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Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1472–1475 | Cite as

Treatment of Breast Animation Deformity in Implant-Based Reconstruction with Selective Nerve Ablation

  • Dustin L. Eck
  • David C. Nguyen
  • Laura L. Barnes
  • David A. Jansen
Innovative Techniques Breast Surgery

Abstract

Breast animation deformity is a known complication of subpectoral implant placement that is usually corrected by repositioning the implant to the prepectoral position. Other less common treatment options include performing the muscle splitting biplanar technique, triple plane technique, neuromodulator injections, and secondary neurotomies via transection of the pectoral muscle. We report a patient with animation deformity successfully treated with direct identification and ablation of the medial and lateral pectoral nerves using selective bipolar electrocautery. The patient is a woman with a history of invasive ductal carcinoma who underwent bilateral mastectomy and breast reconstruction with subpectoral implant placement and autologous fat grafting. Within 1 year of her breast reconstruction, she developed hyperactive pectoralis muscle contraction with resulting distortion of both breasts. Given the disadvantages of repositioning the implant to the prepectoral position and transecting the pectoralis muscles via secondary neurotomy, we chose to directly identify and selectively ablate distal branches of the medial and lateral pectoral nerves. This offers a novel technique for correcting breast animation deformity without transecting the pectoralis muscles, causing muscle atrophy, and preserving the subpectoral implant position.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266.

Keywords

Breast animation deformity Implant-based reconstruction Selective nerve ablation Subpectoral breast reconstruction Subpectoral implant distortion Muscular contraction deformities 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest

References

  1. 1.
    Hammond DC, Schmitt WP, O’Connor EA (2015) Treatment of breast animation deformity in implant-based reconstruction with pocket change to the subcutaneous position. Plast Reconstr Surg 135(6):1540–1544CrossRefPubMedGoogle Scholar
  2. 2.
    Maxwell GP, Tornambe R (1988) Management of mammary subpectoral implant distortion. Clin Plast Surg 15(4):601–611PubMedGoogle Scholar
  3. 3.
    Becker H, Fregosi N (2017) The impact of animation deformity on quality of life in post-mastectomy reconstruction patients. Aesthet Surg J 37(5):531–536CrossRefPubMedGoogle Scholar
  4. 4.
    Khan U (2009) Dynamic breasts: a common complication following partial submuscular augmentation and its correction using the muscle-splitting biplane technique. Aesthet Plast Surg 33(3):353–360CrossRefGoogle Scholar
  5. 5.
    Bracaglia R, Tambasco D, Gentileschi S, D’Ettorre M (2013) Triple-plane technique for breast augmentation: solving animation deformities. Aesthet Plast Surg 37(4):715–718CrossRefGoogle Scholar
  6. 6.
    Figus A, Mazzocchi M, Dessy LA, Curinga G, Scuderi N (2009) Treatment of muscular contraction deformities with botulinum toxin type a after latissimus dorsi flap and subpectoral implant breast reconstruction. J Plast Reconstr Aesthet Surg 62(7):869–875CrossRefPubMedGoogle Scholar
  7. 7.
    Gray H (1985) 6b-The anterior divisions. In: Clemente CD (ed) Anatomy of the human body, 30th edn. Lea & Febiger, PhiladelphiaGoogle Scholar
  8. 8.
    Hoffman GW, Elliott LF (1987) The anatomy of the pectoral nerves and its significance to the general and plastic surgeon. Ann Surg 205(5):504–506CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Gabriel A, Sigalove S, Sigalove NM, Storm-Dickerson TL, Rice J, Pope N, Maxwell GP (2018) Prepectoral revision breast reconstruction for treatment of implant-associated animation deformity: a review of 102 reconstructions. Aesthet Surg J. 38:519–526CrossRefPubMedGoogle Scholar
  10. 10.
    Govshievich A, Kirkham K, Brull R, Brown M (2015) Novel approach to intractable pectoralis major muscle spasms following submuscular expander-implant breast reconstruction. Plast Surg Case Stud 1(3):68–70CrossRefGoogle Scholar
  11. 11.
    Bernini M, Casella D, Mariotti C (2017) Selective pectoralis major muscle denervation in breast reconstruction: a technical modification for more effective and cosmetic results. Gland Surg 6(6):745–750CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Vidya R, Tafazal H, Salem F, Iqbal FM, Sircar T (2018) Management based on grading of animation deformity following implant-based subpectoral breast reconstruction. Arch Plast Surg 45(2):185–190CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Dustin L. Eck
    • 1
  • David C. Nguyen
    • 1
  • Laura L. Barnes
    • 1
  • David A. Jansen
    • 1
  1. 1.Division of Plastic and Reconstructive SurgeryTulane University Health Sciences CenterNew OrleansUSA

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