Animation Deformity in Postmastectomy Implant-Based Reconstruction

Nigro, Lauren C.; Blanchet, Nadia P.

doi:10.1097/gox.0000000000001407

Cited by 61 publications

(69 citation statements)

References 19 publications

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“…Although initially described in patients undergoing breast augmentation, animation deformity in patients undergoing breast reconstruction is certainly more prevalent and likely more severe. Spear et al reported 15% of breast augmentation patients presenting with moderate to severe deformity while studies in reconstructive patients have reported up to 80% with moderate to severe deformity (2,14). In our own series of breast reconstruction patients, we have found an average nipple displacement of 2.12 cm (8).…”

Section: What Is Animation Deformity?mentioning

confidence: 50%

“…Animation deformity is a common and distressing sequelae of breast reconstruction, estimated to occur in anywhere from 75-100% of sub-pectoral breast reconstructions (1,2). Animation deformity is caused by contraction of the pectoralis muscle against the breast implant, causing it and the overlying breast shape to unnaturally shift with muscle contraction.…”

Section: Introductionmentioning

confidence: 99%

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An overview of animation deformity in prosthetic breast reconstruction

Fracol¹,

Feld²,

Chiu³

et al. 2019

Gland Surg

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Animation deformity is an unsightly complication after sub-pectoral breast reconstruction characterized by implant displacement with pectoralis muscle contraction. Recent increased awareness of this phenomenon has driven interest in pre-pectoral breast reconstruction but research is limited regarding the causes and implications of animation deformity. Specifically, no patient-specific risk factors have been identified as contributing to animation deformity. Placement in a sub-pectoral plane and division of the pectoralis are the only peri-operative factors associated with severity of animation deformity. Our own quantitative analysis of animation deformity has further refined our understanding of this phenomenon, which we present here along with a review of current grading scales. We also more broadly review the current literature surrounding animation deformity, including its causes, risk factors, impact on patient outcomes and current treatment options. Overall, patients find this to be an emotionally distressing complication and most patients would like to be educated on alternative surgical options to avoid animation deformity. Treatment options range from conversion to a pre-pectoral plane to muscle-splitting techniques to selective nerve ablation to Botox injections. Further research into causes, implications and ways to enhance pre-pectoral reconstruction are needed to improve patient outcomes with this phenomenon.

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Section: What Is Animation Deformity?mentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

An overview of animation deformity in prosthetic breast reconstruction

Fracol¹,

Feld²,

Chiu³

et al. 2019

Gland Surg

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show abstract

“…Without the breast parenchyma to separate the mastectomy skin from the pectoralis muscle, the skin becomes tethered to the underlying muscle. Any activation of the pectoralis can cause significant deformity of a patients' chest, with lateral breast displacement (1,2).…”

Section: Discussionmentioning

confidence: 99%

“…While many patients achieve a satisfactory aesthetic result, an overwhelming proportion have been reported to develop some degree of animation deformity (Figure 1). Animation deformity refers to the tethering of the patient's mastectomy flap skin to the underlying pectoralis major muscle, resulting in both visible contraction and lateral displacement of the entire breast mound with any activation of the pectoralis muscle (1,2). This can be painful for many patients and extremely visibly displeasing.…”

Section: Introductionmentioning

confidence: 99%

Correction of animation deformity with subpectoral to prepectoral implant exchange

2019

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Background: Breast animation deformity is a known complication associated with submuscular prosthetic breast reconstruction. Patients often will present months to years after their initial reconstruction complaining of chronic pain and visible contraction deformity of their chest, with minimal voluntary activation of their pectoralis musculature. This is aesthetically displeasing and physically uncomfortable. Our preferred method for addressing existing animation deformity and alleviating patients' symptoms involves reoperation, with implant pocket conversion to the prepectoral plane, with acellular dermal matrix (ADM) coverage. Methods: We performed a retrospective review of all patients who underwent prepectoral conversion of their breast reconstruction for correction of animation deformity with the senior author (HS) between March 2016-April 2018. Demographics, operative details, and post-operative outcomes were assessed. Results: Thirty-one patients underwent 55 revision breast reconstructions for a history of significant animation deformity following their initial submuscular breast reconstruction. All initial breast reconstructions were done with partial muscular coverage of their implant at the time of reconstruction. All patients experienced complete resolution of animation deformity without recurrence. Unplanned return to the operating room occurred in 14.5% of reconstructions. This was four cases of capsular contracture, three infections and one hematoma evacuation. Overall rate of infection requiring intravenous antibiotics was 14.5%. One patient lost both of her reconstructed breasts for an overall implant loss rate of 1.8% implant coverage with ADM was performed in 83.6% of cases, whereas 16.4% of reconstructions were performed with implant pocket change alone. The cohort that did not use ADM had a 44.4% instance of capsular contracture requiring reoperation, compared to a 0% rate of capsular contracture when ADM was used (P<0.01). Conclusions: Implant pocket change from the submuscular plane to the prepectoral plane is a safe and effective means of addressing submuscular associated breast animation deformity. The application of preoperative fat grafting and intraoperative ADM coverage contributes towards lower rates of complications and decreases the need for revisionary procedures.

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“…While two-stage sub-pectoral implant reconstruction gave reasonable results, it was apparent on critical appraisal, that patients experience significant physical limitations secondary to sub-pectoral implant placement. Most patients exhibit some degree of animation deformity during activity, particularly during adduction of the humerus (12,(25)(26)(27). Sub-pectoral implant placement may also have more serious morbidity.…”

Section: Introductionmentioning

confidence: 99%

Single stage, direct to implant pre-pectoral breast reconstruction

Jones¹,

Antony²

2019

Gland Surg

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Background: Given the current trends in skin preservation during mastectomy, improved biofilm reduction algorithms, and advancements in tissue bioengineering and perfusion assessment, acellular dermal matrix (ADM)-reinforced single stage, direct to implant insertion in the pre-pectoral space has become a viable alternative to two-stage expander-based, sub-pectoral reconstruction. Methods: The authors performed a retrospective review of their pre-pectoral cases evaluating outcomes for all single stage, direct to implant procedures. Outcomes reviewed included hematoma, seroma, infection, device loss or change, animation deformity and revisional procedures such as fat grafting. The anterior tenting surgical technique is also reviewed. Results: The authors have carried out 305 direct to implant pre-pectoral breast reconstructions using an anterior tenting technique with low complication rates and superior clinical and functional outcomes. The benefits of this technique include less patient discomfort, no need for postoperative expansion, virtually no subjective negative impact on upper extremity function and elimination of animation deformity. Longerterm follow-up demonstrates maintenance of the integrity and quality of the reconstructions over time. Conclusions: The authors consider single stage, pre-pectoral direct to implant breast reconstruction to be a state-of-the-art breast reconstruction technique and have found it to be safe and reproducible. This technique is their primary choice for immediate implant-based reconstruction following mastectomy.

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Animation Deformity in Postmastectomy Implant-Based Reconstruction

Abstract: Supplemental Digital Content is available in the text.

Cited by 61 publications

References 19 publications

An overview of animation deformity in prosthetic breast reconstruction

An overview of animation deformity in prosthetic breast reconstruction

Correction of animation deformity with subpectoral to prepectoral implant exchange

Single stage, direct to implant pre-pectoral breast reconstruction

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