Purpose: Controversy exists over the concepts of implant placement and augmentation mammoplasty. Proponents give good reasons for subpectoral versus subglandular implant placement, with the tendency towards the subpectoral placement in the United States. Informal surveys of plastic surgeons done by the senior author indicate a 50/50 preference, both in Central and South America, and Europe.

Difficulties arise with subpectoral placement of the implant including: malpositioning of the implant, improper superior contouring, inappropriate and unnatural movement with range of motion, and capsular contraction. We have found that correction of these above deformities are relatively easily maintained by removal of the subpectoral implant, reconstruction of the pectoralis major muscle back down to the chest wall, and reaugmentation with the implant in the subglandular space. This study will define a correction modality for the adverse results of subpectoral implant placement in augmentation mammoplasty.

Methods: Pectoralis major reconstruction was performed in 36 patients undergoing revision aesthetic breast surgery from 1995 to 2006. All patients had subpectoral breast implants with unwanted movement, malposition, and/ or capsular contraction. Explantation of the implants with modified capsulectomy and pectoralis major reconstruction was performed. The inferior and medial aspects of the pectoralis major muscle were sutured back down to the chest wall, and reaugmentation of the breast was done with implants placed in the subglandular position. Patients were evaluated for resolution of symptoms, satisfaction and complications.

Results: Thirty-six patients underwent successful reconstruction of the pectoralis major during revision aesthetic breast surgery with an average follow-up of one year. Malpostion (62%), capsular contraction (53%), unwanted movement (33%), and symmastia (10%) were the most common indications for revision. Unwanted implant movement was completely eliminated (100%), symmastia was corrected (100%), and capsular contracture was significantly decreased in each respective group. All patients were satisfied post-operatively.

Conclusion: Pectoralis major reconstruction can be successfully performed in aesthetic breast surgery. It can be safely applied to correct problems of unwanted implant movement, symmastia implant malposition, and capsular contraction.
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