Breast Implants in the Athletic Woman

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Whether it’s a professional athlete, fitness model, or the average woman who wants to be in great shape, female athletes of all
levels face challenges that their male counterparts cannot even begin to understand. After putting forth so much effort to get
into shape and to lower their body fat percentage, women often in turn find a loss of volume in their breasts, turning a positive
experience into a negative one. Should losing a sense of femininity be the price paid for getting fit? Does getting in shape have
to mean being less shapely? Many women who find themselves in this situation turn to breast implants to help bring back their
feminine shape, however it is a difficult decision to make. The questions women ask themselves are fairly practical, in deciding
size, placement and figuring out what the difference is.

When it comes to deciding size, women must consider the fact that implants that are too large can be inconsistent with an athletic
lifestyle and just won’t look natural. You can find the right fit for your body through working with your surgeon, and joining
plastic surgery forums, such as on, where women can look at photos of others with similar body types and
talk to women with similar lifestyles. The real problem occurs when deciding where to place the implant. Implants tend to look
more natural under the muscle, especially in women with low body fat and small breasts. When implants are placed above the muscle
in a woman with low body fat, they can look fake because there isn’t enough “padding.” However, a problem to consider?one which
plastic surgeons don’t often talk about enough?is “animation deformities.” This occurs when the implant is placed below the
muscle and muscle activity occurs, distorting the breast. This is found in at least 5-10% of the cases where the implants are
placed under the muscle (although still using standard techniques), and is probably much more common in the athletic woman.

So is there an alternative to either fake half-melon breasts or distorted breasts with a life of their own? This problem was first
brought to my attention several years ago when a patient consulted me about her recent implants. She was a professional fitness
model who had consulted at least a dozen plastic surgeons across the country, because her problem was so severe that it was
threatening her livelihood. We discovered that the solution was a technique commonly used in South America and other parts of the
world, but has not yet been widely used in America, called subfascial (fascia pronounced like fashion). The fascia is a thin but
tough layer on the surface of the muscle, and it can be used to provide extra implant support with the implant above the muscle.

In many cases, the subfascial technique is an ideal solution, however the fascia is too thin to add padding. To help this, I
developed a variation on the technique called the split muscle approach. When using the standard “dual-plane” technique, the muscle
is actually cut away from its attachment to the ribs. This means there is a free edge of the muscle which becomes part of the
scar capsule around the implant, causing the muscle to pull on the implant every time it contracts. The split technique preserves
all of the normal muscle attachments, while still allowing the option of covering the upper portion of the implant, where it is the
most important.

About the Authors:
Dr. Richard A. Baxter, who is certified by the American Board of Plastic Surgery, has been a practicing Plastic Surgeon for over
20 years, as well as having served as a Past President of the Washington Society of Plastic Surgeons and the Northwest Society of
Plastic Surgeons. Dr. Baxter has pioneered several new techniques in Seattle and the Pacific Northwest and has been recognized as
a plastic surgery expert by regional and national media. Dr. Baxter has lectured on advanced plastic surgery techniques
internationally and has a Certificate of Advanced Education in Cosmetic Surgery. He first published this technique in 2005 and has
used it in more than 400 cases.