by Joseph A. Mele III, M.D., F.A.C.S.

I am often asked if breast augmentation limits athletic ability. Does the placement of implants somehow weaken an athlete? Will their weight cause instability? Does placement under the pectoralis major muscle cause loss of muscle function? Like many questions in medicine, the answer depends on the specific variable for each individual.

Size matters, and the larger the implant the greater the potential impact. Variables influenced include the following: reaching across the chest, lateral (side-to-side) displacement of the breast and implant, the additional weight of the implant, increased drag, discomfort and possible muscle atrophy.

The ability to reach across the chest can be impacted. For someone with AA-cup sized breasts before surgery, the change is proportionally larger than for someone who begins with B-cup breasts. The implants may be more noticeable with sports that require extreme inward rotation at the shoulder with the arm extended. Examples include golf and racket sports like tennis and racket ball. Unless the implants are quite large, most athletes adapt quickly and can compensate by increasing rotation of the torso at the waist.

Lateral displacement of the breast and implant can also interfere with the arm's range of motion. By keeping the implant diameter less than or equal to the diameter of the native breast, the feeling that "they're in the way" can be minimized. This is also a good way to keep the result proportional to the rest of your body.

The weight of the implant is another factor. Women with large breasts (especially those desiring breast reduction surgery) often complain of lower neck, upper back and shoulder pain. Removing breast tissue - usually several pounds - relieves these symptoms. Conversely, if too much weight is added to the breast, similar symptoms can develop. However, since most implants weigh about three quarters of a pound, this problem is rare. Exercise routines that include running and jumping may make the weight more noticeable, but with the proper support, these activities are usually well tolerated.

Competitive swimmers may notice slightly increased drag, but for the recreational athlete, little change is noted. Since most implants used for augmentation are filled with saline (salt water), they are essentially neutrally buoyant. In other words, implants won't make you float on your back - or sink to the bottom of the pool.

A rare complication of breast augmentation is chronic discomfort in the breast. Most discomfort is associated with the surgery itself. This usually resolves over a few days to weeks. Occasionally chronic pain develops. This is more common with larger implants, and may be related to stretching the capsule around the implant. Massage to compress the implant, displacement exercises, adequate support and medication usually help, but this may require some time away from strenuous activity. Again, this not a common problem, but in a few cases the implants had to be removed or reduced in size to provide relief.

As far as I know, there are no large clinical trials measuring upper extremity strength before and after breast augmentation, but anecdotal evidence suggests that weakness in the muscle is usually temporary, and is related more to the discomfort of surgery than to the implants. Most bodybuilders elect to have implants placed in front of the pectoralis muscle because of interference with muscle function. When these athletes pose, and forcefully flex their pectoralis muscles, their implants will raise up if placed behind the muscle. Although an implant is more obvious in front of the muscle, as the cover of many muscle magazines will attest, there is less movement with posing. There is anecdotal evidence that implants of reasonable size can be placed in the subpectoral plane without interfering with function, and many of my patients continue to enjoy exercising and weight lifting after their surgery without significant changes in their routine.

As with anything in life, too much of a good thing really is too much. Keeping the changes you have desire proportional to the rest of your body will help to minimize any interference breast implants may have on your physical activities. Whether you're looking to increase your breast size, or restore lost volume due to weight reduction or pregnancy, breast augmentation can be satisfying, and still cause minimal interference with your lifestyle.

There is no risk-free surgery, but choosing a well trained and practiced surgeon can help minimize the known risks. When choosing breast augmentation, it is also important to seek out a Board Certified Plastic Surgeon, who is well trained and comfortable with the procedure. Ask to see representative before and after pictures of the surgeon's patients. Ask them about their experience with patients' activity after the procedure, and when you will get "back to normal." If you do not personally know someone who has had the surgery, many plastic surgeons can provide you with the names of their past patients, who are comfortable talking about their experiences.

Even though breast augmentation is an outpatient procedure, your surgeon should have admitting privileges at a local hospital for the rare circumstance where you might need to be admitted. Most Board Certified Plastic Surgeons are members of the American Society of Plastic Surgeons (ASPS) and can be found on the society's web site (www.plasticsurgery.org). or the JAM.

Dr. Joseph A. Mele, III, M.D., F.A.C.S. is chairman of the Division of Plastic Surgery at John Muir Medical Center located in the San Francisco bay area in Walnut Creek, CA. He is certified by the American Board of Plastic Surgery and the American Board of Surgery and is an active member of the American Society of Plastic Surgery

Joseph A. Mele, M.D., F.A.C.S.