Hi Doctor, Recently I had bilateral mastectomy with tissue expanders. I noticed that my pectoral muscles push the breasts apart (towards my armpits). I'm a large woman and had large breasts so I'm going to take the full 800cc's (currently 600cc's). Will this change once the implant is inserted? or Is it possible to manipulate the pectoral muscle so that it pushes the breasts towards each other rather than away from each other? Thanks for your time :)
Can the Pectoral Muscle Be Manipulated to Bring the Implanted Breasts Closer Together? (photo)
Doctor Answers 7
Place of tissue expanders and being too far under the armpit.
When the tissue expanders are placed, it is important to realize that this initial placement is leads to expanders sitting too far laterally. There are several reasons for this:
- Dissection of the pectoralis muscles off the sternum will disrupt major blood vessels which are supplying blood to the mastectomy skin flaps, and is not usually performed
- There is less resistance for the expanders laterally and more medially from the muscle
If an acellular dermis is used, suturing of the lateral aspect of the dermal matrix along the chest wall can help provide a more rigid lateral boundary for the expander preventing it from progressing too far under the armpit.
Regardless, during the second stage reconstruction when the expander is removed and the gel or saline implant is placed, moving the implants closer to the midline is certainly possible and often performed.
Expanders moving under pec muscle
Expanders are typically placed under the pec major muscle and the medial attachments of the muscle on the sternum will always move the expanders and implants laterally. Releasing the muscle further will risk accentuating the animation of the breast with muscle contracture. One option is to repair the muscle down to the chest wall but this may leave a thin flap over the implant and make the implant more visible which will then require fat grafting to the upper breast pole and an acellular graft.
How to position implants in breast reconstruction
From your description it sounds like you have a version of what is called an "animation deformity" which is caused as you know by the action of the pectoral muscles. It isn't truly a deformity but there are some things that can be done to improve the cleavage area and minimize the distortion with muscle flexion. It is important not to release the muscle attachment too much or you could end up with symmastia. Options to improve would be to use an acellular dermal matrix graft such as Alloderm, and fat grafting to add some fullness to get better cleavage. The Alloderm would support the implants and prevant them from moving too much to the side, and could also reinforce the pocket to allow the implants to come closer together without symmastia.
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Implants closer to midline
The muscle will restrict your movement midline, but what can be done is tighten the capsule laterally perhaps. Hard to say without seeing you. Good luck.
Can Pectoral muscles be manipulated to bring implants closer?
Unfortunately not, your pec muscles are part of the anatomy that cannot be moved or adjusted. Fat grafting after your final reconstruction can be used to fill the medial aspect of your reconstructed breast and allow for a more natural, closer cleavage plane. Discuss this with your surgeon, you appear to be in the early stages of reconstruction, trust your surgeon and allow time to pass and I am sure you will be happy with the results, good luck!
You would benefit from fat grafting to enhance your cleavage
The position of the breast implants are dictated by the pectoralis muscle position . This can not be changed ,but you can get fat grafting to soften the breast and enhance the cleavage.
From your description, "tissue expander moves to the arm pit with contraction of the pectoralis mscle" can be repaired. The muscle need to be released fully and use Acellular matrix.
As for the cleavage, remember that with the mastectomy some of the fat and breast tissue was removed from the inner aspect of the breast. Your options heare is to convert tha breast reconstruction to reconstruction with your own tissue, a flap reconstruction. Another option is to build the cleavage area with fat transfer. Will need multiple session of fat transfer. (insurance may not pay for fat transfer)