I can't believe I paid to be this uncomfortable and caused this much destruction to my pec muscle. 43yrs old, athletic, hypertrophic scar, BWD 11.7, 450cc silicone, HP, crease, 05/12: PS range 300-400. All options keep me from making a decision; however, I think explant and poss re implant in 6mos is best option even tho I have scarring condition. At 450, the muscle distortion is significant. Is it true that the pec never reattaches and I will always suffer muscle distortion? Please elaborate
Explant and Pec Muscle? (photo)
Doctor Answers 8
Submuscular implants and distortion
I'm not exactly clear on what your tentative plan is, but I agree that decreasing the size of your implants is a good idea, but like the other surgeons who answered here, I do not see why you need to wait 6 months to replace them. Implants are commonly placed under the muscle for a number of beneficial reasons, but one of the downsides is that muscle contraction can cause movement or distortion. Significant distortion can occur if the fibers have not been released enough (or too much), but there is always some implant movement with pec flexion. In a thin, fit person like yourself, placing implants over the muscle has drawbacks - you may trade muscle movement for more visible or palpable implant edges, or a more "fake" look. (These will be less of an issue if you decrease the size). Good luck - please talk with your surgeon at length so that you understand the pros and cons to each plan. There are always trade-offs, so you must understand what the best course of action is for you.
Explant and Pec Muscle?
Thanks for your question and for going to the trouble to include photos. They definitely help. The implants are very large on your frame and are further accentuated by the High Profile shape. You should easily be able to go to a smaller medium profile device with better proportions. The pectoralis functions normally after subpectoral placement but there are certain fibers that must be properly released to prevent the distortion that occurs with muscle activity. That needs to be done when the implants are changed. You do not have to wait any period of time without implants. Of course you can always go over the muscle and avooid all risk of distortion, but the look is often not as good. I can't see the scar in your photo, and some people make less desirable scars because of their genetics. However a precise scar revision coupled with dilute kenalog injections (1 cc of kenalog 10 and 4cc of dilution) will usually result in a fine and delicate scar.
Explant and Pec Muscle? (photo)
The pectoral muscle can be replaced back to it normal position .By saving the fascia,the new implant can be place above the muscle , under the fascia.Additional mesh support may be necessary for the lower pole
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The implant are too large for your body habitus. The muscle does contract a bit but never to its pre-stretch position. Not much you can do about the scar except revise.
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It is not clear when you had surgery. Removing the implants can occur at almost anytime. As for exchange to a smaller that may be a good idea if you think that they are too big. The muscle will not reattach and animation issues can occur with submuscular implants but it often is better than being in a subglandualr plane.
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The decision to remove the implants altogether will be a very personal ( and potentially difficult one) that only you can make. However, you may find the attached link helpful to you as you consider the options.
Explant and Pec Muscle?
I am quite certain that I don't understand some of your concerns.
As to the pectoralis muscle not reattaching, it is actually not detached from anything save a few slips of insertion into the ribs. Its original in the arm and its insertion into the sternum are not disturbed, and it has not been possible to measure loss of shoulder strength (even in patients in whom this muscle is completely detached to use in reconstructive surgery of the head and neck).
I think a smaller pair of implants would appear more natural. I would want to know more than I can tell from the photos as to what bothers you about the under the muscle positioning before suggesting a change to above the muscle or sub-fascial placement.
I am not sure what advantage there is to planning two stages, and would suggest that you discuss all of the issues with your surgeon until you are comfortable that the two of you are on the same page.