How to avoid animation deformity?

Question

Hello, I’ve been researching over vs under breast implants and I’m a bit lost which is best. I’ve had two consults, one recommended over the muscle as Im a 34B and have 2cm of tissue on both sides; the other, dual plane. As I’m active and workout, i want to avoid animation deformity. The doctor who suggested overs said it might result in me needing a lift in 10 years; the other said dual plane would work as he’ll make sure to fully “release” the muscle so that it doesn’t animate. Confused!

Donovan Rosas, MD · Answer

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.
 Subglandular Augmentation (“overs”): 
Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster.Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling when compared to subpectoral augmentation.Subglandular implants can also create the illusion of improved cleavage by preferential over-dissection of the central/medial pocket allowing the implants to be forced more to the midline. There is no limiting muscle as there is in a submuscular augmentation. 
Subpectoral Augmentation/Sub-muscular/Dual Plane (“unders”): 
Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.Subpectoral implants have a lower rate of capsular contracture.Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.In my practice, the vast majority of patients will have the implants placed submuscular for all the reasons listed above. This is also known as a dual plane (due to the fact following muscle release half the implant is under the muscle while the lower pole is not). Complete submuscular coverage is rarely performed due to the distorting pull of the muscle.
With regards to your specific question, subglandular is preferred when animation is a major concern. However, animation is a less noticeable phenomenon in cosmetic augmentation (vs. reconstruction).
Based on your photos alone, you would appear to be an excellent candidate for  a submuscular 
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Paul E. Chasan, MD, FACS · Answer

The question IS how to minimize an animation deformity. As an experienced plastic surgeon who has dedicated a considerable amount of my practice to revisionary breast surgery, I have a few perspectives. The rate of complications associated with implants placed on top of the muscle is extremely high. When you disconnect the attachments between the Pec Major muscle and the breast and place an implant, the inevitable effects of gravity is that the implant will slide down the chest wall or  commonly will develop capsular contracture. The rate is almost double on top of the muscle. You will find very few experienced plastic surgeons placing primary implants in the subglandular space for these reasons. I find that placing a higher profile and more cohesive implant in a slightly higher location on the chest wall diminishes to animation deformity. I use this technique in my figure fitness/ bodybuilder patients with excellent results. Most patients have mild movement associated with flexing their muscle, but it is not a major concern or issue. Best wishes to you.

Luis A. Mejia, MD · Answer

hello thank you for your question and provided inforamtion as well;..based in your question its difficulted evaulate your case if the question dont have a picture, its recommended to get a consultation in personal with a plastic surgeon.

Andrew P. Amunategui, MD · Answer

Hi SunshineGabs and thanks for posting.  The only way to avoid animation deformity is by not placing the implant under the muscle.  Fully releasing the muscle is not recommended and can lead to other deformities and/or the implant ending up subglandular position.  Subglandular position is not "evil."  Pros and cons of all placement options should be discussed in person with your BCPS with expertise in breast surgery.  Please see attached web reference.  Thanks again and good luck!

Dallas Buchanan, MD · Answer

Thank you for your questions. The truth is that while animation deformity is usually not a huge issue with submuscular implants, it is always a risk and runs a spectrum, meaning that it is not whether you have it or don't have it, but how severe or not severe it is. The honest truth is that the only way to avoid it all together is to leave the muscle where it is and proceed with a subglandular augmentation. The trade-off for this benefit is increased risk of capsular contracture and increased implant palpability and visibility. You have to decide which one is more important to you and proceed. The bottom line is that if there were one way to do everything that offered all the benefits with none of the downsides, then there would not be options and everyone would do things that way.......this essentially never exists in plastic surgery.Hope this helps!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Urmen Desai, MD, MPH, FACS · Answer

This is difficult to avoid when placing the implant behind the muscle, which is the better plane to place the implant. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question.  For most patients, placement of an implant underneath the muscle will result in the best outcome as it achieves a natural result and trends towards fewer complications.  That said the only way to avoid all animation deformity potential would be placement above your muscle.  Hope this helps.

Richard Baxter, MD · Answer

Studies have shown that the majority of patients with dual plane placement have some degree of animation deformity, and because it detaches part of the pectoral muscle you lose strength as well. If you have some tissue coverage then go over the muscle, and my preference for this is the subfascial method. If you do require coverage, then the split muscle minimizes animation and does not detach any of the muscle.

Kenneth Hughes, MD · Answer

If there is very little breast tissue and the patient is not depending upon her upper body strength for a career such as weightlifting, boxing, bodybuilding, etc., submuscular placement is a better choice.  As a bodybuilder, I augment professional athletes frequently.  I think for those people in whom the living is made by athletic performance, the implant can be placed above the muscle.  Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Maakan Taghizadeh, MD · Answer

Hi, thanks for your question. The only way to entirely avoid animation deformity is to place the implant over the muscle. The limitations with this are thickness of breast tissue, which can determine how noticeable the implant would be. To asses this, you would need an in-person consultation with a board certified plastic surgeon to see what the best choice for you is. 
Best of luck, Dr. Tag.

How to avoid animation deformity?

Answers (14)

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