Many women who engage in bodybuilding and fitness activities are seeking breast augmentation. One of the down-sides of bodybuilding, in fact, is the gradual loss of breast tissue with increased lean body mass and decrease in body fat. If you’ve lost your curves as you’ve trained and toned, you can consider breast augmentation as a safe way to restore fullness to your figure. Dr. Rick Silverman has performed several breast augmentation procedures at his office serving the Boston area.
Most of the issues pertinent to all patients undergoing breast augmentation remain pertinent to fitness fanatics. Dr. Silverman provides information specific to women who enjoy weight training and are considering breast implants.
What is Breast Augmentation?
Breast augmentation, also known as breast enlargement or enhancement, is a procedure Dr. Silverman performs to increase breast size and/or improve breast asymmetry. This procedure has become one of the most popular procedures performed today. Breast enhancement is ideal for women who want larger breasts and want to restore the breast volume often lost as a result of pregnancy or significant weight loss. The breasts can be enlarged with implants or by fat transfer.
Breast Implants: Over Vs. Under the Muscle
Many women who body build worry about the impact of lifting on the breast implant if it’s under the muscle. Some of the concerns that arise are, “Will it move?” or “Will it deflate or pop?” These things can happen but its not typical and is very rare.
Dr. Rick Silverman recommends the placement of implants under the pectoralis major chest muscle since the appearance of the implant is better, especially in patients with very low body fat. In those patients, the implants tend to be very obvious when placed over the muscle, including features such as rippling. By placing the implant under the muscle, there is more tissue between the implant and the outside world, thus making the implant less obvious.
The patient above was a 34A to B pre-op and 34 C to D post-op. This patient had breast augmentation with submuscular implants filled to 400 cc. The after photos are 8 weeks post-op.
Will the Breast Implant Under the Muscle Be Squeezed by the Muscle?
Yes, the breast implant under the muscle will be squeezed by the muscle, but that’s not necessarily a problem. Breast implants are made to stand up to lots of abuse. The implants are compressible, and in many cases you will be advised to massage the implants to keep them soft. The motion of the muscle will not normally hurt the implant. On the other hand, the motion of the pectoralis muscle can cause “bouncing” of the implant or flattening, when the muscle is flexed. This isn’t a problem either, its just something that you should be aware of.
Breast Implant Placement: Half Under the Muscle and Half over the Muscle
I have had patients tell me that their friend’s plastic surgeon invented a technique like this, and I thought to myself, “hmm…isn’t that how we all do submuscular implants?” If you think of what a man’s chest looks like, the nipple is at the lower edge of the pectoralis muscle. The implants, when properly positioned, are essentially centered under the nipple. That makes half of the implant under the pectoralis muscle, but the lower half is not covered by the muscle. The lower half sits over the serratus muscles on the side and the rectus abdominis muscle below. Those names probably mean something to you if you’re a bodybuilding enthusiast. For everyone else, it’s just important to know that the lower part of the implant isn’t under muscle, except in cases of breast reconstruction, which is very different from cosmetic breast augmentation.
Breast Augmentation Incisions
Boston Plastic Surgeon, Dr. Silverman generally uses one of two incisions which include inframammary fold and periareolar.
- Inframammary: The most frequently used incision is placed in the inframammary fold, under the breast. This is well hidden by the breast (which is now larger and covers the incision), and this incision is the easiest to use. It is one inch long and at times it could actually be slightly smaller.
- Periareolar: The other option used is a “periareolar” incision—around the nipple. We typically use this incision when Dr. Silverman is performing a breast lift (mastopexy) at the same time as the augmentation. In that case, a periareolar (“donut”) mastopexy, we make the incision the whole way around the nipple, but no other incisions. This is important for women who have sagging of the breast after child-bearing or weight loss. The incision which is placed in the axilla (arm-pit) is another option, but I rarely use this incision for several reasons.
Primarily, many of Dr. Silverman’s patients are very active fitness enthusiasts, and they often wear sleeveless clothing, exposing the axilla. An incision there might be visible, whereas they are not going topless very often, thus hiding an incision on or under the breast. Additionally, an axillary approach makes management of the inframammary fold a little more difficult, especially in bodybuilding women. This could result in a high implant. He tries to avoid this, and the other incisions make that easier. Dr. Silverman do not use the transumbilical approach in his practice (through the belly button), but this is another alternative which is employed by a limited number of surgeons.
Types of Breast Implants
In most breast augmentation surgeries, Dr. Silverman has used round breast implants for his patients. Round breast implants are somewhat easier to use, and the results are generally excellent. In a few patients, however, he finds that McGhan anatomic implants may provide more projection and a larger implant with a narrower base. If a patient has a narrow rib cage and wants a larger implant, this can be useful. Additionally, because competitive bodybuilding women may want to be able to exhibit their intercostals and serratus (the muscles on the side), a larger round implant may obscure that area, whereas the anatomic implant might not. This is less important with a moderate sized implant, since the base width is narrower.
The appearance of the augmented breast with a round versus an anatomic implant, Dr. Silverman is fairly unimpressed by any differences with regard to a “more natural appearance”. Both implants give very good results when used properly. With the round implants, he uses a smooth implant, since it is a little softer and less palpable. The anatomic implant is textured, so that it doesn’t spin around once it is implanted. Obviously, an upside down anatomic implant might make you look top-heavy in a way you hadn’t anticipated.
Breast Augmentation Before & After
Is the Breast Augmentation Procedure Painful?
Breast augmentation is somewhat of a painful operation for patients. But 99.9% of women say that they would do it again for the benefit they perceive afterwards. Sort of like child-bearing. One of the good things is that the pain can be managed with pain relievers. During you consultation, Dr. Silverman will discuss any possible discomfort you may feel after surgery along with the pain management he provides to his patients.
When Will I Be Able to Work out After My Breast Augmentation?
Dr. Silverman allows his patients to start cardio in about a week, and they can start lifting with light weights after two weeks. He recommends that the patient does not do any chest exercises for up to six weeks, generally cautioning that if it hurts, don’t do it. In spite of this, most women who bench press share with Dr. Silverman that they are able to bench press the same weight as they did pre-operatively by eight to twelve weeks post-operatively. In a number of my patients who are very serious about their training, they have continued to increase their bench press strength as though they never had implants placed.
Dr. Silverman’s patient shares her breast augmentation recovery process