Will capsulorrhaphy + GalaFLEX fix animation deformity? (Photos)

Question

I have noticeable animation deformity with subpectoral implants — the breast visibly distorts when I flex or move my arms. A surgeon suggested revision with: - capsulorrhaphy - implant exchange (still under the muscle) - GalaFLEX mesh No muscle repair or plane change. Will this actually improve animation deformity, or only breast shape? Is this worth doing, or will the movement still remain?

Daniel Barrett, MD · Answer

Dear Philosophical905843,

though rare, some women who undergo breast augmentation will develop a minor deformity known as a “double bubble,” in which additional folds appear underneath the breasts due to the implant accidentally shifting or contracting post-surgery. In most cases, the implant simply slipped too far down the chest wall and traveled behind the breast inframammary crease (the area where the lower breast meets the chest), instead of moving forward to fill the breast cavity. If left untreated, the lopsided implant will form unnatural indentations, resulting in an odd “four-breast effect” rather than the full, rounded chest the patient initially desired.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mehmet Ozdemir, MD · Answer

I completely understand how frustrating animation deformity can be, especially when your breasts look great at rest but "jump" or distort the moment you use your arms. To be very direct with you, the surgical plan you’ve been offered capsulorrhaphy, an exchange, and GalaFLEX mesh while staying under the muscle is excellent for tightening the pocket and providing internal support, but it may not fully eliminate the animation itself. Since the pectoral muscle remains draped over the implant, it will still exert pressure and cause movement whenever it contracts. While the mesh can help stabilize the implant's position and potentially dampen the severity of the distortion, the only way to truly "cure" animation deformity is to move the implants to a pre-pectoral (over the muscle) plane, which physically separates the implant from the muscle's movement. If you are otherwise happy with the submuscular look and just want to minimize the shifting, this plan is a reasonable compromise, but if your primary goal is to stop the movement entirely, you should discuss a "plane change" to the pre-pectoral position with your surgeon.

Gianfranco Frojo, MD · Answer

Did you have a tuberous breast prior to surgery? It seems that you had a breast augmentation in the setting of a poorly treated tuberous breast deformity. I would recommend finding a legitimate American Board of Plastic Surgery certified plastic surgeon with extensive breast experience, ideally one who has also completed an endorsed Aesthetic Society fellowship.

Safa Sharabi, MD · Answer

Hi there,
I would suggest a plane change, especially if the animation deformity is what is bothering you the most. What I am seeing in your photos suggests that your muscle is pushing down on your implant causing it to shift downward. While gala flex will help support the implant and prevent the downward shift, it will not prevent the animation deformity from occurring, as your anatomy of your muscle and overlying breast tissue would be unchanged with this approach. I would suggest changing your implants to an above-the-muscle position, repairing your muscle, and possibly doing an internal breast lift to reposition your natural breast tissue over the implant. Happy to help however I can!
Sincerely,Dr. Safa Sharabi

Gary M. Horndeski, MD · Answer

You have 2 problems: you have your old inframammary fold, which is highly visible and the other is you have the animation deformity. Animation deformity is caused by capsular contracture. Unfortunately, you have not told us the size of your implants. However, larger implants are more likely to have animation deformity than smaller implants. Moving implants in front of the muscle will decrease the animation deformity but has a higher risk for capsular contracture. GalaFLEX will not solve your problem. The solution will be smaller implants in front of the muscle and you may need a breast lift.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Gerald Minniti, MD, FACS · Answer

No, that will not help at all. With advent of Motiva implants, you can safely have your implants removed, the pectoralis muscle repaired, and have new implants placed in the subfascial position, eliminating double bubble and dynamic implant deformation.

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. A more involved exam or more photos/videos would be required to get a better understanding of the issues at hand. However, the best fix to animation deformity, if that is indeed the problem, would be a pocket exchange from under to over the muscle. This could be combined with GalaFLEX for additional soft tissue support if needed. You likely also need some work on the pocket to optimize the implant position, and may also need some work on the skin and soft tissue envelope for best outcomes. 
Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Matthew S. Kilgo, MD · Answer

Hello and thank you for your question.

Animation deformity is  caused by pectoralis major contraction with implants in the sub muscular or dual plane position. It appears that you have window shading, at least on the right side, based on your first photograph. This is secondary to over release of the pectorals major muscle.

In my opinion, the only way to truly address this is a convert to either a sub glandular or a  sub facial plane. With his approach, there may be subtle movement of the implants with pectoralis activation, but it will be markedly reduced. Capsulorraphy with mesh reinforcement should be based on the presence of implant malposition and the need for soft tissue support. .

You should consult with a plastic surgeon certified by the American Board of Plastic Surgery with extensive experience in revision breast surgery.

Good luck. I hope this helps.

Harry T. Haramis, MD, FACS · Answer

You appear to also have double bubble or lowered fold plus animation deformity. Revision should address all of these issues.

You may wish to consider above the muscle which will alleviate animation deformity.

Then cover with mesh which will also reinforce restored breast fold (capsulorrhaphy).

Further discussion with your/a plastic surgeon is recommended to further discuss.

Johnny Chung, MD, FACS · Answer

Placement of the implant underneath the muscle will produce animation deformity. Performing a capsulorrhaphy , adding galaflex without plane change will not correct this . Only changing the plane of the implant placement will correct this deformity.

Will capsulorrhaphy + GalaFLEX fix animation deformity? (Photos)

Answers (11)

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