Is Window Shading of the pectoral muscle the fault of the surgeon?

In my opinion, window shading occurs with very aggressive release of the pectoralis major muscle. This is something that would be recognized within the appropriate healing time. 2 to 3 months. This is not something that would be new as an asymmetry many years down the road. So if this asymmetry was due to window shading you should have noticed this prior to your second surgeons opinion.

its unfortunate you have a surgeon that doesn't have a favorable revision policy.  The vast majority of surgeons will do a revision within a certain amount of time from your original procedure for no surgeon fees.  Costs of materials, the OR and anesthesia would be the patient's responsibility.  There are some surgeons who simply cannot give away their time because their time is too 'valuable'.  I know one of those surgeons and his attitude and ego are his downfall in his dwindling practice.  I think most people know what fair means.  As for the window shading, if it wasn't there before, then it can be presumed that the procedure contributed to it.  But fault is difficult to assign since that may have been part of the plan to give you what you desired.

I'm sorry to hear of your experience with your previous surgeries.  It's difficult to give you accurate advice without photos and without a more detailed history and physical.  In general, window-shading of the pectoralis muscle can be caused by over-release of the origins of the pectoralis muscle.  It's usually recommended that the insertions along the sternum be fully maintained, so that the lower edge of the pectoralis is maintained in it's low position.  However, the belly of the pectoralis muscle rises slightly whenever an implant is placed beneath it.  Also, many surgeons try to maintain the lateral connections to the pectoralis, a thin fascial connection to the serratus muscle.  This could have been over-released, or more likely it was weak due to repeated surgeries in the same area, and may have been thin or weak to start with.  The window-shading may have been the "fault" of your surgeon, but more likely it was a combination of these factors after repeated procedures in the same surgical field.  Release and redraping of the pectoralis with placement of ADM between the lower edge of the pectoralis and the chest wall can help reposition the muscle inferiorly and would help prevent the inferior malposition you mentioned as well.  Best regards,-Erik Hoy, M.D.

If you had a simple replacement if implants, I am not sure if you can blame the surgeon.This is a complicated problem with a sometime difficult fix. I would seek a competent BC plastic surgeon to take care of the problem. You can ask him his opinion of "blame". These question are too complicated for this venue.

Windowsahding may or may not be the fault of the operating surgeon.  The pectoralis may lift and cause an unsightly transverse ridge despite minimal release of the pectoralis muscle.  While overaggressive muscle dissection is a know cause, I cannot pass judgement without a physical examination.

WIndow shading can occur with submuscular implants and may or may not occur because of overaggressive muscle release.  Difficult to say for sure.

Dear UB,Thank you for your post.  It is difficult to give advice without photos.  Window shading is a common occurrence when placing implants under the muscle.  The following link is a photo of implants that I placed under the muscle.  Notice how she had a large gap in between her breasts pre-op, and nice cleavage post-op.  This is only possible by releasing the pec muscle on the lower inside aspect of the muscle and letting it 'window shade' up.  this allows the implant to sit towards the center of the chest, giving you cleavage.  Without releasing the muscle on this patient, the muscle would force the implant to the side causing a gap in between the breasts.  Window shading is not necessarily a bad thing.  However, I perform most of my augmentations in the sub-fascial pocket (above the muscle) because no manipulation of the pectoralis muscle is necessary.  What I would be more worried about is 'bottoming out' of the breast as you said the implant is lower than your fold.  This is a difficult problem to correct, but without photos, it is difficult to give you advice.  Best wishes, Pablo Prichard, MD

I'm very sorry to hear of your situation.  Photographs would be helpful.  In my practice bottoming out and window shading after a breast implant revision is usually corrected without a surgical fee but the patient is responsible for facility fees, anesthesia and materials fees.  Good luck.