What could be causing my Natrelle implants to extend to the armpit area? 6 months post op, 375 cc under the muscle (photos)

Question

I had 375cc Natrelle implants inserted under the muscle about 6 months ago. I'm not thrilled about how they look relaxed (extend way too far into my armpit) but they look especially weird when I flex my muscle. Is this normal and they still need to drop or could it be an indication of something wrong? I have no idea what this could be.

Sean T. Lille, MD · Answer

Dear Anonymous, You have something wrong going on with that implant. Is the other side normal? It appears that the lateral side of the pocket is not holding the implant in place. This can happen for various reasons but it doesn't look normal from the front either. Please go see your surgeon or get other opinions in person.

Semih Yildiz, MD, FEPOBRAS · Answer

At 6 months, this is less likely to be simply a matter of the implants still needing to “drop.” In the photos, the implant contour appears to sit quite lateral toward the armpit, and the change with flexing suggests a component of submuscular animation deformity.

Possible causes include a breast pocket that was made or stretched too far to the side, an implant that is wide for your chest, lateral chest wall anatomy, or muscle pull on a subpectoral implant. An in-person exam is needed to tell whether the implant is actually displaced laterally, whether the pocket support is weak, and how much is caused by pectoralis muscle movement. If it bothers you enough, revision options may include lateral pocket tightening, implant size or profile adjustment, and in selected cases changing the implant plane. I would review this with your operating surgeon first, because the exact fix depends on the pocket and muscle findings, not the photos alone.

Gianfranco Frojo, MD · Answer

You have a double bubble deformity from the implant bottoming out below your original breast fold. This is likely from poor incision planning/placement and too large of an implant for your tissues. You will need a complex breast revision that will likely need Galaflex scaffold to support the tissues. Please find a very experienced plastic surgeon to address these issues as this is a very challenging issue to address.

Jeffrey Lisiecki, MD · Answer

Being evaluated in person is the surest way to know what is going on, but based on your description and photos, two things are going on here. Your implants are likely laterally displaced (going under your arm too far) at rest, and what you describe with movement is animation deformity. Animation is when your implants move with muscle activity, which can happen with implants below the muscle. The fix for both of these problems would be implant revision with pocket repair so the implants don't slide so far to the side and converting the implants into a subfascial plane where they won't animate.

Leopoldo Baccaro, MD · Answer

You have something we call an “animation deformity”, which is when you can move your implant and breast quite significantly with your pectoralis muscle, wrinkling the skin too.

You’d need a surgical revision to tighten the pocket and release the muscle more. Possibly fat grafting too.

I’d discuss this issue with your plastic surgeon.

Hope this helps, good luck!

Jonathan Heistein, MD · Answer

Hi.  When you flex your muscles and your implants shift to the side with an indentation close to the middle, it's called animation deformity.  It is not uncommon, but sometimes it is so significant that you may want to correct it surgically.  Talk to your surgeon about the options.  Sometimes it is better to leave it alone rather than take a chance on some of the other options.   Best of luck!

Daniel Barrett, MD · Answer

Dear Anonymous3419,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Carlos Marciales, MD · Answer

You will need a revision of your implant, the muscle it’s to attach to the implant, and also could be the implant it’s rotated

Zoran Potparic, MD · Answer

Based on these photos you seem to develop capsular contracture which may be the reason for this dynamic deformity and displacement of implant. You should discuss this issue with your surgeon ASAP. Good luck.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  Difficult to comment without "before" images as well as seeing your other breast.  I would advocate seeking out second, in-office opinions from other board certified plastic surgeons as something does appear to be amiss. Best wishes.

What could be causing my Natrelle implants to extend to the armpit area? 6 months post op, 375 cc under the muscle (photos)

Answers (19)

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