When discussing breast augmentation with fitness models and body builders, there is often debate regarding the placement of an implant above or below the muscle. I often tell patients that either location is perfectly fine. What determines whether the implant is best placed above or below the muscle is how much soft tissue coverage the patient has in the upper pole of the breast.
When an implant is placed in the submuscular position in athletic women, the implant will move when there is contraction of the pectoralis major muscle. This can be bothersome to the patient. When the implant is above the muscle, there is no motion of the implant with contraction of the muscle. The trade-off is visibility of the implant beneath the breast tissue versus motion. It can often be indistinguishable from the still result whether or not the implant is above or below the muscle.