When a breast implant has been positioned beneath the pectoralis major muscle, removing it involves more than taking out the implant. The muscle has been lifted, partly released, and held in a stretched position for as long as the implant has been in place. How it settles afterwards is one of the more common questions patients raise when considering implant removal, and it is one that depends heavily on where the implant was originally placed.
Where Breast Implants Sit in Relation to the Pectoral Muscle
There are three broad positions used in breast augmentation, and each has different implications for the muscle when the implant is later removed.
Subglandular. The implant sits in front of the pectoralis major, directly behind the breast tissue. The muscle is not disturbed during the original operation, so removal has little direct effect on it.
Subfascial. The implant sits in front of the muscle but behind the thin fascial layer covering it. Again, the muscle itself is largely undisturbed.
Subpectoral or dual plane. The implant sits partly or wholly behind the pectoralis major. To create this pocket, the lower attachments of the muscle along the ribs are released. This is the position most relevant to questions about muscle change after removal, and it is a common position in Australian practice.
If you are unsure which position was used, your original operation report will state it. Where that is not available, it can often be inferred at examination, and this forms part of the pre-operative assessment.
What Happens to the Muscle When a Subpectoral Implant Is Removed
Once the implant is removed, the muscle is no longer held forward and stretched over a device. It retracts towards the chest wall and, over time, re-adheres to the tissue beneath it. This process is gradual and continues well beyond the point at which the wounds have healed.
Because the lower muscle attachments were divided at the original augmentation, the muscle does not reattach exactly where it started. The lower border generally sits slightly higher than its original position. In some patients this is not apparent. In others it produces a visible change in the upper chest contour, particularly on movement.
There is also a period during which the muscle is thinner and less well defined than it was before. Muscle that has been held under tension over a device for a prolonged period can show some degree of thinning, and this can take time to recover once normal loading resumes.
Animation Deformity and Why It Occurs
Animation deformity describes visible distortion of the breast or chest when the pectoral muscle contracts. It occurs with subpectoral implants because the contracting muscle moves across the implant beneath it, and it is one of the reasons some patients consider changing implant position or removing implants altogether.
After removal, animation deformity related to the implant itself resolves, since there is no longer a device for the muscle to move over. What can remain is a degree of contour irregularity on contraction, related to how the released muscle has re-adhered and to any adherence between the muscle and the overlying breast tissue or skin. This is generally less pronounced than animation deformity with an implant in place, and it often becomes less noticeable over the first year.
The Chest Wall Over the First Twelve Months
The appearance immediately after implant removal is not the final result, and the difference between the two can be substantial. Understanding the general sequence helps set realistic expectations.
In the first few weeks, swelling and firmness are usual, and the chest may feel tight. Between roughly six weeks and three months, swelling settles significantly and the muscle begins to re-adhere. From three to six months, the soft tissue contour becomes more settled and any skin redundancy becomes more clearly apparent as swelling resolves. Beyond six months and out to around twelve months, scars soften, muscle definition improves with normal activity, and the shape stabilises.
Assessment of the final result, and any discussion about whether further surgery might be considered, is generally deferred until at least six to twelve months have passed.
Factors That Influence the Final Appearance
Outcomes after implant removal vary widely, and several factors contribute.
- How long the implant was in place, which affects the degree of tissue and muscle adaptation
- The size of the implant relative to the chest, since larger implants stretch tissue further
- How much of the muscle was released at the original augmentation
- The volume and quality of remaining breast tissue
- Skin elasticity, which determines how well the skin envelope retracts
- Whether the capsule surrounding the implant is removed, and to what extent
- Previous surgery, radiotherapy, pregnancy, breastfeeding, and weight change since the original operation
- Age and general health, including smoking status
Where skin redundancy is significant, some patients discuss whether a breast lift may be considered, either at the same time as removal or as a separate procedure. Combining procedures carries a different risk profile to removal alone, and whether it is appropriate is an individual clinical decision made at consultation.
Sensation and Strength
Altered sensation across the chest and nipple is common in the early period after implant removal and usually improves over several months. Some change in sensation can be permanent.
Pectoral strength is generally preserved. The muscle remains innervated and functional, and while it may feel weaker initially because of swelling, discomfort, and a period of reduced activity, most patients return to their previous level of upper body function. Return to loading and exercise should follow the specific advice given by your treating surgeon, as timing depends on what was done at surgery.
What Is Assessed Before Implant Removal
Assessment before implant removal covers the original implant position and size where known, the current condition of the implants, the volume and distribution of remaining breast tissue, skin quality and elasticity, nipple position, chest wall symmetry, and any symptoms you are experiencing. Imaging is arranged where clinically indicated, particularly where implant rupture is suspected.
The discussion covers what removal alone is likely to achieve, whether capsulectomy is indicated in your case, whether any additional procedure would be considered, the risks involved, and the expected recovery. Suitability and the appropriate approach are determined on an individual basis following examination.
Dr Mark Hanikeri FRACS (PLAS) sees patients to discuss breast implant removal in Perth. A referral from your general practitioner or another medical practitioner is required before consultation.
Frequently Asked Questions
Does the pectoral muscle return to normal after breast implant removal?
The muscle remains functional and innervated, and pectoral strength is generally preserved. It does not return to precisely its original anatomy, because the lower attachments were divided when the subpectoral pocket was created, so the lower border commonly sits slightly higher than it did originally. Most patients regain their previous level of upper body function, though the appearance of the muscle can differ.
How long does it take for the chest to settle after implant removal?
Swelling settles substantially by around six weeks to three months. The soft tissue contour continues to change out to six months, and scars and muscle definition continue to improve towards twelve months. Assessment of the final result is generally deferred until at least six to twelve months after surgery.
Will animation deformity resolve after implants are removed?
Animation deformity caused by the muscle moving over an implant resolves once the implant is removed. Some contour irregularity on muscle contraction can remain, related to how the released muscle re-adheres and to adherence between the muscle and overlying tissue. This is usually less pronounced than with an implant in place and often becomes less noticeable over the first year.
Does the capsule need to be removed at the same time?
Whether capsulectomy is performed, and how much of the capsule is removed, is an individual clinical decision. It depends on factors including the condition of the capsule, whether the implant has ruptured, the implant type, and your symptoms. The indications and the additional risks involved are discussed at consultation.
When can I return to upper body exercise after implant removal?
Timing depends on what was done at surgery, including whether capsulectomy or any additional procedure was performed. Return to loading should follow the specific advice given by your treating surgeon rather than a general timeframe, as returning to activity too early can increase the risk of complications.
Further Reading
- Breast Implant Removal Perth: https://markhanikeri.com/breast-implant-removal/
- Breast Shape After Implant Removal: Factors: https://markhanikeri.com/breast-shape-after-implant-removal-factors/
- Safe Exercise After Breast Implant Removal: https://markhanikeri.com/safe-exercise-after-breast-implant-removal/
- Implant Removal Consultation Considerations Perth: https://markhanikeri.com/implant-removal-consultation-considerations-perth/
- Breast Implant Removal and Medicare Perth: https://markhanikeri.com/breast-implant-removal-medicare-perth/
- When Should Breast Implants Be Reassessed: https://markhanikeri.com/when-should-breast-implants-be-reassessed/
| Written by Dr Mark Hanikeri – Specialist Plastic Surgeon, Perth WA. Dr Hanikeri holds Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic and Reconstructive Surgery and has practised in Perth for over two decades. Consultations are conducted at accredited facilities in Subiaco and Murdoch. |
