What does typical animation deformity look like after BA?

Question

I'd love to prepare myself for a typical pec flex outcome after sub-musc BA. I'm an active person (retired professional dancer) who performs occasionally. My BA is scheduled soon (yay!). From everything I've read, it seems that severe cases are rare (~15%?) but some animation deformity is to be expected. Yet all cases I see online look severe! 1) What percentage of women see flexing with every movement (vs. full-on pec contraction)? 2) Do you have any photos/videos of "normal" post-op flexing?

John L. Burns Jr., MD · Answer

Submuscular breast augmentation in athletic women can result in animation deformity.  Flexion of the pectoralis muscle can distort and move the implant around in the pocket.  I recommend a form stable, anatomic implant with a textured surface such as the Allergan Style 410.  The pocket should be carefully made exactly the same size as the implant so that the implant does not have any room to move with flexion of the muscle.  The form stable gel resists deformation much better than saline or a softer gel.  Careful division of the pectoralis muscle leaving sternal attachments also helps prevent animation deformity.

Curtis Wong, MD · Answer

of implants but when the dual plane method is employed, the animation is usually minimal but nevertheless, still present.  So expect movement and ask your surgeon if the dual plane technique is used.If you cannot handle the movement at all, you have to consider going over the muscle instead.

Terrence Murphy, MD · Answer

Most patients get a degree of change in the appearance of the breast with flexing with sub muscular implants. The benefits of submuscular placement however outweigh any issues you might see. I have two patients who convinced me to convert their implants to on top of the muscle this year due to flexing deformity. Both are unhappy and one is having more surgery to go submuscular again. I strongly advise my patients to go submuscular

Bradley Remington, MD · Answer

With slight pectoralis flexion, there will only be minimal, if any, movement of the implant.  Of course, this happens as the pectoralis muscle is moving upward and toward the shoulder - with the implant under the muscle it moves in the same direction.  With full contraction/flexing, there will be a more significant movement of the implant.  Going subpectoral in a breast augmentation is a compromise: with thinner tissued and fit patients with small breasts, the extra thickness of the muscle in the upper portion of the chest can minimize the appearance and feel of the implants.  Since not flexing is 99% or more of the time, it is the better option to help camoflage the implant with this extra layer of natural tissue.  A careful teasing and separation of the lower portion of the muscle will result in the least amount of animation.
Cheers,
Brad Remington, MD

Brooke R. Seckel, MD, FACS (retired) · Answer

Congratulations on your planned breast augmentation. Under the muscle is by far the best option. With proper implant placement animation deformity is very rare and avoidable. The Pectoralis muscle should only be opened at the bottom and not detached from the sternum or breast bone. On the side, only a small strip or sling of muscle should be left to support the implant preventing bottoming out-the "internal bra."With proper technique there should only be very slight movement with pectoralis contraction-just a very slight compression of the implant with downward movement. Animation deformity is rare and most often happens when the pectoralis muscle is detached from the sternum or breast bone.

What does typical animation deformity look like after BA?

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