Muscle Flex Deformity, What are my Options? (photo)

Question

30 yr old, breastfed 3 children. 1st Op: 375cc mp, coh1 submuscle,axilar incision. Got Muscle flex deformity and double bubble. 2 Op: Muscles are cut in, pockets reshaped. Probleme remains, rippling on the outside. 3rd Op: Surgeon wants to change to bigger firmer implants. Mentor 500cc MP+ coh2, muscles are cut in, pockets reshape. MFD and DB remains. Rippling on the outside gone but instead rippling in the cleavage. What do you suggest? I want softer, smaller and more natural breast

Gary M. Horndeski, MD · Answer

According to your history, you currently have 375 cc implants.  Your breasts appear quite large, like a D or DD.  One option for you is to remove the implants altogether and have a mastopexy.  This will look normal since it will be all natural without implants.  If after that you are still dissatisfied you can consider a smaller implant.  The delay will give you a chance for the pocket to heal.  I would definately NOT, under any circumstances, put a 500 cc implant in you.

	Best of Luck,

	Gary Horndeski, M.D.

Richard Baxter, MD · Answer

Your picture shows significant animation deformity from detachment of the pectoral muscle with the dual plane procedure. This is also why you see more rippling in the cleavage area; the muscle is no longer attached so it has pulled away. Bigger implants will not help and in the long term will make other issues worse. You need to have the muscle reattached behind the implant, with either converting to the split muscle plane or above muscle.

Jed H. Horowitz, MD, FACS · Answer

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. Stretch #Deformity occurs when the breast fold is in the correct position, however, the length of the tissue between the nipple and the fold stretches. This may be due to the patient’s soft tissue inelasticity and/or the size or shape of the implant that is used. Skin laxity can change with age, pregnancy, weight changes, or heredity. Correction of this problem usually includes skin excision as part of a mastopexy (breast lift/reshaping).It may be necessary to use ADM to further support the breast tissue if too thin. 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.

Steven Wallach, MD · Answer

You should really have an in-office consutlation with another doctor or review things with your doctor. It sounds like you need a smaller implant and adjustment of the pocket. Rippling can be treated with strattice if necessary.

Peter E. Johnson, MD · Answer

Your surgeon might have suggested yet a bigger and firmer more cohesive implant, but this may just be your undoing. If you want a soft and smaller implant, ideally in a new pocket then you might have to find another surgeon.

	Best of luck, Peter Johnson, MD

Ronald V. DeMars, MD (Retired) · Answer

Sorry, but your implants are aleady quite oversized for your frame. Going bigger is not going to help at all. I think you need another opinion from a local surgeon but if the doctor feels he has done everything he can to release the muscle you will need to go over the muscle with the new, smaller implants. You may still have some rippling, some patients do and it is unavoidable. But to me it looks like the doctor only released the inner (medial) muscle attachments, thus the rippling medially, and did not release the front surface of the muscle from the back surface of the breast tissue (the dual plane technique) which is necessary if you want to keep the top half of the implant under the muscle.

Muscle Flex Deformity, What are my Options? (photo)

Answers (6)

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