6 months post-op. What can be done to fix my animation deformity? Should I downsize the implant? (photos)

First it is important to understand the cause of animation deformity: The pectoral muscle is partially detached, and the cut edge of the muscle then heals into the scar capsule around the breast. You are correct that animation can persist after moving the implants in front of the muscle unless the muscle is re-attached. Another option is to convert to the split muscle plane; this preserves muscle coverage over the upper part of the implant but moves the lower part behind and re-attaches it. 

Obviously, an in person exam would be the gold standard.  That being said, you appear to have tuberous breasts with a short constricted distance between your nipple areola complex and your inframammary fold.The muscle animation deformity you refer to is apparent, but in my opinion is not your main problem.  I totally agree with your personal plastic surgeon that you needed a periareolar incision, but possibly there was inadvertently not a complete release of your constricted subareolar tissue.  At this point, I don't think your considering going on top the muscle is appropriate, especially considering complications that occur from supra pectoral implants.  At this juncture, I believe you should go back and discuss further release of your constricted tuberous breasts with your personal plastic surgeon.  

Thank you for your question.  This is a difficult problem and should be best discussed with your PS.  Animation will usually improve with either implant removal or placement above the muscle.  An alternative if the muscle has been released fully in the first surgery is to denervate that segment as it is not contributing to your physical strength at that point anyways.  A recent article in our PS journal has described this option well.  It is really difficult to reattach the muscle back and options include using allograft such as processed cadaver or pig dermis (expensive) or a rectus fascia turnover flap.  Based on your photos it also appears that the implants are not expanding your lower poles very well at the six month mark and the areolar incisions seem indented.  
There is no substitute for an in person consultation with a board certified PS and I would go back to your original surgeon for a review of the shape and the retraction.  If they are unwilling or unable to fix this, then a second opinion is best.  

Hello there If this is a major problem then switching to in front of the muscle is the only effective solution .However if you are thin then this may make the implant more visible in the upper breast . Placing the implant in the subfascial position is likely to get you enough coverage but reduce animation .Sometimes subsequent fat grafting can also be of benefit .CheersTS

Dear mini556,
the most common method of correction of animation deformity is replacement of implants above the muscles. In most cases, this reduces symptoms significantly or completely resolves it. If you are considering a revision surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

after presumably having a full consultation and being fully informed of the 'what ifs'.  Sometimes you  have to accept  known shortcomings and in your case, it would have been the concern the implant would not have enough tissue coverage.  But if you wanted to work out your chest muscles or did not want animation at all, then subglandular would have been the way to go from the beginning.  You are right in that animation may still persist, as the muscle repair could fail in your revision procedure.  Doubt any lift will be needed but now that you are in the place between  the rock and a hard place, you need to choose what is best for you and your lifestyle and just go for it and hope for the best.

HiThanks for your question and photos.Please see a board-certified PS for an in-person examination. It is possible your muscle may not have been fully released which could be responsible for the lower pole constriction. Releasing this may improve the aesthetics of the breast though it may not fully address the animation deformity. Switching the implant to over the muscle with your body frame would be a last resort because of implant visibility and contracture concerns.I hope this helps......Dr. G.

The best way to correct animation problems after implants are placed under the pectoral muscle, is to place the implant above the pectoral muscle. The skin has already been stretched so the only difference in outcome is likely to be positioning and the effects of that. If you have very little tissue in the breast, particularly in the upper pole, then you are more likely to be able to feel or see the implant in certain positions. If your nipples lie below the inframammary fold then you might want to consider an uplift to return the nipples to the normal position. However, looking at your pre operative photographs, it doesn't look like you had nipple ptosis, so it may be that changing the position of the implants from below the muscle to above the muscle would be all that you need. As always, it's best to see a surgeon for a face to face consultation to make sure any advice given this way is linked to your face to face examination findings. Hope this helps

Hello. Thank you for your inquiry.

It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually. Continue to update your doctor in the matter and follow their post-op protocol.

Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

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