Introduction: Breast distortion during pectoralis muscle contraction following subpectoral breast augmentation is a known entity, however, its prevalence and significance are unclear in the literature. While there are a number of  techniques that have been described to correct muscle-related implant distortion, a comprehensive review of this issue has not been done. While undoubtedly there are patients where distortion may be clinically significant, it is not clear how much this distortion bothers most patients. The purpose of this study is to propose a classification system for breast distortion, objectively measure distortion in an unselected consecutive group of patients, and quantify its significance on patient satisfaction.

Method: The first portion of this study involves proposing a four-point classification system for breast distortion. Twenty consecutive primary subpectoral breast augmentations performed by a single surgeon were evaluated by 9 plastic surgery residents with photos of the patients at rest and with pectoralis muscles aggressively contracted.

The second part of this study involves an IRB-approved questionnaire that was mailed out to 200 consecutive patients who underwent primary subpectoral breast augmentation by a single surgeon beginning in January 2000. All augmentations were performed using the dual-plane technique.  The questionnaire focused on the possible adverse effects of muscle-related breast distortion and patient satisfaction with the results.

Results: Out of the twenty patient photographs that were evaluated by plastic surgery residents, 75% were scored as having none to minimal distortion. 10% were rated as having severe distortion.

Out of the 200 questionnaires there were 63 responses (32%). 79% of patients felt their distortion was none to mild, while 8% reported having severe distortion. However, only 1 patient reported being unsatisfied and 2 patients said they would not recommend subpectoral implants. The most common complaint was distortion related to lifting weights with 24% of patients reporting this as a problem.

Conclusion: As a result of this study, surgeons and patients should have accurate and reliable information regarding both the objective effect and subjective patient response to muscle-related distortion after subpectoral breast augmentation. While breast distortion can be significant, most patients remain satisfied with their results.  The technique of dual-plane subpectoral breast augmentation will be briefly presented.