Will getting breast implants under the muscle make it hard for me to do my job as a Massage Therapist?

I usually insert breast implants below the muscle because it gives an extra layer of tissue over the implant and looks more natural. I also release the muscle at the lowest part of its origin on the sternum. This method works nicely and I use it in personal trainers and others who have very physical jobs. No loss of strength. Incidentally, if you have breast tissue already, putting the implant above the muscle is a very acceptable alternative. I do it occasionally in body builders or women who are very concerned about animation deformity.

I've had patients who are personal trainers, massage therapists, and athletes. The superior contours from under the muscle implants (especially if small) have been worth any concern. Of course your milage may vary but this is just my experience.

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

• Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster
when compared to subpectoral augmentation.

• Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

• Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

• Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

• Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

• Subpectoral implants have a lower rate of capsular contracture.


• Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

• The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.

With regards to your specific question, division of the muscle will cause a slight decrease in upper body strength. However, for most the difference is negligible. You should be able to perform the same activities as prior. It is a compromise not in ability but rather intensity.

As always, your board certified plastic surgeon can help guide you in your decision making process.

You probably should not expect any weakness or problems from a small muscle release. You may have a little bit more tenderness in the first few weeks of healing, but that is usually a trade off for other possible benefits of being under the muscle.

Individuals who perform a lot of pectoralis muscle workouts (bodybuilders, etc.) may have less discomfort and distortion if their implants are placed above the muscle (prepectoral or subglandular placement). When sizable implants are placed under the muscle it places significant strain on the pectoralis which will be aggravated with excessive repetitive pectoralis contraction. If the implants are placed dual plane where the origin of the pectoralis muscle is cut to create a pocket for the implant, the remaining muscle fibers are mostly those between the breastbone and shoulder. Repetitive contraction of this less effective pectoralis muscle can contribute to soreness and lateral displacement of the implants with time. If your work involves a lot of chest press type maneuvers you may want to consider subglandular implants.

There are bodybuilders, fitness models and weightlifters who have gotten implants partially under the muscle and have successfully continued in their path after they recovered from surgery. It is important to note that there will be a period of time after surgery during which you’ll need to take off from work, as well as other physically strenuous activities. This may be a month or more, depending on the opinion of your surgeon.

It is rare that implants under the muscle lead to negative affects (e.g. scarring, displacement), but it is still considered a possibility. If you don’t want to take this risk, then you may want to reconsider getting implants.

You can still perform your job as a massage therapist with implants placed under the muscle. After surgery you will have some restrictions with activity including the exertions required by your job. Best of luck to you

When implants are placed under the muscle, often times the muscle origins are off the lower ribs and need to be released. This decreases the mechanical strength of the muscle. Also, putting implants under the muscle, stretches the muscle and can cause adverse effects. Placing the implants behind the muscle also cuts the nerves to portions of the muscle and may lose strength. If you are interested in maintaining the maximum strength possible then go in front of the muscle.

Best Wishes,

Gary Horndeski, M.D.

I have massage therapists and triple crown body builders return to their work and activities with no problem after under the muscle breast augmentation. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Thank you for your question. The thinking has changed quite a bit in the last few years about implant placement with regard to under or over the pectoral muscle. In my own practice, after thousands of breast augmentation procedures for the past 35 years, my #1 preferred approach is subfascial (OVER the muscle) which eliminates the possibility of animation deformity, which is only a risk when the implant is UNDER the muscle.

If you are very thin and have minimal breast tissue, we may have no choice but to undergo subpectoral placement. Otherwise the implant border can be very apparent if the is not enough breast tissue to disguise the implant.

If you provide photos it would be easier to advise you, but I recommend you consult with an experienced board certified plastic surgeon whose aesthetics appeal to you when viewing his or her Before and After gallery. Best of luck to you.