Extensive Implant Distortion, Can It Be Fixed? (Photos)

7 months post op. dual plane (muscle splitting technique) bilateral breast augm. with 300cc cohesive silicone, periareolar insicion. Experiencing extensive implant distortion upon muscle flexing, even though muscle splitting tech. was performed on me. Can this be fixed without moving implants above muscle? Was muscle-splitting performed poorly on me, or not performed at all??? Also have asymetry with left implant sitting higher than right. No asymetry before operation.

Doctor Answers 11

It's always a trade-off

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I agree that this will be difficult to alleviate without moving the implant to the subglandular position.  However, this placement is not without its disadvantages...including increased capsular contracture rates and worsening of ptosis.

Austin Plastic Surgeon
5.0 out of 5 stars 86 reviews

Extensive Implant Distortion, Can It Be Fixed? (Photos) Answer:

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This is the tradeoff with under the muscle and is experienced by almost all that have that placement. The advantage is more implant coverage in the upper pole and supposedly less hardening. So if it only bothers you when you are naked in front of a mirror and only in certain poses or situations, then it may not be worth it to you to go above muscle. Your pictures, even with a bit of asymmetry, look good so it really is up to you. If it bothers you once a month, forget it. Once a day, fix it!

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Breast implant revision

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I agree with you that the distortion you're seeing is more than the average patient experiences after sub muscular augmentation. This does not mean, however that muscle was not released in your case.

Muscle distortion is difficult to completely eliminate with revisionary surgery unless the  implants are replaced in the sub glandular position.  However, because of the significant  disadvantages associated with implants in the sub glandular position, I would recommend revising your current breast implant pockets (with further release of the pectoralis muscle attachments medially  and inferiorly. This revision, of course carries its own risks such as medial or inferior implant malposition (bottoming out).

The breast asymmetry that you're referring to may be improved with the revision surgery as well. Make sure you are working with a experienced  board-certified plastic surgeon.

Best wishes.

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Distortion after breast augmentation

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It is rare that an under the muscle, even partially under the muscle, placement should be used for breast augmentation with gel implants.  My rule of thumb is to reserve this approach for patients whose bones I can read across their chest.  The problem with an under the muscle approach is just what you are experiencing: distortion with muscle acitivity.

Gel implants are so well tolerated under the gland that there is little reason (except as I noted above) to distort anatomy by dissecting the muscle and isolating the implant volume from your own natural breast volume.  Based on your photos I would immediately convert your implants to an on top of the muscle pocket.  This will not change your appearance overall but will completely get rid of the weird crease when you flex.

Extensive Implant Distortion, Can It Be Fixed?

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Distortion may occur when the breast muscle pulls across the breast implant. The result can be worse with heavier breast muscles. There are #options to correct #distortion. One option is to change the positioning of the #implant to the #submammary position and also creating an #incision within the muscle along the sternum. The best #option for #revising this is to be discussed during a one-on-one consultation with a board-certified plastic surgeon. Deciding on additional #elective cosmetic #surgery is a personal #choice. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Implant distortion with submuscular implants

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 I've found that occasionaly implant distortion will happen more commonly with textured gel implants. Having said that it can also happen with smooth gel implants as well.

This problem isn't necseesarily related to surgical tecnique.

Your best option may be to change to implants to a subglandular pocket in front of the muscle. You may need the a relase of the fold on the higher side to allow for more equal positioning.


Isolde Hertess, MD
Gold Coast Plastic Surgeon

Breast Asymmetry and Implant Wrinkling

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No asymmetry before operation??  Look at your "before" pictures closely, and you will likely find that the right nipple areola complex was slightly higher than the left.  This asymmetry is magnified by augmentation.  My solution to the animation you see is to reoperate and disinsert the pectoralis major muscle from the capsule around the implant.  It is true however, that to be most certain of complete resolution, subglandular placement is preferred.  This, of course, carries its own risks:  Increased implant visibility and palpability, more visible rippling and/or wrinkling.

Steve Laverson, MD
San Diego Plastic Surgeon
4.9 out of 5 stars 50 reviews

Implant distortion with submuscular implants

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All submuscular implant can be distorted or shifted to a degree when the muscle is flexed. Most have little shift and problem, though some have the issues as in your photo with the marked shift and band across the breast. You will likely be happier with a  subglandular implant, and slight release of the fold on the higher side.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Breast distortion with chest muscle contraction

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Your posted question is actually two questions


Your first concern is distortion of breast shape with chest wall muscle contraction. This is seen with essentially all  breast implants that are placed either partially or completely under the chest wall muscle. If this is objectionable, the only sure remedy is to place the implant subglanular (above the chest wall muscle)


Your second concern is for asymmetry. To be absolutely sure, you would need to be examined, but from your pictures posted, it would appear that there is a mild asymmetry for the positon of your implants. The is unrelated to how they were placed (above or below muscle) but can be addressed with a minor repositioning procedure.

Jack Peterson, MD
Topeka Plastic Surgeon
4.6 out of 5 stars 47 reviews

The implant may need to be moved.

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With the fact that you used a periareolar approach and have a partial submuscular implant, your capsule may be strong enough to cause distortion when you flex your pectoralis muscles.  In my experience the easiest way to guard against this problem is to place the implants in the subglandular, above the muscle plane.  This is done most safely when you have an adequate pinch test showing a good amount of tissue coverage on top of the proposed implant.  In my practice, patients who are extremely athletic or have jobs that require a large about of lifting are counselled about the need to avoid long-term displacement of the implants and that subglandular. above the muscle implants may be most appropriate for their long-term breast augmentation success.

I hope this helps,

Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 69 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.