Problems with breast implants under the muscle are a significant concern for many individuals considering breast augmentation surgery. When discussing breast implant placement, submuscular positioning (under the pectoralis major muscle) is one of the most common choices made by patients and surgeons alike.
This technique involves placing the implant beneath the chest muscles, specifically under the pectoral muscle, rather than directly behind the breast tissue48. While this placement option offers several advantages, it’s crucial to understand the potential complications and challenges that may arise.
Introduction to Breast Implants Under the Muscle
The decision between submuscular (under the muscle) and subglandular (over the muscle) placement is one that requires careful consideration of your anatomy, lifestyle, and aesthetic goals. Submuscular placement is generally preferred by many patients as it provides greater coverage and can create a more natural appearance14. However, this positioning comes with its own set of unique challenges and potential problems that anyone considering breast augmentation should be aware of.
Problems with breast implants under the muscle can range from minor discomfort to serious complications requiring additional surgeries. Understanding these potential issues before undergoing surgery can help you make an informed decision and prepare for the recovery process. This comprehensive guide will explore the various complications associated with submuscular breast implants, providing you with essential information to discuss with your surgeon.
Common Complications of Submuscular Breast Implants
Problems with breast implants under the muscle can manifest in various ways, both immediately after surgery and in the long term. The FDA and medical literature have documented numerous complications associated with breast implants regardless of placement, but some are particularly relevant to submuscular positioning2.
One of the most distinctive complications of submuscular implant placement is animation deformity, also known as “dynamic breast deformity” or “jumping breast deformity.” This condition occurs when the pectoralis muscle contracts, causing the implant to displace, often in a superolateral direction. Studies have reported incidence rates as high as 76% following reconstruction3. This deformity not only affects the aesthetic appearance of the breast during movement but can also cause musculoskeletal discomfort along the pectoralis major and shoulder.
Other common complications include:
- Capsular contracture, where scar tissue forms around the implant and squeezes it, potentially causing pain, hardness, and visual distortion
- Implant malposition or displacement
- Changes in nipple and breast sensation
- Breast pain and discomfort
- Seroma (fluid collection) and hematoma (blood collection)
- Implant rupture or deflation
- Infection
For active individuals, problems with breast implants under the muscle can be particularly troublesome. Athletes or those who engage in weight-training or yoga may experience more noticeable animation deformities during physical activities3. This is an important consideration when deciding on implant placement, as your lifestyle may significantly impact your satisfaction with the results.
Animation Deformity: A Unique Challenge
Problems with breast implants under the muscle often include animation deformity, which deserves special attention as it’s exclusively associated with submuscular placement. This condition occurs when the pectoralis major muscle contracts during movement or exercise, causing the implant to visibly shift or the breast to appear distorted3.
Animation deformity can be particularly distressing because it affects the natural appearance of the breasts during everyday activities. Simple movements like reaching, stretching, or exercising can trigger noticeable breast distortion. The severity varies among patients, with some experiencing minimal movement while others face significant displacement that impacts their confidence and quality of life.
Medical professionals have developed various grading systems to assess the severity of animation deformity, with recent approaches quantifying it based on the degree of nipple displacement3. This helps surgeons better understand the extent of the problem and recommend appropriate solutions.
For patients experiencing severe animation deformity, treatment options include:
- Conversion from submuscular to prepectoral (above the muscle) placement
- Fat grafting to camouflage the deformity
- Botulinum toxin injection to temporarily paralyze the pectoral muscle
- Nerve ablation techniques
The literature consistently demonstrates that complete resolution of animation deformity symptoms, along with full recovery of pectoralis function, is most effectively achieved through prepectoral conversion and resuspension of the deep muscle surface to the anterior thoracic wall3. This highlights the importance of discussing this potential complication with your surgeon before deciding on implant placement.
Pain and Discomfort: Short and Long-term Issues
Problems with breast implants under the muscle frequently include various forms of pain and discomfort. In the immediate post-operative period, patients with submuscular implants typically experience more significant pain compared to those with over-the-muscle placement. This increased discomfort occurs because the surgery involves manipulating the pectoral muscle, which is used in many upper body movements12.
Short-term pain issues include:
- Post-surgical pain requiring medication management
- Muscle spasms as the pectoralis adjusts to the implant
- Restricted range of motion in the arms and shoulders
- Discomfort during initial healing that may last several weeks
Long-term pain problems with breast implants under the muscle can persist in some patients. These may include:
- Chronic discomfort during certain movements or activities
- Muscle aches that worsen with exercise or physical exertion
- Joint pain that some medical experts believe may be related to unusual autoimmune responses to the implants12
- Persistent tightness or pressure sensation in the chest
For some patients, these pain issues resolve as the body adapts to the implants. However, others may experience ongoing discomfort that significantly impacts their quality of life. In severe cases, removal or replacement of the implants, or conversion to over-the-muscle placement, may be necessary to alleviate chronic pain.
It’s worth noting that some patients report systemic symptoms such as fatigue, memory loss, rash, “brain fog,” and joint pain that may be associated with breast implants regardless of placement2. These symptoms, sometimes collectively referred to as “breast implant illness,” remain an area of ongoing research and discussion in the medical community.
Aesthetic Concerns and Appearance Issues
Problems with breast implants under the muscle can include various aesthetic concerns that affect the appearance of the breasts. While submuscular placement is often chosen for its ability to create a more natural-looking result, particularly in women with minimal natural breast tissue, it can still lead to appearance issues that patients should be aware of16.
One common aesthetic concern is the potential for a less defined upper pole of the breast. Because the muscle covers the top portion of the implant, there may be less projection in this area compared to over-the-muscle placement. This can be either an advantage or disadvantage depending on the desired outcome – some patients prefer this more subtle transition, while others desire more upper fullness.
Other aesthetic issues may include:
- Visible rippling or wrinkling of the implant, particularly in thin patients
- Double-bubble deformity, where the natural breast tissue and implant create separate contours
- Symmastia, or “uniboob,” where the implants appear to merge in the middle of the chest
- Bottoming out, where the implant descends below the inframammary fold
- Lateral displacement, where the implants move toward the sides of the chest
Problems with breast implants under the muscle may also include changes in appearance during muscle contraction. As mentioned earlier, animation deformity can cause visible distortion of the breast shape during certain movements. This can be particularly noticeable when performing exercises that engage the pectoral muscles or even during everyday activities like reaching or lifting3.
For patients considering breast augmentation, it’s important to discuss these potential aesthetic concerns with your surgeon and view before-and-after photos of their previous patients with similar body types. This can help set realistic expectations about the final appearance of submuscular implants.
Table: Comparing Under vs. Over Muscle Placement
| Aspect | Under Muscle (Submuscular) | Over Muscle (Subglandular) |
|---|---|---|
| Natural Look | More natural appearance, especially with minimal breast tissue | May look less natural in women with minimal breast tissue |
| Implant Visibility | Less visible implant edges and rippling | More visible edges and potential rippling |
| Mammography | Less interference with mammogram imaging | May interfere more with mammogram imaging |
| Pain Level | More painful recovery | Less painful recovery |
| Animation Deformity | Risk of visible movement during muscle contraction | No risk of animation deformity |
| Capsular Contracture | Lower risk in primary augmentation | Higher risk in primary augmentation |
| Suitable For | Thin patients with minimal breast tissue | Patients with adequate breast tissue coverage |
| Impact on Exercise | May affect chest exercises and physical activities | Less impact on physical activities |
| Recovery Time | Longer recovery period | Shorter recovery period |
Long-term Complications and Revision Surgery
Problems with breast implants under the muscle can develop or persist long after the initial surgery, potentially necessitating revision procedures. Understanding these long-term complications is crucial for anyone considering submuscular implant placement9.
Capsular contracture remains one of the most common long-term complications of breast implants regardless of placement, though some studies suggest submuscular placement may have a lower incidence rate in primary augmentations7. This condition involves the hardening of scar tissue around the implant, which can cause pain, distortion, and firmness of the breast. Severe cases often require surgical intervention to remove the hardened capsule and possibly replace the implant.
Other long-term complications that may necessitate revision surgery include:
- Implant malposition, where the implant shifts from its original position
- Implant rupture or deflation, requiring removal and replacement
- Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL), a rare type of non-Hodgkin’s lymphoma
- Reports of Squamous Cell Carcinoma (SCC) and other rare conditions2
- Chronic pain or discomfort that doesn’t resolve with time
- Persistent animation deformity that affects quality of life
For patients experiencing significant problems with breast implants under the muscle, conversion to prepectoral (over the muscle) placement has become an increasingly popular solution. Recent advances in surgical techniques and implant technology have made this conversion more successful than in the past19. The procedure involves removing the implants from the submuscular pocket, releasing the pectoral muscle, and creating a new pocket above the muscle for implant placement.
It’s important to note that all breast implants, regardless of type or placement, are not considered lifetime devices. Most patients will require additional surgeries at some point, whether due to complications or simply to replace aging implants. The FDA recommends regular monitoring of breast implants through appropriate imaging methods to detect silent ruptures and other issues2.
Impact on Physical Activity and Lifestyle
Problems with breast implants under the muscle can significantly impact physical activity and lifestyle, particularly for active individuals. The pectoralis major muscle plays a crucial role in many upper body movements and exercises, and having an implant beneath this muscle can affect both comfort and performance during certain activities3.
For athletes, fitness enthusiasts, and those who engage in regular upper body training, submuscular implants may present several challenges:
- Discomfort or pain during chest exercises like push-ups, bench presses, or swimming
- Visible breast distortion during activities that engage the pectoral muscles
- Potential limitation in strength or range of motion
- Psychological impact of visible animation deformity during exercise
Problems with breast implants under the muscle are particularly relevant for women who participate in bodybuilding or competitive fitness, as the animation deformity can be more pronounced with developed pectoral muscles. For these individuals, over-the-muscle placement might be a more suitable option, despite other potential drawbacks3.
It’s worth noting that many women with submuscular implants adapt to these changes and continue their active lifestyles with minimal issues. However, for those experiencing significant problems, solutions may include:
- Modifying exercise routines to reduce pectoral muscle engagement
- Considering conversion to over-the-muscle placement if symptoms are severe
- Working with physical therapists specialized in post-breast augmentation rehabilitation
- Using supportive sports bras designed for implants during high-impact activities
When consulting with your surgeon about implant placement, it’s essential to discuss your lifestyle, exercise habits, and athletic goals to determine the most appropriate option for your specific needs.
FAQ Section: Problems with Breast Implants Under the Muscle
What is the most common problem with breast implants under the muscle?
Animation deformity is one of the most distinctive problems with breast implants under the muscle, with incidence reported as high as 76% following reconstruction. This occurs when the pectoral muscle contracts, causing the implant to visibly shift or the breast to appear distorted during movement3.
How painful is recovery from submuscular breast implant surgery?
Recovery from submuscular implant placement is typically more painful than over-the-muscle placement because it involves manipulation of the chest muscle. Most patients experience significant discomfort for the first few days, with improvement over the first two weeks12.
Can problems with breast implants under the muscle resolve on their own?
Some issues like initial pain and muscle tightness typically improve as your body heals and adapts to the implants. However, complications like animation deformity, capsular contracture, or implant malposition usually require medical intervention and don’t resolve spontaneously3.
Is it possible to convert from under-the-muscle to over-the-muscle placement?
Yes, conversion from submuscular to prepectoral (over the muscle) placement is possible and has become an increasingly common solution for patients experiencing significant problems with breast implants under the muscle. Recent surgical advances have made this conversion more successful than in the past19.
Do breast implants under the muscle affect mammogram accuracy?
Submuscular implant placement generally interferes less with mammography compared to over-the-muscle placement. However, special displacement techniques are still required to visualize all breast tissue properly during screening13.
How long do submuscular breast implants typically last?
Breast implants, regardless of placement, are not lifetime devices. Most patients will require additional surgeries at some point, whether due to complications or to replace aging implants. Regular monitoring is recommended to detect any issues2.
Conclusion: Making an Informed Decision
Problems with breast implants under the muscle are important considerations for anyone contemplating breast augmentation surgery. While submuscular placement offers certain advantages like a more natural appearance and reduced risk of visible rippling, it also comes with unique challenges including animation deformity, increased post-operative pain, and potential impact on physical activities.
The decision between under-the-muscle and over-the-muscle placement should be made after thorough consultation with a qualified plastic surgeon who can assess your individual anatomy, discuss your aesthetic goals, and consider your lifestyle factors. What works best for one patient may not be ideal for another, making personalized advice crucial.
If you’re experiencing problems with breast implants under the muscle, know that solutions exist, from conservative management approaches to surgical interventions including conversion to over-the-muscle placement. Advances in surgical techniques and implant technology continue to improve outcomes for patients seeking resolution of these issues.
Problems with breast implants under the muscle should be weighed carefully against the benefits when making your decision. By understanding the potential complications and maintaining realistic expectations, you can approach breast augmentation with confidence and preparedness for the journey ahead.
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