What submuscular incision causes more animation deformity?

Animation deformity is not a function of incision but rather a function of plane of dissection/implant placement.

Animation is a consequence of muscle activity overlying the implant. If the implant is behind the muscle regardless of whether it is split, released, or left intact, there will be some measure of animation. The movement of of the implant is caused by the movement of the overlying muscle.

If animation is a major concern, subglandular augmention may be preferred.

As always, discuss you concerns with a board certified plastic surgeon (ABPS).

Dear LexieCooper,

I tend to prefer the periareolar incision because its the most well hidden. There is a natural border between the areola and the rest of the breast skin the hides the incision extremely well. You have to be completely naked to see it vs other incisions like transaxillary and inframammary are visible in clothing such as sleeveless shirts and bikini tops when extending your arms up. I've also noticed increased rates of bottoming out with inframmary incisions that is not reported. Transaxillary implants are always wide in appearance because the surgeon is not able to dissect medially enough to provide better cleavage. Ultimately, I can perform any of the incisions but I recommend the periareolar. There is no difference in sensation because the nerves that control nipple sensation come in laterally from the back and injury to them occurs when surgeons dissect to far laterally which is why transaxillary incisions have the highest nipple sensation disruption. There is no difference in breast feeding ability. One study did show a slight increase in capsular contracture with use of periareolar but that study was small and did not incorporate modern techniques such as below muscle placement, keller funnel usage and triple antibiotic irrigation.

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

This is an important question and there is a specific technique called the split muscle that provides muscle coverage with minimal animation. Unlike the dual plane approach, the split muscle does not require detachment of the muscle. Animation deformity can be corrected by converting from the plane to split muscle and re-attaching the muscle. Another option that is sometimes considered is to go in front of the muscle using the subfascial plane.

I prefer inframammary incision. I have seen patients who had periareolar incision and the incision puckers or dents with muscle for ion

Animation deformity in breast augmentation usually comes down to how the implant sits under the pectoralis major muscle, not the type of incision. When implants are placed partially or fully under the muscle, normal muscle movement—like when you exercise—can cause the implant to shift or temporarily distort, which is what we call animation deformity. While the incision itself (inframammary, periareolar, or transaxillary) doesn’t directly cause this, certain combinations, such as periareolar or axillary incisions with dual-plane submuscular placement, can make the movement a bit more noticeable since the muscle pulls on the top of the implant.

The good news is that animation deformity can often be minimized with thoughtful surgical planning. For example, partial submuscular or dual-plane placement lets the lower part of the implant sit under breast tissue rather than muscle, reducing distortion when the muscle contracts. Surgeons may also perform a careful release of the muscle’s lower attachments so the implant rests naturally while limiting muscle pull. In some cases, placing the implant above the muscle but under the fascia or breast tissue—known as subfascial or prepectoral placement—can completely avoid animation deformity.

Other factors that affect animation include implant size, profile, and your individual anatomy. Patients with thinner tissue or more active muscles are more likely to notice animation, and larger or high-profile implants can make it more pronounced. Choosing an implant that fits your chest and body type helps reduce the effect.

Ultimately, implant placement, muscle technique, and your unique anatomy all influence how much animation you might see. That’s why having a detailed conversation with an experienced, board-certified plastic surgeon during your consultation is so important—they can guide you toward the best approach for natural-looking, long-lasting results.

Placing the implant behind the muscle will cause animation when the muscle is tensed. The lowest fibers of the muscle that attach to your sternum can be partially cut to help decrease this movement.