In submuscular breast augmentation, the implant is placed under the pectoralis major muscle. This muscle begins with attachments along the sternum and on your ribs and then it fans across your chest, inserting onto the humerus bone. If you flex your arms like you are doing a fly, you can feel the edge of the muscle near your armpit. The lower, outer half of the breast implant is covered by the muscle, not the whole implant.
Causes of Pectoralis Muscle Detachment
Breast implant placement below the pectoral muscle requires partial detachment of the muscle, which is usually limited to a specific part of the muscle. However, excessive detachment can contribute to complications like symmastia or skin dimpling upon muscle contraction. In most cases, your plastic surgeon will release the muscle where it attaches to the ribs. If this is not done, the tight attachment to the ribs will prevent the breast implant from sitting low enough; it will be pushed up too high, towards your clavicle. Most of the attachments along the sternum are left in place.
After breast augmentation, there may be some atrophy of the muscle; the part of the muscle that is released from the ribs will not work like it did prior, and the muscle in that area will lose bulk. The upper part of the muscle is not affected as much because its attachments are not changed.
If the implant is removed, the situation remains unchanged. It is almost impossible to reattach the muscle and we do not try to do this. In my experience, patients do not report any significant weakness, etc. However, the situation is different for body builders, who want to demonstrate the definition of the entire muscle in their competition. These patients represent a significant challenge as they do not want the muscle changes and yet they have very little breast tissue to cover an implant if it is placed on top of the muscle.
Correcting Complications of Pectoralis Muscle Detachment
Correction of a complication caused by pectoralis muscle detachment requires experience in plastic surgery techniques that relocate or improve the shape of the breast implant pocket. Dr. Pfeifer might recommend moving the implant from below the muscle to a new location above the muscle. A frequently used technique by Dr. Pfeifer is the "neo-subpectoral" which is essentially a new subpectoral breast implant pocket.
In cases of Symmastia, the muscle and tissue must be reattached to the breastbone, while sutures are placed to hold the implants and new breast pockets in place. The correction may also involve replacement of the breast implants with a smaller size. Breast crease and areolar incisions are typically used for this type of revision breast surgery. Because these are typically used for the initial breast augmentation, scarring can be kept to a minimum. Depending on how extensive your breast augmentation revision, you may need anywhere from a few days to a few weeks to recover.
If you believe that you are negatively affected by pectoralis muscle detachment, we encourage you to contact plastic surgeon Tracy Pfeifer in New York to discuss treatment options. During a surgical consultation, you can discuss the revision procedures that may address this complication. We have offices in Manhattan, Great Neck and the Hamptons. Call 631-653-6112 to schedule an appointment.