I have had two breast surgeries. The 1st was a non-dual plane aug with small implants. The second was a mastopexy and implant exchange with slightly larger (25-50cc) implants and dual planed. What would my best approach be at this time? I have considered subglandular placement. Both or just the affected implant? I can rarely avoid involunatrily flexing my peck and causing this breast to "jump." Personally, I am dating and already have to explain the pexy scars, this "trick" breast is a bit much.
What Are The Options For This Animation Deformity After 2 Surgeries? (photo)
Doctor Answers (16)
Correcting a dynamic crease of the breast due to pull of the muscle
Correction requires a re-operation and release of the pectoralis muscle along the lower medial pole of the breast this would decrease but not totally correct the problem. Also the fascial bands can be released as well that are creating the crease along the bottom of the breast.
Pectoralis Major banding following breast augmentation.
Thanks so much for your question. There are a few different ways to approach this problem. It's always a solution (although not a popular one) to remove the implants and allow things to heal, then replace the implants. Another is to place the implants in a "new" pocket. This can either be on top of the muscle or under the muscle in a neocapsular pocket. Finally you can use a dermal replacement material and try to repair the muscle so it doesn't contract in the manner it currently does. This can be successful but can also have limitations based on your anatomy and the forces that the muscle exerts on the repair. Hope that at least gives you some direction and useful topics to discuss with your local surgeons.
There are some good answers here to this difficult situation but there are also some that I strongly disagree with. There is only one problem and it's a double-bubble deformity caused by the pull of the inferior (and too high medial) edge of the pectoralis muscle on the connective tissue (fascia) around the breast transmitted to the skin level. It is not the old inframammary crease and the mastopexy done at the second procedure did nothing to correct it nor was the pectoralis adequately released from the lower pole, particularly on the right (which is problematic if done at the same time as a real mastopexy). The existing inframammary crease level is not the source of the problem although the situation can be helped by raising or tucking up the crease level.
Revision would be best done through an inframammary crease incision but exposure needs to be adequate to release the pectoralis muscle totally out of the lower pole and back of the breast while checking to make sure the fascia along the lower pole is not restrictive which would require radial cuts. The crease level can be tucked up a bit to help the lower pole and implant fill up and out over the crease. This leaves the implant covered by the pectoralis muscle for the upper pole of the breast but keeps it from "animating" the lower pole. I would also consider tacking the medial edge of the pectoralis muscle back to the medial side of the ribs on the right as it was released too high on the medial side which aggravated the double-bubble on the right.
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Correction of “Animation Deformity” after Breast Surgery?
Thank you for the question and pictures.
Because there are many advantages of keeping the implants in the partial self muscular position, I would suggest that you avoid replacing the breast implants in to the sub glandular position if at all possible. Instead, I would suggest that you have the right breast implant pocket explored; it is likely that there is muscle and/or scar tissue that can be divided to improve your situation significantly. I also think that additional skin excision along the horizontal axis will be helpful to improve the contour of the breasts.
I hope this helps.
How to fix my right breast problem? (photo)
The first step in treatment is diagnosis. The fact that contraction of your muscle deepens the crease informs us that the lower inner border of the dynamic pectoralis, which has indeed been "released" from its lower sternal and costal origins and now lays superficially across the implant surface, is attached to the skin, perhaps via the implant capsule. This attachment must be divided. Repositioning the implant in the subglandular space will fix the problem, but this is not the only way to correct the deformity. My choice would be just to do your right side, and I believe this will also improve what other responders are calling a "double bubble." Can radially score lower pole parenchyma to be sure.
At least one such case is shown in the breast revision section of the gallery on our website. The problem is not uncommon.
More muscle release for animation deformity
I am going to disagree with most of the other answers. Subglandular placement will correct this animation deformity but may lead to other issues. I would first explore the right breast to see what is causing the problem - most likely incomplete muscle release and then try to release some more muscle. May also be some tethering along the double bubble that should be released as well.
Web reference: http://www.breastimplantrevisions.com
What Are The Options For This Animation Deformity After 2 Surgeries?
You may have enough tissue thickness to camouflage a silicone gel implant of moderate size in a subglandular position, and moving these implants (yes, you should have both implants in the same plane) above the muscle is the most reliable way to eliminate both the animation deformity and the unusual contour of the lower pole of your right breast. This contour problem on the right side is related to disruption of your inframammary crease and division of your muscle, the division being necessary in a subpectoral procedure. It is not always well understood why some of these contour problems occur, and it may in part be related to how the pectoralis fibers reattached to the overlying breast tissue. In any event, the same technique may be performed on both breasts and only one side develop this problem. In a patient who is very, very thin, and whose implants need to stay subpectoral, an attempt can be made to dissect a new subpectoral pocket (neo-subpectoral), reestablish the inframammary crease at the proper level, and maybe even consider using Strattice as a spacer between the muscle and the overlying breast tissue. This is complex, expensive (for the Strattice), and less assured of working. So if you have a reasonable amount of tissue thickness, placing the implants above the muscle should guarantee success.
Double bubble and animation deformity
You have two issues. 1) double bubble amd 2) animation deformity. The animation deformity may improve with placing the implants above the muscle. This may lead to the implant being visible in the upper pole if you do not have a lot of soft tissue coverage. The double bubble may be corrected by placing a smaller implant and adjusting the fold position. Good luck.
Double bubble deformity
Your problem is not an easy one and although it may be an occasional source of entertainment for you, should be corrected. That is certainly easier said than done. Fortunately, you already have the mastopexy scars that can be utilized to gain wide enough access to your pectoral muscle and the breast fold. In my hands the correction would entail either reinserting the pectoral muscle to the chest wall on your right breast or releasing the breast fold from the pectoral muscle that is retracting it up on the right. This would depend on the status of the left pectoral muscle. In this way you might not have to abandon the biplanar postion, which provides better coverage of your implants. Good luck!
Web reference: http://francisnyplasticsurgery.com/breast_aug.asp
Because the implant gets deformed as the overlying muscle contracts with use, the breast that is heavily dependent on the implant for size and shape may experience the deformation you have. Obviously the smaller the implant, the less this deformity so that a pea-sized implant will have no such anomaly. You must remember that augmentation with implants is an imperfect operation and you should prepare yourself to be able to accept some "imperfection". These can be contour irregularities (like your 'double bubble' contour), visibility of the edge on the implant with rippling, firmness ( particularly with subglandular implants), excessive roundness (also more evident with large and more superficial implant), various rates if leakage, etc. If the jumping breasts are excess and you are willing to live with the imperfections of a sunglandular augmentation, then it may pay to change the position of the implants. Without accepting this concept, some patients end up "chasing the imperfections."
Dr. Robin T.W. Yuan
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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