Explant and muscle reattachment?

Question

From my understanding my implants are FULLY submuscular and my muscle wasn't "fully released". I am looking at explanting and curious about muscle reattachment. Some surgeons say they can and some say the can't and it's virtually impossible to do. Is it possible? I have seen photos of explants of women who explanted without muscle reattachment and their breast is completely pulled up? Is this common?

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Although the muscle is not completely released everyone has a different outcome of where the muscle is after years of having an implant. Each individual is different. You can approximate where the pec muscle is by flexing them and seeing the outline. Usually over time the muscle becomes atrophied unless you regularly exercise it. During an explant, if the muscle is in good position we leave it alone and if it has retracted to the upper pole, it is very difficult to stretch the muscle back down without tearing it. It is still a very functional muscle regardless of where it ends up and like any other muscle can be rebuilt through strength training.

Alan Gonzalez, MD, FACS · Answer

Hello @Feelinglost16 I appreciate your question. A prostheses can be reimplanted in the muscle depending on the characteristics of the previous implants, whether or not there was contracture, and the symptoms associated with diseases associated to implants such as ASIA. If the patients wants to explant definitely then the surgical plan would imply a breast reconstruction with reposition of the tissues and in this way achieve an aesthetic result that is adequate. The best course of action is to consult one or several board certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD FACS

Richard Baxter, MD · Answer

"Muscle release" usually means muscle detachment, so without knowing more details it isn't possible to give you a good answer. If you have animation deformity then there is probably a degree of muscle detachment and so it should be re-attached or it can persist after implant removal.

Gary M. Horndeski, MD · Answer

When the muscle is cut for the placement of implants, the muscle retracts and cannot be advanced. Over the years, the length has been lost and is anatomically impossible. It can try to be reattached to a point closer but will not have the strength it had originally so there is no point in doing it.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear Feelinglost16,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you 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

Nelson Castillo, MD · Answer

Thank you for sharing your question.  The best decision would be based on your current appearance and animation as well as what the muscle looks like once the implant has been removed.  Talk to your surgeon about your concerns as they are in the best position to discuss the possibilities of surgery

Connie Hiers, MD, FACS · Answer

Anatomy does vary somewhat from woman to woman. Some detached muscle components can be reattached, and some cannot. Also, the pectoralis muscle only partially covers the implant. There is no muscle coverage on the lower outer part since there is no muscle in that area.

Brent Moister, MD · Answer

In my practice it is possible to perform muscle repair after removal of a submuscular implant. The success of this depends on a variety of factors including the size of the implant removed, health of the muscle, the degree of muscle release performed at the time of surgery (the pectoralis muscle is rarely if ever "fully released"), and the degree of scarring around the implant.

Douglas Taranow, DO, FACOS · Answer

I have not re-attached the muscle post submuscular explantation in more than two decades.  The pectoralis major muscle is made up of billions of muscle fibers.  Attempting to place sutures through these fibers will cause fraying of the muscles with contraction.  True you may be able to suture the capsule to capsule, but I have not seen the 'pulled up" appearance of post explant patients.
Dr. Taranow

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