Horrible muscle distortion post explant. How can this be fixed? (Photo)

Some breast distortion with chest muscle contraction is normal in all patients with implants placed behind the muscle. Your distortion seems significant and you have what is called "window shading" after breast augmentation. The right appears worse than the left. There are many reasons that this can occur to include the cutting or post-op tearing of the pectoralis muscle along the sternum or scar adhesions between the pectoralis muscle and the skin. Muscle repair and capsulectomy are fraught with high recurrence rates. Changing the implant from the submuscular position to the subglandular position is totally corrective and the the issue will not recur. This can also be done with less severe distortion in patients that do not want to have any visible breast changes with chest muscle contraction after breast augmentation.

Thank you for your question.  You have windowshading of the muscles after explant.  Re-attachment of the muscle with reinforcement would help to improve the deformity.

You'll most likely need to have the scar tissue removed and Strattice placed to help prevent the tethering that is going on.

Agree with all the comments so far. Your right breast is particularly difficult to fix because it appears that the pectoral is muscle was aggressively detached from the eternal border. I think that your problem can be improved but will be difficult to correct entirely. 

That is a difficult problem to fix.  When your implants were first placed, the muscle was cut.  It either wasn't repaired or the repair was inadequate when the implants were removed.  You need to have an attempt for reattachement of the muscle.  It may be retracted and need either seri or strattice to repair.  Fat grafting may or may not help hide some of the deformity.

This is a very difficult problem to try to correct, and may not improve with any of the maneuvers that were described below.

Breast animation is what you have. The capsule needs to be removed, the muscle apparently was released too much and has retracted. Will need repair of the muscle and re-attaching the muscle to the chest wall. Whether Acellular  matrix is needed or other material to prevent adhesion of the breast tissue to the muscle again. Botox can be used on the muscle so that it does not contract and detach and also helps with the natural healing where one puts the muscle. If I can avoid fat graft to the breast I would.

I'm very sorry for the problems you're having.  Your case illustrates how difficult it is to "undo" surgical procedures.  Your implants were in for just 4 months, and yet you have recurring irregularities following their removal.  Fortunately, your appearance at rest is excellent - some women who have undergone implant removal don't even have that.You have adherence of the breast tissue to the underlying muscle associated with flexing of the muscle.  There are many reasons why this may have occurred - they include detachment of the pec muscle from its sternal origin with subsequent windowshading and other possibilities.  But "fixing" it may be difficult.  Simply reattaching the muscle may not be adequate, and is not that easy to do, anyway.  Inserting Strattice (or another ADM) may separate the breast tissue from the underlying muscle (which is where it appears to now be attached) but has its own set of potential problems.  It's also a reasonably complex surgery.I would suggest that you start with what may be the simplest procedure - fat injections to the lower inner quadrants.  That may give you a little volume and, more so, add a layer of tissue in between the bottom of the breast and the pectoralis fascia (superiorly) and the fascia over the intercostal muscles (inferiorly).Another choice, of course, is to do nothing about it, and be grateful that it's not worse than it is.  Easy for any of us to suggest that, but you could also be headed down a road where you undergo one or more surgeries, each associate with its own risks, and still not get the result you want.I hope that this helps and good luck,Dr. Alan EnglerMember of #RealSelf100@RealSelf

You have a very difficult problem.....especially on the right side.    Your pectoralis muscle has been extensively released from its attachment.   The trick is to reattach the pectoralis muscle to the sternum.   This can be done and would help.  This is not an easy surgery.   I would see the plastic surgeon in your area that does extensive breast cancer reconstruction.   This is the skill level you will best be served by.   Seek several consultations from reconstructive surgeons and gather your options.   In your consultations seek advice from at least one university service.   My Best,  Dr C

Explanation without removal of the entire scar capsule is prone to complications.  We always remove the capsule, repair the muscles, and do not see seromas, muscle distortion (unless the muscle cannot be repaired), infection, and interference with cancer detection.  The peer reviewed literature in plastic surgery recommend total capsulectomy in order to avoid these complication.  I wrote the book on explantation and have done about 2000 surgeries, so I also  have the clinical experience to make these statements.  I frequently remove retained capsules and repair chest wall muscles.