Breast augmentation in athletic women: update
While every woman considering breast implants needs to be fully informed about her options, there are specific issues for athletes, fitness models, trainers, and really any woman into fitness. Athletic women considering breast implants have several specific things to consider in order to achieve the look they want without compromising their lifestyle. The most important of these are soft tissue coverage (which may be limited because of low body fat) and effects of the pectoral muscle if implants are placed behind the muscle (submuscular/subpectoral.) The size, type and profile of the implants used are also key.
Effects of submuscular placement of breast implants: dual plane vs split muscle
There are several good reasons to place breast implants behind the pectoral muscle, especially the effect of covering the upper part of the implant. This creates a smoother transition from the chest wall into the implant for a more natural look. Because athletic women often have lower body fat, there is less “padding” to conceal the implant, so this is especially important. But one thing that is not often discussed is the fact that the dual plane method involves detaching a portion of the pectoral muscle, leading to two potential problems: The first is called animation deformity, a distortion of the breast with muscle activity because the detached muscle pulls on the implant capsule. The second is loss of strength; a study published in 2017 documented loss of muscle volume and functional strength following dual plane breast implant placement.(1) This can be avoided by using either the split muscle technique or subfascial. With the split muscle, my standard method, there remains upper pole implant coverage with muscle without having to detach a portion of it. Muscle function is preserved while providing most of the benefit of submuscular placement. Subfascial (in front of the muscle but under the thin fascia layer) provides minimal extra coverage and is not as commonly done. Subfascial works best with low-to-moderate profile implants.
Low body fat and implant coverage issues
Regardless of which method is used, the muscle does not cover the bottom or outside part of the implant. Low body fat accentuates this, so there is a higher probability of being able to feel or see the implant. In these cases, fat grafting is sometimes recommended in order to add some “padding” around the implant. But athletes typically have low body fat and so there isn’t much available to use for this purpose. The best way to minimize visible rippling and related issues is to choose the right implant. This would be no higher than moderate profile, and with a base diameter matching the natural base of the breast. Larger implants or cases where the tissue envelope has thinned over time can be improved with an internal bra, using Strattice or Gala mesh. The newest implants are also available in a firmer gel, which minimizes rippling and holds the shape well.
- 1. Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation. Roxo AC, Nahas FX, et al. Aesthetic Surgery Journal 2017 June 1;37(6):654-661.
This is an article I published many years ago on the technique: http://www.drbaxter.com/uploads/pdf/subfascialthemevariations-1.pdf