluation.  Over the muscle in thin patients makes you more prone to rippling.  

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Which implants?

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Saline implants above the muscle in someone with very little soft tissue cover could be a disaster as far as looks go because of the near 100% chance of visible ripples. The wrinkling is unlikey fixable. You might want to get a few more consults. Overfilling has almost nothing to do with wrinkling unless you filll them to such pressure that they are hard and visibly deformed in other ways.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Not a great plan IMO

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Saline implants are not good above the muscle especially in a slender patient.  They will wrinkle terribly and if you overfill them too much to lessen that, they will feel hard.  Gels are better above the muscle, but I would still consider going below the muscle.  Also, the best implants are the ones which will give you the desired look and cup sizes are not very accurate.  But I can't believe a 270-310 cc implant will take you yo a full D.

Body building and breast implants

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Thanks for the question. First of all, the difference between a 310cc and 340cc implant is one ounce. I would not recommend saline implants for you, would do better with silicone gel implants. I'm not sure where the information given to you came from about saline implant rippling is easier to fix. This is not true. To fix rippling of saline implants, the options are fat grafts (I assume you do not have a lot of fat) or placement of tissue matrix into the implant pocket to mask the rippling. The second option is quite expensive, the material could cost you between $1800-3600, not counting the reoperation and other added costs. I would discuss these issues in detail with your surgeon, that when you will develop rippling, what is the plan for fixing it and the costs involved. Good luck.

Breast Implants for Body Builder?

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Thank you for the question.

You may want to be very careful with the decisions you are making. Generally speaking, patients who are active in the body  bodybuilding world tend to have very little soft tissue/adipose coverage making them higher risk for breast implant rippling/palpability. I have found the silicone gel breast implants tend to provide a better look for these patients. I have also found that ( despite the disadvantage of “animation deformity”)  that the sub muscular (dual plane) breast implant positioning  provides the best aesthetic results for this patient population.

In regards to breasts and plant size/profile etc havea full discussion regarding your desired goals  with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "huge and fake” etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.

You may find the attached link helpful.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.