Introduction

Breast distortion during pectoralis muscle contraction following subpectoral breast augmentation remains an uncertain entity and its prevalence and significance are unclear in the literature. While there are a number of dubious 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 classifying breast distortion on a four-point scale: 1—no significant visible change with muscle activity, 2—minimal visible change (some distortion along the lower half of the breast), 3—moderate visible change (overall breast distortion visible with possible implant displacement), and 4—severe visible change (disfiguring change to the entire breast). Twenty consecutive primary subpectoral breast augmentations were evaluated by 9 plastic surgery residents. Patients were shown both at rest and with pectoralis muscles aggressively contracted. Results were tabulated for each patient. All procedures were performed by the same surgeon using the previously described and published dual-plane technique.

The second part of this study is a patient survey. An IRB-approved questionnaire was mailed out to 200 consecutive patients who underwent primary subpectoral breast augmentation beginning in January 2000. 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, a majority (65%) were scored as having minimal distortion while 10% revealed no distortion. 15% of patients were rated as moderate distortion and the most severe distortion was present in 10% of the study patients. Results of the questionnaires that were mailed out to 200 patients are being collected and will be presented.

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.