Submuscular breast implantation is an augmentation procedure with several benefits. But it also has risks, such as delayed healing, implantation shifting or reshaping, and waterfall deformity.

Ahead, plastic surgeons explain the possible downsides of submuscular breast implants.

Although you may start to feel like you’ve healed 2 to 4 weeks after surgery, healing takes an average of 6 to 8 weeks, says Constance M. Chen, MD, a board certified plastic surgeon and breast reconstruction specialist based in New York City.

For a frame of reference, recovery after a fat transfer breast augmentation procedure generally takes 1 to 2 weeks.

First, scar tissue has to form around the capsule. “Then, any tissues that touch each other fuse,” she says.

Exercising or attempting other strenuous movements too soon after surgery can disrupt this process.

“If a person with breast implants under the muscle, for example, starts working out the upper body before the tissues are completely healed, they can push the breast implants into the armpits or into strange positions because the tissues are not yet fused,” explains Chen.

“You can also slow down the healing process by not taking in sufficient nutrients, by smoking, by taking steroids, or otherwise not prioritizing your health and wellness,” she says.

Dynamic distortion — also known as animation deformity — involves movements in the implant.

Distortion occurs specifically when the chest muscles are activated and engaged, says Alexander Zuriarrain, MD, a quadruple board certified plastic surgeon with Zuri Plastic Surgery in Miami, Florida.

Often, people who experience dynamic distortion say that the implant looks:

  • like it’s protruding
  • squished
  • wrinkly
  • rippled
  • bulbous

Some people may also feel pain with visible distortion.

“While contracting the breast muscle may compress the breast implant and cause a temporary slight change in shape, this quickly resolves upon muscle relaxation,” says Glenn Vallecillos, MD, a board certified plastic surgeon based in Beverly Hills, California.

“The issue is never a permanent one,” he says. That said, the only way to prevent it from happening even temporarily is to undergo surgery, usually one of the two procedures outlined below.

Prepectoral revision involves removing the implant under the muscle and positioning a new implant on top of the muscle.

Explant and autologous reconstruction also involve removing the implant. But here, the doctor replaces the implant with a graft of your own tissue.

Modern breast implants are usually made of a cohesive silicone gel andretain their shape over time, says Vallecillos.

However, the implant can temporarily flatten when your pectoral muscle contracts.

When your chest muscles contract, they squeeze anything beneath the muscles. This can change the shape and appearance of your breast for as long as your muscles contract.

While there are no health risks associated with flattening, it’s a concern that athletes and bodybuilders, in particular, may take steps to remedy.

For example, wearing a padded sports bra or baggier workout shirt can help hide the temporary flattening.

Prepectoral revision and explant and autologous reconstruction are the two main surgical fixes.

Submuscular breast implants typically do not become indented, says Zuriarrain.

But when people flex their chest muscles, some people report an indentation where the muscle ends.

This is usually only apparent when they flex their chest muscles. People bothered by this might choose to fix it with a prepectoral revision or explant and autologous reconstruction.

This occurs when the breast implant “freezes” while the rest of the breast tissue continues to grow, change shape, or fall due to gravity.

If the preexisting breast tissue starts to “droop,” the implant can look like a hard, bulbous lump that the rest of the tissue hangs off or spills over.

It usually occurs years and years after the initial breast augmentation, says Chen.

Waterfall breast deformity is most common in people who had a breast lift and breast augmentation executed at the same time, according to Zuriarrain.

“When you perform a breast lift with an augmentation, you’re adding weight to the breast during the most critical time of healing the incisions from the breast lift,” he explains. This increases the risk that the incisions stretch, creating thicker scars and leading to faster stretching of the breast skin.

Ideally, you would get a breast lift first. Then, after at least 6 months of healing, insert the implants, he says. “This gives you the best opportunity to avoid breast sagging,” adds Zuriarrain.

Waterfall deformity can also happen if your surgeon positions the implant too high up. Though, even then, it’s much more common in individuals who already have a decent bit of breast tissue on top of the implant.

To correct this, you can replace and reposition the implant, remove the implant and insert a fat transfer, or undergo a breast lift.

How long do breast implants under the muscle last?

Implants all last for about 10 years, regardless of whether doctors place them above or below the muscles, says Zuriarrain.

Can breast implants under the muscle sag?

It’s unlikely that the implant itself will sag, says Vallecillos.

“But over time, the breast tissue can sag over the breast implant and surrounding capsule and create the waterfall deformity effect,” he says.

Doctors can fix this surgically.

How common is capsular contracture under the muscle?

“Capsular contracture is by far the most common problem with submuscular breast implants,” says Vallecillos.

“Capsular contracture is usually marked by the hardening of the breast, a painful or tight feeling in the breast, new onset breast tingling, or the breast becoming misshapen.”

An older study suggested up to 30% of people with implants develop capsular contracture — but it may be even more common, according to him. “The problem is that cases of capsular contracture aren’t adequately recorded.”

How do you know if your breast implants are causing complications?

If your implants are under your pectoralis muscle and appear to be moving into your armpit, then you should talk with a practitioner, says Chen.

“If you have an infected breast implant, you’ll have high fevers and chills, and your breast may be hot, red, and tender,” says Chen.

“Leaking saline implants can be readily identified by the patient because the breast shrinks,” she says. “Silicone implant rupture is usually silent.”

In some cases, the breast itself can grow unexpectedly large due to the inflammation caused by the leaked silicone, she says.

If you’re trying to figure out which type of breast augmentation procedure is best, it’s a good idea to learn more about the potential risks.

However, the likelihood of each potential risk varies, depending on your breast size, implant size, age, overall health, and more.

Always consult a healthcare professional before ruling out or opting into any procedure.

If you have implants and notice a change in your breast shape, texture, size, or temperature, contact your surgeon or another healthcare professional as soon as possible.

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Healthline, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.