A Definitive Solution to Animation Deformity: Sub-Pectoral to Pre-Pectoral Conversion

Background: A significant disadvantage of sub-pectoral breast reconstruction procedures is animation deformity during pectoralis major contraction. The prevalence of this post-operative complication may be as high as 75.6%.¹ Many authors have explored solutions to animation deformity associated with breast reconstruction and augmentation including muscle splitting² and botulinum toxin injection into the pectoralis major.³ These options, however, increase muscle morbidity or are temporary interventions. With the advent of intraoperative angiography and Alloderm, implant placement in the anatomic pre-pectoral position has become a safe alternative to sub-pectoral breast reconstruction.⁴ In this study, we discuss one surgeon’s experience with elective sub-pectoral to pre-pectoral implant site conversion as a definitive solution to animation deformity.

Methods: Authors performed a retrospective review of patients with a history of a sub-pectoral breast reconstruction procedure who underwent implant site conversion to the pre-pectoral plane. Procedures were performed to alleviate chronic pain or animation deformity. All procedures were performed by a single surgeon. Implants placed in the pre-pectoral plane were supported with total anterior AlloDerm coverage.

Results: 90 patients underwent 142 revision procedures to change implant sites from years 2014­ to 2018. Average follow­up period for the study group was 1.5 years (maximum follow­up time, 3.6 years). Mean patient age was 54.8 years and average BMI was 27.7. History of smoking was present in 60.0% of patients, with 8.9% of patients being current smokers. 14.8% of patients had a history of pre­operative radiation. Post­operative complications included minor supero­medial contour deformity or implant edge visibility (28.9%), minor rippling (4.9%), infection requiring oral antibiotics (3.5%), minor seroma requiring needle aspiration in the clinic (1.4%), seroma requiring drain replacement (0.7%), hematoma (0.7%), dehiscence (0.7%), partial thickness necrosis requiring local wound care (0.7%), and one infection requiring IV antibiotics with eventual explantation (0.7%). 18.3% of patients received a secondary fat grafting procedure for rippling or implant edge visibility. There was no incidence of capsular contracture. Animation deformity was completely resolved.

Conclusions: Breast implant site conversion from the sub-pectoral to the pre-pectoral plane is a safe and definitive solution for animation deformity.

References

1. Nigro LC, Blanchet NP. Animation Deformity in Postmastectomy Implant-Based Reconstruction. Plast Reconstr Surg Glob Open. 2017;5(7):e1407.
2. Baxter RA. Update on the split-muscle technique for breast augmentation: prevention and correction of animation distortion and double-bubble deformity. Aesthetic Plast Surg. 2011;35(3):426-9.
3. Richards A, Ritz M, Donahoe S, Southwick G. Botox for contraction of pectoral muscles. Plast Reconstr Surg. 2001;108(1):270-1.
4. Nahabedian MY, Glasberg SB, Maxwell GP. Introduction to "Prepectoral Breast Reconstruction". Plast Reconstr Surg. 2017;140(6S Prepectoral Breast Reconstruction):4S-5S.