Suggestions for implants for bodybuilder? Saline or silicone? Under or over pec? 36yrs, 5’2, 135lbs, muscular build. (photos)

Question

I have a consult booked in December with a top surgeon in my area. I would love to have other opinions. I’m a competitive bodybuilder with a muscular build. I’m 36, 5’2, 135lbs, no kids. I had a Brest reduction about 11 years ago. I’m looking for small implants around C cup. I’m thinking about saline implants under the pec. I’d love some recommendations on the following. Under pec vs over pec, Saline vs silicone, Low profile vs high profile etc, concerns about scaring from prev reduction

William Bruno, MD · Answer

It's recommended to have implants placed subglandular (on top of the muscle) in bodybuilders. I would also recommend silicone due to the decreased chance of rippling compared to saline. The profile is a matter or personal taste/style, but a moderate or moderate plus profile tends to look most natural. The implant would be placed through a small portion of the horizontal existing scar from your breast reduction. I hope this helps.Best wishes,Dr.Bruno

Robert Cohen, MD · Answer

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. I also take into account their overall height and weight, the size and shape of the underlying chest and ribcage, the tightness and elasticity of the skin, and the amount of natural breast tissue. Prior to the procedure, we discuss and make decisions regarding location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use (I offer multiple types of silicone gel breast implants, as well as saline implants).
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Ronald J. Edelson, MD · Answer

tough question to answer since all options have their drawbacks.  I think you have enough breast tissue that rippling or animation deformities will be minor issues.  You have now read many conflicting opinions.  I think you’ll be fine either above or under muscle, saline or silicone.  I would let you make your own choice.  You’ll get a nice result with all options.

Shim Ching, MD · Answer

Thanks for your question.  You really should have implants over the muscle.  Animation deformity, or movement of the muscle while flexing your pectoral muscles, is the main issue that women who have your hobby would want to avoid.  I believe the subfascial position is best.  A surgeon could go through your current breast lift scars.  A firmer implant such as the Natrelle Cohesive implants would be a good choice as they ripple less and there is an increased risk for rippling when implants are over the muscle.

John J. Corey, MD · Answer

I recommend in all of my bodybuilders that they go above the muscle. There is too much distortion on stage when you are flexing and because you do a lot of chest exercises that muscle flexion has a tendency to push the implant to the side if they are under the muscle.You have breast tissue so silicone or saline is probably an OK option but if saline , I would probably overfill to counteract any rippling and some of my bodybuilders like more of that round,  overfilled shape!

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos and that you are a competitive body builder, I would suggest placement of smooth round subglandular implants, to fill out the emptiness, collapsed looked you ended up with from your breast reduction. I would caution against large implants which would cause sagging early. In my practice, I use the Vectra 3D to simulate the outcome using different profile and projection implants. Submuscular or dual plane implants will cause muscle animation especially when you flex your chest muscles in competition (not a pretty sight). Recovery, it really depends on the surgeon's meticulous dissection and attention to detail. I use tumescent solution in my breast cases, and this blunts the pain response significantly. No magic about 24 hour recovery. Recent reports about BIA-ALCL (breast implant associated- anaplastic large cell lymphoma) in breast augmentation associated with textured implants, are rare, but real.See a board certified plastic surgeon for an in person consultation/evaluation to see what are your best choices based on your life style as well.

Austin Hayes, MD · Answer

Thank you for your question. There are pros and cons to placement of implants below or above the pectoralis muscle. In general, I place implants in a dual plane position, which means under the muscle at the top of the implant and just below the breast tissue at the lower aspect of the breast. This does have the drawback of implant movement with muscle flexion. If you compete on stage, then it's important to determine if this implant movement would be detrimental. If so, then implants can be placed above the muscle. I would find a board-certified plastic surgeon who is experienced in both techniques. Discuss your goals, so that they can help you decide which position is best for you.

Daniel Barrett, MD · Answer

Dear Smithkim911,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Curtis Wong, MD · Answer

can be put over or under the muscle... it just depends on how much do you have to strengthen your chest muscles and are  you in bikini competitions where you are flexing your muscles in front of the crowds?  If toning of your pectorals are good enough and if you do not have to flex the chest in a bikini, you can have it done under the muscle.  Otherwise over the muscle is recommended.  As for implants above the muscle, I would recommend textured anatomic gel implants to diminish the increased risks of contractures and to provide durability to the outcome since textured implants do not move as easily as smooth round ones do.  Pros and cons should be discussed at length so you can make the best decision for yourself.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. Based on your photographs, you are starting at a good place and should have a very nice outcome with a well executed breast augmentation procedure.There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.   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)  that can be seen with breast implants placed in the sub muscular position.  
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well. Working together you will come up with a good plan to achieve your goals.  
 Best wishes.

Suggestions for implants for bodybuilder? Saline or silicone? Under or over pec? 36yrs, 5’2, 135lbs, muscular build. (photos)

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