Do the pectoral muscles need to be stiched back down during explant with lift?

You typically cannot get the chest muscle back to a normal position.  I have done many of these types of cases and it is not possible to get the chest muscle back to its normal position.

I always repair the pectoralis muscle when I remove a submuscular implant.  When your implant is removed, the stretched, partially detached muscle can jump and look abnormal even with the implant out.  I have not seen that this improves with time.  This is especially true if you already have a significant muscle flex deformity.  I have found that repairing the muscle at the time of removal prevents this, and the repair holds up beautifully long term.  You should also consider internal lift and fat grafting at the time of your removal to help repair the stretching and thinning that occur with an implant.  Good luck!