I am considering having my implants moved above my pectoral muscle. Any suggestions? (photos)

I recently received my silicone implants, under my muscle but am very bothered by the distortion when I engage my pecs. The shape of my breast is affected even when the muscles are relaxed. However, I am concerned with the increased risk of capsular contracture if I move my implants. Included is a picture of relaxed and flexed. Please advise.

Doctor Answers 9

Submuscular breast augmentation.

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Animation of the implant is possible after submuscular breast augmentation. Animation can some-times create creases in the skin which is sometimes called "window-shading" and is probably what you are experiencing. Further release of the muscle from the skin can help to decrease this issue. 

Even at rest your lower pole contour does not look smooth and rounded. This could be a sign that your implant is either bottomed out or that you had a component of breast constriction prior to surgery that was not corrected at the time of your operation. 

Salt Lake City Plastic Surgeon
4.9 out of 5 stars 299 reviews

Moving the implants

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I am only looking at pictures. Your case really should have an in person evaluation. This is one of the things that can happen with submuscular placement. Moving to the subglandular position is one option for this, and I think that might be a good choice. There is an increased risk of capsular contracture. You seem to have more going on than just the muscle issue. You really need a good consultation. There are several very talented plastic surgeons in your area. Go back and talk to your surgeon, and you may want a second opinion before going ahead with surgery. Good luck!

Tracy E. McCall, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 1 review

Implants below the muscle

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HiThanks for the question.  I am not sure you need to change the implant pocket right off the bat.  You have a combination of a double bubble and possible inadequate muscle release.  I like to do a dual plane technique to release the muscle at the bottom so that it can ride up and not constrict the lower portion of the implant.  The other important thing is releasing the old fold so you don't get a double bubble afterwards.  i would go back to your surgeon to see what they think and discuss a revision down the road.  If you don't like their answer then consider a second opinionGood Luck

Moving your implant

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Without seeing you in person, it is impossible to say for certain, but this doesn't look like just a problem with implant placement. You need to get this assessed in person by your surgeon and/or get a second opinion from another board certified plastic surgeon in your area who specializes in breast revisions. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Breast distortion following breast augmentation

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Your problem is not being under the muscle. Your problem is that either you muscle was not released, or that your muscle was sewn down during the closure of your incision line by mistake. Don't ask me how I know that ! This is a rookie mistake. Please consider correcting the problem, not creating another problem by going over the muscle.

Arian Mowlavi, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 108 reviews

Breast Implant Revision

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Thank you very much for your question, and for providing the pictures.

I can understand your concern regarding the animation deformity, it looks quite significant in your case.  As you suggest, a way to treat this is to move the implant above the muscle.  I recommend you discuss this with your original doctor.  If your original doctor does not provide the answers you desire, or does not have extensive experience with revision breast surgery, I recommend getting a second opinion from another plastic surgeon.  Best of luck!

Daniel Krochmal, MD
Chicago General Surgeon

Find the right surgeon

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Have a consultation with a board certified plastic surgeon specializing in revisions. 
Choose the surgeon and not the procedure. 

Distortion possibly from incomplete release of the inferior medial pectoralis muscle

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Thank you for the photos and question.  A detailed physical examination and review of the original surgeon's operative report would contribute greatly to a new consultant's opinion.  Nevertheless, your photos are excellent and demonstrate 1) inferior areolar incisions suggesting transareolar implant access.  2) soft tissue tightness at the lower inner breast pole has caused medial flattening of the breast.  3) active flexion of muscle displaces the implant laterally and further accentuates the deformity, suggesting the tissue tightnesses were consequences of incompletely divided inferior medial pectoralis muscles.  

Most surgeons who place implants in a "submuscular" position intentionally divide the inferior medial pectoralis muscle.  Division permits a submuscularly placed implant to descend and form the rounded gentle feminine curves of the lower inner breast.  When this muscle is incompletely divided, the lower inner breast is pressed flat even when the muscle is relaxed.  Active contraction of an incompletely released muscle further accentuates the deformity by displacing the implant outward.  

This can be addressed in several ways.  If your soft tissues are robust, implant site change to a subglandular position would be an effective method of correction, albeit with a minor increase in capsular contracture risk.  Alternatively, reoperation with division of the residual inferior medial pectoralis muscle can also be effective and is a preferred alternative when breast tissues are too thin for subglandular implant repositioning.

Consultation with an experienced reputable plastic surgeon will enhance the diagnostic accuracy of the problem and permit a proper discussion of treatment options/risks/benefits.

Chen Lee, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 21 reviews

More distortion than expected

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It is difficult to give concrete advise by purely a picture due to the nature of the dynamic deformity described and seen in the pictures however it is evident that there is more distortion than normally present. I would venture to say you have more than a poorly developed sub muscular pocket made and would want to know more about the status of the implant. I would suggest full exam with possible revision while maintaining a dual plane pocket. This would maintain som elf the implant under the muscle.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.