Tuberous Breasts, Highly Athhletic Lifestyle, Nursed 3 Babies. Can I Go over the Muscle? (photo)

5'6" 135 lb. I am generally quite active with running and crossfit. Crossfit involves dynamic upper body strength/balance. It is nothing for me to whip out 30 consecutive pull-ups or push-ups. I am worried a breast augmentation under the muscle will affect my strength and abilities. I went to 5 consults and only 1 doctor recommended over the muscle. With the tubular, droop and minimal tissue would I be a candidate for over the muscle augmentation? I am looking to use 300-350 of round silicone implants.

Doctor Answers 16

Breast Enhancement Surgery

I dont agree with everyone that you have to go sub muscular, I think it is reliable and ok to go above the muscle the only issue is that you have to use a smaller implant

New York Plastic Surgeon
4.9 out of 5 stars 71 reviews

Breast implant under muscle and breast lift is your best option

Thank you for your photo and question. As others have mentioned because of the lackof breast tissue and the constriction and sagging of your breasts, a breast lift and under the muscle breast implants should give you the best result.

Silicone breast implants placed beneath your breast would likely be very visible and also at risk for capsular contracture.

In my experience if you choose a reasonably sized implant in the 250 cc range I doubt that it wouldn't interfere with your sports activities.

Breast Augmentation with Mini Ultimate Breast Lift for athletic lifestyle

The goal of breast surgery is to achieve beautiful breasts.  Beauty is determined by several factors including symmetry, skin tone, position of breast on the chest wall, position of areola, cleavage and volume.  Your breasts are asymmetrical and very ptotic.  You are focusing on implant volume when other factors are more important.  I recommend you undergo a circumareola approach leaving a scar only around the areola.  With this technique, it is possible to lift your breast tissue higher, reshape your breast tissue to create upper pole fullness and increase your cleavage.  At the same time, the implant can be placed.  I recommend silicone gel implants placed retro-pectoral since they look and feel more natural.  Your desire for 300 to 350 cc implants may not be appropriate and you may benefit from a smaller implant.  Placing the implant over the bony prominence of your chest wall then elevating your breast tissue and the areola all in the same horizontal plane will maximize projection.  This allows the use of a smaller implant to achieve the desire projection.  The smaller imlant is less likely to dislocate or distort with muscular activity.  You are an excellent candidate for a new technique called Breast Augmentation with Mini Ultimate Breast Lift.

Best Wishes,

Gary Horndeski, M.D. 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 222 reviews

Above or under the muscle

I agree with the majority.  I feel implants are better in the sub muscular position, especially if you are using saline.  I have done plenty of breast implant cases under the muscle in very athletic women, and it does not sauce any problems with working out.  Good luck!

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Tuberous Breasts in Atheletic Lady

The long term results with the submuscular implants far exceed the subglandular placement especially in women with relatively little subcutaneous tissue of the breasts, such as yours. I think submuscular placement with areola reduction and limited subcutaneous breast scoring is the way to get the best result.

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Breast augmentation is very challenging in very thin, very athletic patients.

Under the muscle will give a much better look and feel to your breast. The implants under the muscle will feel a little weird when you start back with upper body exercise but you will likely get used to it.   In a perfect world, I would have you gain about 10 or 15 pounds to put some feminine padding on your very, very fit but way to thin body!  Just sayin'.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

Athletic Lifestyle can affect implant placement options

There are pros and cons for each implant placement. The "over the muscle" placement will allow you a quicker recovery and not affecting your athletic and active lifestyle. The downside of this breast implant placement location is higher risk of rippling, especially in thin, deflated breast like your. If you are not considering altering your lifestyle, then I would still recommend that you consider above the muscle placement. You can decrease the risk of rippling by either adding autologous fat to your existing breasts or adding a layer of acellular dermal matrix graft (Alloderm or Stratice). At very least, have a discussion with your plastic surgeon about your concern, and possible options that allow you to keep your current lifestyle and still achieve your aesthetic goal.


Stewart Wang, MD FACS, Wang Plastic Surgery

Stewart Wang, MD, FACS
Los Angeles Plastic Surgeon
4.6 out of 5 stars 28 reviews

Can I Go over the Muscle?

Thank you for your question and for the attached photos. without going into the findings that can lead to the diagnosis of tubular breasts, I find it to be borderline from these photos, and wonder about the breast appearance before pregnancies and nursing. At any rate, the photos and a live exam determine what it is,and giving a name to the diagnosis doesn't change it!

As for as above or below the muscle, here are the pros and cons.

•Advantages of under the muscle include:

•implants more likely to stay soft
•breasts look more natural (at least at rest)
•fewer ripples, harder to feel the implant
•mammography a bit better--less breast is hidden
Advantages of above the muscle
•no animation (movement of implant when chest muscles are flexed)
•less discomfort after surgery (just a couple of days)
For weight lifters, body builders, the disadvantage of animation may trump the advantages of submuscular placement. Otherwise, absent some unusual anatomic situation most surgeons prefer submuscular placement.


As I look at your photos, I find that the amount of breast tissue and the size of the proposed implant make me favor under the muscle placement. Without the extra soft tissue cover I think that the outcome of an above the muscle augmentation will not be as attractive as a submuscular placement would be. I would hold with the five out of six consultants. 

Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Tuberous Breasts, Highly Athhletic Lifestyle, Nursed 3 Babies. Can I Go over the Muscle?

In your situation I would recommend staged operations. First do the lifting operation. allow 3 months to heal than second operation abodes UHP 450 cc 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Over vs. under muscle fro breast augmentation in athletic women

In my experience, patients do very well returning to athletic lifestyles after breast augmentation under the muscle. I have patients who work in the fitness industry and patients who do crossfit with implants under the muscle. No one has been unable to resume these activities.

In general, women with thin tissues tend to have a lot of implant visibility, including ripples and wrinkling, when their implants are above the muscle. The risk of capsular contracture would also be significantly higher above the muscle. 

Obviously, no one can guarantee that you will have your same level of ability after a breast augmentation under the muscle, although issues are unlikely. Likewise, no one can guarantee that you would end up with a "bad" result or problems after an aug above the muscle. But, if you look at what is most likely, you are probably more likely to have problems related to implants placed above the muscle than you are with activity restrictions from implants under the muscle.

Find a board certified plastic surgeon who you connect with and really listens to your concerns. He or she will help you figure out what will work best for you. I am very impressed with your commitment to personal fitness!


Best wishes,


Michael Vennemeyer, MD 

Michael Vennemeyer, MD
Southlake Plastic Surgeon
5.0 out of 5 stars 48 reviews

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.