Over or under the muscle? I train and take part in competitive figure competitions (bodybuilding)?

I'm getting my boobs done later in the year. I went for consultation yesterday and I'm unsure on whether I should go over or under the muscle? I'm worried with training that my implants will move and look far apart? I've heard this happening and wouldn't want it to happen to me! I'm 36A, considering 415cc or 450cc - again unsure on size also. Would like DD cup! Help?

Doctor Answers 6

Implants over or under the muscle for a competitive body builder

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Thank you for asking about your breast implants.

  • In general, for a body builder, I recommend implants over the muscle.
  • Otherwise, during competition the implant may move up or to the side, visible through your snug clothing and distract the judges.
  • Also the muscle is lifted off the bone - and you will find it hard to train for at least 2 months after surgery because of muscle discomfort.
  • Choosing your implant can't be done on-line - you need to be examined, measured and advise what will fit your chest and what profile - 
  • Fitting a large implant into a narrow chest can require a high profile implant.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Over or under the muscle? I train and take part in competitive figure competitions (bodybuilding)?

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Thank you for the question. There are pros and cons to the placement of breast implants in 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 (including athletes) 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 these sub muscular position.    Best wishes with your upcoming surgery.


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Without photos, I cannot be specific. However, implants placed under the muscle may show more lateral movement with flexion of your muscles. Some competitive body builders like this, and some don't. If you have enough breast tissue, implants placed behind the breast do give a more natural look and movement. I would suggest meeting with a board certified plastic surgeon and discussing all your concerns. during the consultation, you will be measured to see what range of sizes would work best for your frame and tissue.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 reviews

Over or under the muscle? I train and take part in competitive figure competitions (bodybuilding)?

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Please put your front, side pictures. These pictures are easier to see if they are taking by someone else not close to the camera of the area you are interested only to give you a better answer.      over or under muscle doesn't dictate what size implant we can use.  The muscle coverage is helpful in very thin patients and seems to reduce capsular contracture according to some scientific studies. Under the breast tissue is the most natural feel and has a less chance of animation deformity when the pectoralis muscle contracts. In most instances only the top implant is covered by muscle and the reset of the implant ends up under the breast tissue.Choose a board certified plastic surgeon who has done a ton of breast augmentation  and has privileges to do this surgery at a local university hospital. This says his credentials have been checked out by fellow Drs. All surgeries carry risk, talk to your plastic surgeon and choose one wisely.  

Many surgeons, including myself, offer online virtual consultations where you send us your photos and we can estimate the cost. I, like many surgeons, also offer free consultations so that you can be examined and given the most accurate quote.

Breast Implant Over or Under Muscle

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You are the one exception I make to my preference going under the muscle. There are several advantages to going under the muscle. You will typically have a more natural appearance to the upper part of your breast. The action of your muscle will help massage the implant and keep the scar tissue capsule soft. The muscle protects the implant from the natural bacteria in your breast to decrease the risk of infection and capsular contracture. Going over the muscle does allow for more “lift” but if a “dual plane” approach is taken you can pair the advantages of both approaches. All this being said, in a competitive bodybuilder, the progressive wear and tear can result in lowering and pushing the implants apart. I typically use a subfascial pocket in cases like yours.

Body builder seeking large breast implants.

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There are many advantages IMO of subpectoral breast implants but in a competitive body builder I would suggest that they be placed in a subglandular position instead.  Heavy use of the pectoral muscle may displace or distort your breasts with subpectoral implants so you need to consider silicone smooth suprapectoral (subglandular) IMO.  The larger the implant choice however, the greater the likelihood that you will develop or see tension ripples due to your thin subcutaneous layer.

Good luck with your decision and in your future competitions.

Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Extreme Makeover Surgeon ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 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.