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

Abstract

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