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

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?

Doctor Answers 15

Muscle flexion deformity and double bubble with implants: how to correct

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.

Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

You have detached inframmary fold and uneven pectoralis muscle release

Your pictures show a detached pectoralis muscle and infra-mammary fold tissue from the chest wall and implant migration. This is a hard problem to fix and may require more than one surgery to fix it. Looking back to your original surgery,you had too much sagging and there were a need for a lift. The treatment will need to involve replacing the implants,reattaching the infra-mammary ligaments and possible lift.

The other option is to remove you implants and do lift and fat grafting at the same time. I have performed this on more than 50 patients that have failed implants and did not want implants anymore.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 122 reviews

Muscle contraction deformities after breast implants

Pectoralis Major muscle contraction deformities can be a significant complication after submuscular augmentation mammoplasty in a small percentage of cases.  Unfortunately you are one of those few.  It can always be corrected by converting your augmentation to an above the muscle implant relocation.  But why give up the many benefits of below the muscle implant placement, such as the more natural look above your nipples, and lower contracture rate.   I have also successfully treated this problem with modified breast lift and open capsulotomy surgery.

Raymond A. Capone, Jr., MD
Pittsburgh Plastic Surgeon
4.0 out of 5 stars 10 reviews

Breast Implant Animation Deformity

                  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. 

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Muscle flexion

What you are experiencing is  the pectoralis muscle contracting. This can happen with submuscular implants. Some say releasing the muscle more may help..but I am not sure. The only way to improve this is to place the implants in a subglandular pocket, but this may predispose you to more rippling.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Deformity of the breast caused by muscle contraction compressing breast implant

What you are seeing is your pectoralis major muscle contracting and compressing the underlying breast implant causing the deformity. This is one drawback for submuscular implants but at the same time it is this type of actions which helps keep the rate of capsular contracture lower versus above the muscle. The extent of the deformity can often be decreased by a partial release of the muscle and muscle fibers which reduces the force of contraction.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 30 reviews

Breast implant distortion

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.

Christopher J. Morea, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 187 reviews

Under the muscle

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.

Sam M. Sukkar, MD
Houston Plastic Surgeon
4.6 out of 5 stars 39 reviews

Breast Augmentation and Muscle Deformity

When the implant is placed under the muscle, the muscle can attach to the capsule around the implant and cause this effect.  This is a difficult problem to correct, but the advantages of placement under the muscle are lower rates of capsular contracture and other problems.

Jeff Scott, MD
Everett Plastic Surgeon
5.0 out of 5 stars 10 reviews

Breast shape change with under the muscle breast implants

What you are experiencing in your breast augmentation is a deforming effect the chest muscle will have on the breast when the chest muscle is flexed firmly. Relax the muscle and the breast looks fine. This is the drawback in under the muscle breast augmentation. The reason we do this however is the better contour and coverage of the implant, and lower capsular contracture rate. If you are greatly bothered and can handle the risk of a visible upper implant edge, the implants can be safely placed over the muscle.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.