What Are The Options For This Animation Deformity After 2 Surgeries? (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. 

Sometimes when breast implants are placed under the muscle, the contracting chest muscle can make the implant "jump". This animation deformity is quite disturbing as you know. Moving the implants to a location above the muscle will help this problem.  You should speak to a board certified plastic surgeon about this revisional procedure.

The problem you describe is (in my opinion) the main downside of going under the muscle.  To correct it I would have both implants repositioned above 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.  

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.

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.

 

 

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. 

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.

Erin,

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!

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