Why is the pec muscle not repaired during explant surgery?

Great question. Surgeons are divided on this matter. I personally do repair the pec muscle during explant surgery, and suture it back to its native position on the chest wall for natural movement and biomechanics. I feel that this helps restore normal anatomy and prevents it from healing in the wrong place where it might distort the breast. I would leave it to someone who doesn't reattach the pec to explain why they don't!

You ask a very important question, because most under muscle implants are placed with the dual plane method which detaches a portion of the pectoral muscle. My opinion is that it should be re-attached to restore its normal function. There are other options such as the split muscle plane that do not involve detaching the muscle in the first place. This can also be done without removing the implants. I just published on this, see the link.

Hello @SSLacey Pittsburg, thank you for your question. The pectoralis muscle generally has the ability to return to its condition in a short time. When breast surgery is done and part of the breast is placed behind the muscle while the rest is placed on the outside of the muscle, when reconstruction is done, unless there is a pathology that prevents this from happening or a rupture or something special, the muscle may return to make the contraction and stay in place. For more information and recommendations, it is best to consult one or more board-certified plastic surgeons. Best wishes! Alan Gonzalez MD, FACS.

Once the implant is removed, the muscle tend to settle back down in place. Initially, the lower attachments are partially release to avoid too much muscle pull on the implant close to the breast bone. However, this has been healed for quite some time, other natural attachments are still in place, and usually needs nothing to be done.

I'm sorry that your question wasn't answered the first go around. I'll try my best to give you the answer you are looking for. Once the implant is removed from underneath the pectoralis muscle, the muscle will lay back on the chest wall in nearly a similar position as before surgery and can often heal in place via scar tissue and adhesions even if the capsule isn't completely removed. This attachment will not be as strong as prior to surgery nor will the muscle be at the same insertion point into the ribs (it usually is a bit shorter or contracted) which can effect the overall strength load of the muscle. The reason many surgeons don't connect this with every explant is that freeing up the muscle again from the surrounding skin and tissue is often difficult due to scarring and can cause bleeding. Also, while some patients may note a slight weakness in the pectoralis major muscle function the majority don't, so the additional surgery isn't worth the risk. I hope this better answers your question.