Long term consequences to the pectoral muscles of placing a breast implant under the muscle?

I have performed under the muscle augmentation in several professional bodybuilders and fitness individuals, and in general, the appearance of the augmentation is better under the muscle, particularly when the body fat is low.  However, there is a decrease in strength of the muscle to some degree.  

The single biggest damage physicians do to the pectorals major muscle is by separating it excessively from the sternum to accommodate a very large implant.  It causes animation problems and the muscle jumps unnaturally when it is used.  It is very difficult to correct and most repairs are only partially successful.

It's better to choose an implant that fits your anatomy and doesn't require extensive modification of the chest  muscle.  This will maximize the normal function of the chest muscle.

from experience I can tell you that there is no way to accurately predict the animation deformity someone will get when the implant is placed under the muscle. I would express your concerns to your surgeon and see if you are a candidate to have the implant placed sub fascial, For example, how thin you are.

Hello and excellent question,

Body builders have a unique situation: low body fat percentage and little breast tissue making a subglandular augmentation implant more visible and feelable and very developed pectoralis chest muscles making a subpectoral augmentation implant distort the breast when working the chest and flexing for competitions.  I have seen many patients who are either fitness competitors or true professional body builders.  You must understand that either position will be a compromise; either more visibilty/palpability or animation/possible poor shape.  For fitness competitors, where it is less of a profession, a subpectoral implant may be advantageous with muscle coverage of the upper implant offering a more natural look.  For professional, flexing-muscle-groups-on-stage competitors, I would be more inclined to recommend a highly cohesive gel implant above the muscle.  A shaped implant often is selected to avoid the truly 'round look'.  I recently did an implant exchange in a nationally ranked professional body builder and changed the position to above the muscle using a shaped, cohesive implant which resulted in very beautiful breasts that she was much more pleased with.

Be honest with yourself and your trusted board certified plastic surgeon about your body building and fitness goals and to what degree you intend to compete.  Then, consider the above, accepting that there will be some trade-offs, and choose the better option.

Brad Remington, MD

This is a great question and I do not have a great answer.  Having placed breast implants on many body builders, every situation is different.  Some women need implants under the muscle and some on top of the muscle.  This procedure does not harm the muscle, long term, but there is definitely an animation deformity when flexing the pectoral muscles.  So, an important question is; are you competing and what type of competition?  Posing? Flexing? are implants legal for your competitions?  Most of the time we place the implants under the muscle because the the body fat percentage is so low that the implants show wrinkling and rippling.  Please see a Board Certified Plastic Surgeon who performs breast enhancement surgery frequently to assure the best possible result.

After placement of breast implants under the pectorals muscle, the muscle significantly atrophies and, because of changed angulation of the muscle ,power is weakened. Additionally, there are significant animation deformities. Therefore, in a bodybuilder, the implants should never be placed under the muscle. Because of a somewhat increased capsular contracture rate when placed above the muscle, the implants should be textured. When done properly by an experienced surgeon the results are very natural and as good or better than implantation below the muscle.