I got silicone 500cc implant 11 months ago, through the areola, under the muscle (because I was told that was the best way to go) so more and more this is bothering me. Its only when I flex I get an indentation across each breast, I can feel it kindof pulling. they have always been a bit lower than I had hoped. Please tell me whats wrong. I did not lift weights I followed all directions what is wrong with me?? were my muscles cut wrong or did my body heal wrong
What is Wrong with my Implants?
Doctor Answers 13
Breast implants underneath the muscle cause distortion on flexing
When breast implants are placed underneath the chest muscle(pectoralis major), on flexing the muscles, you will see an indentation across the chest. When you do not have implants, you can flex(like in curling weights) and see how the muscle distorts the breasts. This is accentuated when the implant is placed in this position.
If any of you watched the recent Oscar program and saw Jennifer Hudson,who looked fantastic after her tremendous weight loss, you may have noticed when she was talking and moving her arms, that between her breasts there was movement. This was more than likely as a result of breast implants being placed underneath the pectoralis muscle!
Many years ago, when silicone implants had a great incidence of becoming hard, I and most plastic surgeons placed them in that position. Now, I rarely place silicone implants there because the newer implants have less of a tendancy to capsular contracture in my practice and the contracture/distortion is definitely bothersome to some patients. Also, after years, the breast tissue "falls over" the breast implant subpectoral mound, which are "held up" by the muscle, and further visible distortion usually occurs. This can usually be corrected and improved but requires a revisional surgery.
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Implant distortion from the pectoralis muscle.
What you are experiencing is very common in sub-muscular implants. When the implant is placed under the muscle, the capsule (scar) which forms is adherent to the muscle. When you flex that muscle, you can often see the implant rise up, a transverse or oblique ridge develop, and a distortion of the implant occur. There are several methods to treat this distortion. The simplest is to change the placement of the implant from under the muscle to on top of the muscle. Women sometimes have distortion with on-top placement but it is much less common. The second option is to use an acellular dermal matrix such as Strattice to secure the lower edge of the pectoralis muscle down to the chest wall. This effectively prevents the muscle from "clotheslining" the implant and significantly improves the line that you see with flexion of the muscle. Given your photos, it appears as though you would be a good candidate for either technique.
Animation Deformities with Breast Implants Placed Under the Muscle: Expected or Extreme
Movement of the breast implant with muscle contraction is expected with an implant placed under the muscle. This is very commonly worse on one side, depending on muscle anatomy. Incomplete or over dissection of the pectoral muscle can cause predictable implant movements which are sometimes called animation deformities. It seems like you have window shading of your pectoralis muscle over a low riding implant, unlikely from over release considering it happens on both sides. Treatment options would include placing the implant over the muscle or utilization of acellular dermal matrix to prevent deformity of the muscle.
I hope this helps.
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Implant Distortion With Movement
The problem you are having on the left breast is that your pectoralis major muscle is contracting and distorting the implant. This can be repaired in a revision surgery which releases the pectoralis muscle along the bottom to where it attaches to your breast bone so that it cannot distort the implant like it is doing. This is a simple outpatient surgery and will make a big difference for you. Good luck!
Distortion with subglangular implants
Your photos show a good result with implants in the appropriate position. All patients will have a degree of breast distortion during activities which produce contraction of the pectoralis muscle. Obviously, this is more prominent on the left.This could also represent "windowshading " of the left pectoralis muscle, characterized by a higher position of this muscle subsequent to the surgery. Three options exist. One, leaving them alone. Two, changing the plane to the subglangular position, and three,revising the left side using a dermal matrix such as alloderm to help resecure the muscle to a lower level.This last option is obviously the more costly and complex.Replacing the implants in the subglandular plane means another surgery and also has some drawbacks.Unless this is really bothering you it may be best to leave things alone
I do not agree that moving to over the muscle is your best solution
I agree with the other Surgeons in that you do have "Animation deformity", and that the best way to correct it is to move your implants from under your muscle to above your muscle. But! I do not agree that this is the right thing to do. You ask what is wrong with you and your breasts. Nothing is wrong with you or your implants. Yes they do look funny when you flex and yes moving them to above your muscle will likely correct this, but there are many benefits to being under the muscle, especially capsular contracture. When this occurs,it is a "constant deformity", not just when flexing your muscle. You have a beautiful result as they are. I would recommend leaving your implants where they are and just avoiding flexing your muscle in public.
To correct this you will revision
Breast implant movement with muscle contraction
Breast implants can move with muscle contraction when placed in a subpectoral location, this does not necessarily mean anything went wrong with your surgery. If this really concerns you, you can have the implants placed into a subglandular (on top of or in front of the muscle). This is the only definitive way to prevent this movement of the breast implants.
What is Wrong with my Implants?
Thanks for the posted photos. This is a very common result with submuscular placement of implants. The indentation is the perpendicular forces of the pectoralis muscle fibers causing the folding upon contraction. The only way to correct is further surgery. From MIAMI