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.
Extensive Implant Distortion, Can It Be Fixed? (Photos)
Doctor Answers 10
It's always a trade-off
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.
Breast implant revision
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.
Extensive Implant Distortion, Can It Be Fixed? (Photos) Answer:
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!
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Distortion after breast augmentation
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.
Breast Asymmetry and Implant Wrinkling
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.
Implant distortion with submuscular implants
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,
Breast distortion with chest muscle contraction
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.
The implant may need to be moved.
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,
Muscle flexion deformity is common with submuscular implants
Muscle flexion deformity is part of equation with all submuscular implants. For this reason alone subglandular placement of implants is anatomically and functionally closer to a natural female breasts and should really be preferred way to do augmentation in all situations.
Your implants will need to be positioned in front of muscles to correct this occurance.