Patients who are thin, athletic, and small-breasted are susceptible to breast implant rippling and palpability. To compensate for the lack of “coverage,” the prostheses are typically positioned underneath the thick pec muscle rather than above it, a technique called submuscular or unders.
But for these patients, muscle flex deformity is almost always expected and predictable, although once the chest muscle is relaxed the distortion immediately resolves on its own.
One way to avoid muscle flex deformity is to position the implants above the pec muscle, a technique called subglandular or overs. However, this is not a viable solution for small-breasted and thin patients who are at significant risk to implant rippling and scalloping, which is deemed more problematic.
If the degree of muscle flex deformity is minimal and it does not bother the patient, a revision surgery is unwarranted. More often than not, this is the case for the vast majority of women who had breast augmentation, a procedure that resulted in up to 98 percent satisfaction rate according to a recent study.
But for women with an overdeveloped pec muscle—i.e., bodybuilders and professional athletes—the degree of muscle flex deformity tends to be problematic. Nevertheless, using the subglandular implant placement is not a good alternative because of the rippling and palpability issue.
If the muscle flex deformity is severe, there are two options to correct it without resorting to the subglandular implant placement. The first approach uses an acellular dermal matrix or ADM, which is a soft tissue replacement.
The idea behind the use of ADM is to “thicken” the tissue especially at the lower poles of the breasts where muscle flex deformity occurs. This treatment is also applicable to various reconstructive and cosmetic plastic surgeries, explains Dr. Smaili.
Another possible treatment for muscle flex deformity is the subfascial implant placement. Instead of using the entire muscle to cover the implant, the thin but strong fascia on top of the muscle is lifted and used to support the prosthesis, according to the leading breast surgery Orange County.
Advocates of this implant placement suggest that it combines the benefits of both the submuscular (good support to reduce palpability and rippling) and subglandular (without the breast animation).