Why Does my Breast Look Deformed when I Flex the Muscle?

Question

I am one year post-op. My right breast looks deformed when flexed. Why does this happen? How complicated is the revision surgery to correct this issue?

Richard Baxter, MD · Answer

Your problem is unfortunately common and preventable. It is caused by the release of the pectoral muscle attachment from the ribs, which is routine but the edge of the muscle then heals into the scar capsule. When you flex you can see exactly where the muscle is pulling up. The groove across the breast, where the myuscle is attached, then creates the double bubble. The simplest method to correct it is conversion to a split muscle technique. There are photos on my website illustrating how this is done. If there is inadequate coverage and support of the implant, then a Strattice internal bra procedure would be better. I would be happy to send you some information about the procedure.

Jed H. Horowitz, MD, FACS · Answer

When the muscle pulls across the implant, the appearance may be affected. This can appear worse with more muscle #density and the #muscular strength. There are options to enhance this though. One is to change the implant to the submammary position. Another is to cut the muscle more along the sternum for the implant to reside.

Jeffrey D. Wagner, MD · Answer

You have fairly obvious double bubble due to muscular distortion of the breast shape due to hypertrophic chest musculature.  The edge of the muscle heals into the scar capsule and creates this deformity.  In selected patients, sub glandular pockets are an excellent option and will provide a more natural cleavage and movement of the breast.  This approach requires that you have enough tissue coverage and is easier to do with silicone gel implants than saline.  You should be aware that it will be somewhat more difficult to obtain mammograms and you may be at somewhat higher risk of having capsular contractures with sub glandular implant pockets, however.

Stuart A. Linder, MD, FACS · Answer

This is a serious problem that will require a complete revision. Open capsulectomies, inferior capsular sling to elevate the inframammary fold, and a full formal breast lift or mastopexy.

Richard J. Bruneteau, MD · Answer

Based
on your pictures, it appears that you have breast implant animation deformity.
This condition usually results from dividing the perctoralis muscles during
creation of the breast pocket. The muscle then becomes adherent to the
surrounding tissue and with muscle contraction causes distortion of the
overlying breast tissue.

Although
the condition can occasionally be treated by repair of the muscles, the
majority of patients are treated by relocating the breast implants to a
sub-glandular position. This decision should be considered carefully because
the majority of patients are happy with their breast when they’re not
exercising.

It’s
important to realize that moving implants to a position on top of the muscles
involves a series of tradeoffs. Sub glandular implant relocation can be a
technically difficult procedure with the potential for complications. In
addition, patients give up the advantage of sub muscular placement of breast
implants. For instance, when breast implants are on top of the muscle,
mammography may be less effective and there is an increased rate of capsular
contracture.

Before
proceeding with any type of surgical correction, it’s important that you
understand these tradeoffs. Make sure you discuss these issues with your
surgeon before proceeding with surgical correction.

Christopher J. Morea, MD · Answer

Breast implants placed under the muscle may alter their shape when the muscle is utilized.  One of the risks of sub muscular breast augmentation is implant distortion with use of the pectoral muscle.  To help with your problem, there are a few options. The lower origin of the pectoral muscle can be released to help limit distortion.  If you have a textured implant, changing to a smooth surface implant will help.  Both of these options are relatively simple.  The surgery can become more complex if the lower aspect of the pocket needs to be closed down. I would discuss these issues with your Board Certified Plastic Surgeon.

Sam M. Sukkar, MD · Answer

The deformity caused by placing a breast implant under the muscle is worse than any potential implant visibility of a silicone implant placed above the muscle. Silicone implants above the muscle rarely cause visibility issues.
All of my patients are shown a video of sub muscular breast implant animation deformity. After viewing the grotesque shape of the breast and the fact that the implants get pulled away from the midline decreasing cleavage, they almost all choose silicone above the muscle. With regards to capsular contracture rates- I am still waiting for a conclusive study to answer this question. I have seen no difference in contracture rates with both below and above muscle implants.

William Aiello, MD · Answer

Hi Sacramento9219, You have a common "animation" deformity. I say it is common, after 30 years I've seen my share. But it is preventable with proper implant placement, so I would not say it's likely or common in that regard. Going back and repairing it after it happens is possible, but not always recommended. (I definitely don't recommend changing the implant placement to over the muscle opens you up to higher risks for capsular contracture and long term it will not age well.) I understand you are unhappy with the look when you are flexed, but if you spend the majority of your life in a relaxed position, you really have to weigh the risk versus reward for this revision. It is a complicated revision. I would recommend meeting with your surgeon to discuss and get their best advice. There are options for revision that do not involve changing your implant placement. If your original surgeon isn't on board, make sure you meet with qualified, board certified surgeons with a lot of experience with breast implant placement revisions just like yours. Good luck!

Lisa Cassileth, MD, FACS · Answer

This is muscle flex deformity. Every subpectoral implant has it a little bit, but it is at its worse with lower breasts where the pectoral muscle is very well released and "floats up" the breast; meanwhile the new implant sits below it, ruining the relationship between the breast and the muscle. I've see a lot of surgeons fix this by "releasing" the pec muscle, but THIS MAKES it WORSE, so do not do that. The key is to readvance the pectoral muscle to minimize the deformity, which puts it back in a more anatomically normal position, as opposed to hanging out near your breast skin where it is now ;)

Rachel Streu, MD, FACS · Answer

You unfortunately have and animation deformity which is caused by release of the pectoralis muscle from its attachments to the chest wall when placing the implants initially. The visible animation when you flex your pectoralis muscle is likely due to the scar tissue that formed after the operation and this distorts the appearance of your breast when your muscle contracts. There are a number of considerations when trying to correct this problem, many of which related to the thickness of the tissue that would overlie and support the implant once the deformity is surgically released. You should consider speaking with your plastic surgeon about their recommended approach to your animation deformity.