Can a muscle that has been released too much during a BA be repaired?

I am a very active 55 year-old in excellent health who lifts 5 times a week. I had a BA on 10/20/15 to replace 15 y/o saline implants with silicone. The left implant failed to drop down and a pocket revision was done on 2/25/16 by the same board-certified PS. Unfortunately, the muscle was released at the top near the armpit resulting in a noticeable loss in muscle mass and a drooping, rippled breast. I am very distressed about the possibility of permanently compromised strength and appearance.

Doctor Answers 6

Muscle release repair for droopy implant

The situation you describe is unusual and so online consultations will be of limited benefit. You may be able to get significant improvement with Strattice for implant coverage and support. There are several things to consider regarding possible repair of the muscle, such as whether there is any active muscle contraction. I use a split muscle technique (not dual plane!) to minimize the risk of problems like this.

Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Muscle release

Unfortunately, the scenario that you present is not uncommonly seen in attempts to place larger and larger implants. The muscle will then "window shade" such that it migrates upward towards the clavicle leaving no muscle covering the implant nor to hold it up. This risks exposure of wrinkles and a bottoming out appearance. I've had good success in these situations with freeing up the lower border of the pectoralis muscle and suturing it entirely across its width using a very large piece of Strattice. The bottom of this Strattice material is then sutured to a flap of posterior capsule containing some of the fascia overlying the underlying muscles for added strength. In this way, the muscle which is been freed up from above is pulled under tension back downward to cover the implant and the hammock like support of the bottom of the Strattice will not only hold the implant up will also act as a barrier to prevent the visualization of rippling. Try to find a board-certified plastic surgeon with experience in complicated breast revisions. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Redo breasts augmentation

Dear Fiftyfine,
 Sorry for your unfortunate series of complication from a procedure that in the overwhelming majority of times, result in beautiful and very gratifying results. 
 To be more helpful to you, before and after pictures will be necessary. 
 Your description is extremely rare and in my 29 years of practice , I have never seen it. However, I can imagine how during a capsulotomy (scar release) or capsulectomy (scar excision) this can occur if the surgeon is not very meticulous and careful. 
 I hope for you, that the muscle was only cut and not excise. In that case a two entry approach - sub areola incision and armpit incision, might allow for the reconstruction of the muscle. 
  You will have to do a very careful due diligence and find an experience board certified plastic surgeons who do lots of redo breasts augmentations in an accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with natural look.
  Check also the 'Realself' reviews for ratings and positive experience reports.
             Best of luck,
                                 Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 126 reviews

Breast implant revision - did not turn out well

Thank you for asking about your breast implant revision.
  • I am so very sorry to hear of this problem.
  • Release in this area is unusual.
  • I do not think this site can solve your problem although photos may help.
  • The treatment will depend entirely on the cause - which could be nerve injury, separation of the muscle from the bone, both or another problem entirely.
  • The problem will need treatment depending on the cause -
  • In addition to a second plastic surgery opinion, I suggest you consult a neurologist and an orthopedic surgeon specializing in shoulder injuries as well.
Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Please send pictures

I am sorry that your results are not what you were expecting. it is hard to comment without examination or at least seeing the pictures before and after revision. It is unusual to release pectoralis muscle over the arm pit. There are options to help , but will need more information and pictures first.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

Can a muscle that has been released too much during a BA be repaired?

I'm sorry to hear about the concerns you have after revisionary breast surgery.  You may benefit from posting photographs with your next question here; otherwise, online consultants will not have a good idea of what is going on and what might be advisable.  Generally speaking, it would be unusual to "release" the pectoralis major close to the axillary area;  you may wish to clarify exactly what was done with your plastic surgeon.

  Otherwise, careful physical examination and/or viewing photographs would be necessary to provide you with more specific assessment/advice.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,498 reviews

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