What is happening anatomically when animation deformity persists after explant?

Question

I had breast implants via the dual plane technique for 3 years. I explanted and the surgeon advised that he secured the pec muscle back to its natural position with sutures. Animation deformity and chest muscle tightness was an issue whilst I had the implants and this has persisted after removal. I've searched endlessly and have found information about the mechanics of animation deformity with implants but I can't find any information about what is occuring anatomically post explant.

Shaher W. Khan, MD · Answer

Hello, thank you for your question. Animation deformity after breast implant removal can be a frustrating issue, especially if it persists despite the surgical effort to secure the pectoral muscle back to its natural position. Understanding the anatomy behind animation deformity and what happens after explantation involves looking at the mechanics of both the implants and the chest muscles. Please see the attached video that answers your question specifically. Anatomically, after explant, animation deformity persists due to a combination of muscle weakening, scar tissue, muscle retraction, and abnormal muscle movement as a result of the implants. Even though your surgeon secured the pectoralis muscle back to its natural position, it’s possible that the muscle and surrounding tissues have not fully regained their original state, which is contributing to the ongoing deformity and tightness. Time, physical therapy, and possible additional interventions may be necessary to fully address this issue. If you continue to experience tightness or deformity that impacts your quality of life, it would be worth discussing this with your surgeon to explore further options for relief.

Alan Gonzalez, MD, FACS · Answer

Hello @adawgg, 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 aesthetic reconstruction (reacomodation of mammary tissue to give breast projection with BRALAN technique) 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.  If you are considering a breast explantation, consultation with a plastic surgeon who is experienced in this procedure is essential to ensure optimal results. Best wishes! Alan Gonzalez MD, FACS.   American Society of Plastic Surgery Member (ASPS),  International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

Emre Guvercin, MD, FEBOPRAS · Answer

This is an excellent and very thoughtful question &mdash; and you’re right, there’s surprisingly little clear information online about post-explant animation deformity, even though it’s a real and well-recognized phenomenon.What animation deformity actually is (with or without implants)Animation deformity is not caused by the implant itself.It’s caused by abnormal mechanics of the pectoralis major muscle after it has been:DetachedStretchedScarredOr reattached under tensionSo removing the implant alone does not automatically normalize muscle behavior.What’s happening anatomically after explantEven though your surgeon sutured the pectoralis back, several things can still persist:1️⃣ Muscle reattachment ≠ muscle normalizationWhen the pec is elevated for a dual-plane augmentation:Its native insertion points are alteredMuscle fibers remodelScar tissue forms between muscle, chest wall, and overlying tissuesAfter explant, suturing the muscle back:Restores position on paperBut does not erase scar planes or altered muscle glideThe muscle may still contract against abnormal resistance, creating visible movement and tightness.2️⃣ Internal adhesions restrict normal muscle glideScar tissue can tether:Pectoralis majorChest wallOverlying fascia and skinWhen the muscle contracts, instead of sliding smoothly, it pulls the skin and soft tissue with it, creating persistent animation &mdash; even with no implant present.This is one of the most common causes of post-explant animation.3️⃣ Muscle shortening and chronic toneAfter years in a stretched or elevated position, the pec can develop:Adaptive shorteningChronic hypertonicity (always “on”)A sensation of tightness or pullingThis explains why patients often feel:Chest tightnessDiscomfort with arm movementVisible distortion when flexing4️⃣ The dual-plane pocket doesn’t fully disappearEven after explant:The dual-plane dissection plane often remainsThe muscle–gland interface is altered permanentlyThe breast envelope may still be partially influenced by muscle contractionSo animation can persist even when the implant is gone.Why this isn’t widely discussedMost explant discussions focus on:ImplantsCapsulesSystemic symptomsBut muscle biomechanics are often overlooked &mdash; even though they are central to animation deformity.Can this be corrected?In selected cases, yes &mdash; but not with implant removal alone.Meaningful improvement may require:Surgical release of muscle adhesionsRestoration of normal muscle glide planesRebalancing of the lower breast envelope (often with a Push-Up–style tissue repositioning)Occasionally, partial muscle release or conversion to a non-muscle-influenced breast envelopePhysical therapy alone is often insufficient once dense internal scarring exists.

Connie Hiers, MD, FACS · Answer

Scar tissue from the first surgery has attached to the muscles. When you flex, the scar tissue does not stretch as much as the muscle, so there is a pulling effect by the muscle on the scar tissue.

James Knoetgen, III, MD · Answer

Animation deformity after explant occurs when the breast tissue moves unnaturally due to changes in the anatomy following implant removal. This can happen because:

1.	Loss of Support: Removing the implant leaves less natural tissue to cover the chest, leading to visible movement.
2.	Capsule Scar Tissue: A tight or fibrous capsule left behind can cause irregular movements.
3.	Muscle Adaptation: The pectoral muscles may continue to function as if the implant is still present, causing unnatural tissue shifts.
4.	Reduced Volume: Loss of breast volume from explant may make the tissue more prone to abnormal movement.

In some cases, additional surgery like a lift or fat grafting may help correct this issue. Should schedule a consultation with an SA surgeon.

Tracey Cook, MD · Answer

Hello! Although your surgeon may have secured the pectoralis muscle back to the chest wall following removal of your implants, several things could have occurred. Depending of the type and number of sutures placed, perhaps the repair could have been jeopardized at some point during your recovery and are no longer in place. Also, because the pectoralis muscle becomes disconnected during your original surgery it is allowed to retract upwards - this may have shortened the muscle overtime making it difficult to place the muscle back in its exact original position. Depending on how much ptosis you have in your breast tissue, you may have also needed a lift to recentralize your breast tissue over your chest.

What is happening anatomically when animation deformity persists after explant?

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