How can pectoral muscle indents when I flex be fixed? What caused it? (photo)

The cause is multifactorial but it involves the pectoral muscle and it's release and it's re-attachment where it should not be. It will require a capsuloraphy and re-attachment of the muscle where it was released. These types of complex issue post-op are best dealt with in person. Good luck

Judging from the pictures, both the animation problem and the double bubble have the same cause: The part of the pectoral muscle that was released from the rib cage attaches to the scar capsule in front of the implant. You can confirm this by seeing if the crease along the bottom of the breast that defines the double bubble is where it pulls up when the muscle is flexed. If that is the case, it is not the original inframammary fold. This can be very effectively corrected using the split muscle technique (see link to my article below and before & after pictures on this site). The capsular contracture and possible bottoming out make your case a very complicated one and I would advise thorough research before having any revision surgery.

You have a dynamic deformity caused by adhesions or scar between the edge of the pectoralis muscle and the overlying gland. So, you flex and the muscle pulls on the undersurface of the gland/skin.  A double-bubble would result from the old infra mammary fold being preserved in your larger, lower breasts. I'm assuming this fold didn't travel through your areola as the photos show. Also, the double bubble deformity would be present at rest, which you didn't describe. The dynamic deformity could be corrected with dual-plane revision, or conversion to subglandular implant positioning. Bottoming out is a separate issue, and you should talk to your surgeon about these findings. Best regards!-Erik Hoy, M.D.

You have a typical double bubble deformity.I usually repair these by returning the muscle to it original position, and placing the implant sub-pectorally.

I consider it a myth that this double-bubble deformity is caused by the old inframammary crease. As most of the responses I see indicate, the problem is caused by the detachment of the lower edge of the pectoralis muscle in order to create a pocket beneath it. If the muscle edge is not properly released and defunctionalized in the lower pole of the breast it can become attached to the fascia, breast, or capsule above it and cause a deformity when the muscle is flexed. The dual-plane release for breast augmentation is designed to avoid or minimize this situation.One suggestion as I think Dr. Becker was suggesting was to convert the pocket for the implant to a position above the pectoralis muscle. If the implant is left in the subpectoral position (the best overall choice) then the pectoralis muscle has to be resected out the of the lower pole of the breast up to the level of the nipple. Aside from capsule contracture problems, this is the best solution with a revision. A "lift" of the breast/nipple-areola is not needed. Another solution is to replace the muscle and the capsule in the lower pole of the breast with a dermal graft which seems to address both the muscle problem as well as the risk of capsule contracture.