Muscle Distortion, Bottoming Out and Deformity in Both Breasts

I had Breast Augmentation with an uplift in Feb 2010,to regain my fullness,i had 255cc in each breast. in Aug 2010 had a re-opp due to muscle distortion in my right breast & my left had bottomed out and needed uplifting more, now,6 months later still feel i have the same problems, my right breast looks deformed when i tense my muscle and my left implant feels like it overlaps when i bend over,it feels strange against my chest wall & nipple is across to the left, do i need a re-op?

Doctor Answers 13

Correction of bottoming out and animation with breast aug - important to get it right

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One of the problems that plastic surgeons don't talk about enough is animation distortion, which actually affects 70% of patients to some degree when the implants are placed under the muscle using the traditional (dual-plane) technique. That is because the muscle is cut from its attachment to the rib cage, and it then heals to the scar capsule as it forms around the implant, so that it pulls on the breast. Often a double-bubble contour forms for the same reason. To make matters worse, with each re-operation the problems can multiply since there is more scarring and thinning of the tissue, so it is very important to get the first revision surgery right.

There are 2 options: the simplest is to convert to a split technique and re-attach the portion of the muscle that pulls on the implant (I can send you an article describing that.) This works if there is adequate coverage and support of the implant on the bottom, which there probably is not since there is also bottoming out already. The next option is to use a Strattice graft. I can also give you some reference material on that. It will probably be your best option since it addresses both issues. The temptation at this point may be to try and do simple things since you have already spent a lot and been through a lot but this is no time for short cuts.

Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

See your surgeon for revision surgery

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I am sorry to hear that you’ve had a bad experience. You should definitely see your surgeon to talk about your concerns. Judging from your photos, you’ll probably need revision surgery which may involve recreating the pocket.


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It appears you have answered your own question. My vote is for revision.  I feel the easiest means of correcting both issues is to place the implants under the tissues. The muscle deformity will be a non issue.  The pocket will be recreated on the left correcting the bottoming out issue.  I would not wait.  Discuss another revision with your surgeon.  I am certain he will give you a discount whereas another surgeon will charge you full price.  If money is not a concern get another opinion.

Todd B. Koch, MD
Buffalo Plastic Surgeon
4.6 out of 5 stars 37 reviews

You need a diagnosis.

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Your photos present an interesting problem. You have right breast distortion with pectorals muscle flexion without apparent compression of the implant. My best guess without examining you is that the original operation was above the muscle and that subsequent sub muscular placement didn't work. I feel that the implant is still above the muscle and that the muscle is lifting the implant from behind. Effectively pushing the implant back to a sub glandular placement. The key to successful treatment is to first diagnose the problem and then reestablish a connection between the gland and the muscle, then once the sub glandular space is obliterated, do whateveer is need to the muscle. This is as complicated as it sounds! Good luck and don't be scared of second opinions.

Peter D. Geldner, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 34 reviews

Breast issues

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Three strikes and your out!  Be careful underoing so many re-ops. Your right and left breasts are different, with the left one being much largee than the right.  They will never be exactly the same. You may want to reduce the left side and leave them alone.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Enhancement Surgery

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Tough problem, lots of great ideas here. I would suggest removing the old implants closing that space than placing a small implant above the muscle

Muscle Distortion, Bottoming Out and Deformity in Both Breasts

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It appears you have ahd many excellent recommendations. Your right appearas smaller and above the muscel so muscle release may be required with or without a larger implant or learn to not contract the pectoralis. Your left  mayrequire another lift or caspulorrhapy or downsizing. Measurements and examination will help with this decision.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

The 3rd operation

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You should undergo another surgery to repair this distortion.  It looks like the main problem is the right sided muscle distortion which can be addressed at another surgery.  The best thing about combining a lift and augmentation is that you only undergo one operation and one recovery - but a downfall to combining the procedures is that revision surgery is very common (12-16%) and you unfortunately fall into this group.  Good luck!

Bad breast aug

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Unfortunately, as you may have come to the conclusion on your own, the result today is not great.  It's certainly not what you had in mind, but I'm willing to bet that it's also not what your surgeon had in mind.  Somethings are totally out of both of your control. 

The solution much to your satisfaction is out there!  I think that if your implants were to be removed of all of that scar tissue and they were to be placed in the correct location then you'd be in good shape with great cleavage and the nipple location still not so bad.  You'd need to come in for a consultation for details.

Ricardo A. Meade, MD
Dallas Plastic Surgeon
4.9 out of 5 stars 124 reviews

Muscle distortion after breast implants

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Muscle distortion is 'the' problem with under the muscle breast implants. The implant will flex and deform if the chest muscle is contracted tightly. The effect if minimized if the implant fills out the breast skin envelope well. When augmentation is combined with a breast lift, especially with a smaller implant the miss-match between the implant and skin is greater and with flexing the implant can move beneath the breast in a disconnected way. We recommend that you consider a silicone gel subglandular implant with the size adjusted left to right, and a revision of the breast lift to properly position the nipple. A new surgeon may give you a fresh start.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 43 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.