In most breast implant reconstruction surgeries, the plastic surgeon places the implants under the chest muscle (pectoralis muscle). This is known as “subpectoral implant placement.” Since breast tissue was removed during the mastectomy, the skin is now in contact with the underlying pectoralis muscle. As the tissues heal, the skin tends to stick to the pectoralis muscle. When you flex your pectoralis muscle, your breasts may move in unnatural looking ways. For example, they may appear to pop upward and outward or to shift down. Plastic surgeons call this problem “dynamic distortion” or “animation deformity.”
If dynamic distortion is making you feel self-conscious or causing you pain, there are two main surgical approaches that can correct it:
You may be able to have your implants placed on top of the pectoralis muscle and directly under the skin — switching from a “subpectoral” to a “prepectoral” implant placement.
During this surgery, your plastic surgeon will remove your existing implants from behind the pectoralis muscle and suture the pectoralis muscle back to the chest wall. Next, your surgeon will create new pockets of tissue on top of the pectoralis muscle and place new implants in the pockets. They will be wrapped in a dermal matrix material (a skin substitute made mostly of collagen), which provides an extra layer of soft tissue between the implant and the skin.
This surgical approach will stop the dynamic distortion, but it has a couple of potential drawbacks. Since the implants will not be covered by as much tissue, there is a risk that implant rippling and wrinkling will be visible through the skin. If your skin is thin, you might also be at risk over the long-term for implant positioning problems.
Your surgeon may recommend one to three fat grafting (or “fat injection”) treatments sometime after the surgery to help thicken the soft tissue layer over the implant. Fat grafting involves removing fat tissue from another part of your body, such as your thighs or belly, by liposuction. Then the tissue is processed into liquid and injected into the breast area.
Autologous or “flap” reconstruction
Another option may be to have your plastic surgeon remove your breast implants and replace them with transplanted flaps of tissue from another place on your body. This is called “autologous reconstruction” or “flap reconstruction.” A tissue flap will provide a layer of living fat between the skin and the pectoralis muscle, eliminating dynamic distortion.
Flap reconstruction is a more complex and time-consuming surgery than implant reconstruction. But an advantage of flap reconstruction is that, if it’s done well, you may not need additional surgeries in the future. Implants are more prone to develop problems that require additional surgeries.
Learn more about autologous reconstruction.