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Cut/torn pectoral?????

Cut/torn pectoral?????

Postby Boogaloo71 » Sun May 11, 2008 2:44 am

As some of you know from my whining posts on here, I had an issue with my sx wherein my left implant, two days after surgery, popped up to around my collar bone. My PS had to grab it and yank it back into place.

Well, I had my surgery 3/25, so I'm 6.5 weeks post. As my swelling in my left traumatized breast is going down, my nipple is beginning to straighten out.

The color of that breast, though, is still not normal. It's red. It's not beet red, but just red. That has remained.

Well, with the reduction of swelling, and with tenderness decreasing, I've been able to feel around some. I've noticed a lot of sternum pain, which I understand to be normal.

As the swelling has decreased, a dent has begun to show on the left breast, toward the top of my cleavage. I can feel above and below the dent, and it is the insertion point for the pec muscle, where it joins the ribcage at the sternum. At the dent, I can feel a ridge, like a spot where muscle used to be. The lack of the muscle is what's causing the dent. This is a spot of great tenderness, and actually some sharp pain.

So I've begun to wonder, was the muscle cut during dissection of the pocket, and that's what allowed the implant to pop up like it did? I never understood the implant popping up like it did, because in every descriptive picture I've seen about sub-muscular placement, it shows that the muscle is closed at the top. It's not like a belt lying across the top of the implant. It's actually like an upside-down V, closed at the top.

Or maybe it was just dissected close to the insertion point, to create close cleavage, and then in my first two days, the muscle tore and allowed the implant to pop up.

I'm flying to Anchorage to see my PS on Monday. I'm certainly making a list of questions. I posted a question to a PS that had a Q&A board on his page, and asked him about this, and he suggested the discoloration of the breast could be a slight hematoma from the trauma of the muscle tearing. He said if hematomas are bad, they have to be drained. But I've looked up pics of breast hematomas, and my breast looks nothing like what I found pics of. I just have a very red breast, like it's sunburned. But not beet red.

I've attempted to research this, but I can't seem to find the right search terms. The word "cut" of course will come up with "augmentation" and "tear" brings up info on tear-drop-shaped implants.

So if my muscle is torn, have any of you ever heard of that? Does it grow back? Do they have to fix it? If they don't fix it, will the dent fill in with scar tissue? Does anyone make breast bondo?

Okay. I guess that's the start of my list of questions for Monday.

Some of you ladies who have been around this board for awhile, have you heard of this happening?

Anyone have any additional informative questions I should ask on Monday? I live on Kodiak Island, so I only get to see my PS rarely. It's been a month. The dent wasn't showing last time I was there, as I was still pretty swollen.

Okay. I've rambled (freaked-out) enough.

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Postby Doreen627 » Sun May 11, 2008 6:22 am

Boogaloo,
I'm not sure if I have the same thing or not. About 1 1/2 weeks ago in the middle of the night I had my implant jump up near my coolarbone boy did that hurt I was able to push it back down after alot of massaging. it was sore for a couple of days then I noticed there was a flat area towards cleavage and on top of breast (left) then I also noticed I cannot flex that pect muscle at all the right flexes easiliy. I also have alot of side boobage on the left and now the left looks bigger or should I say wider. the pictures shown are before this I have to have my DH take some pictures. please keep us posted as to what your PS says I think I should call my PS this week my next scheduled appoint isn't until the middle of July.
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Postby Boogaloo71 » Sun May 11, 2008 9:57 am

Hi, Doreen.

I posted on here not long after this happened to me to see if I could find anyone else this had happened to. Yes, it sounds like exactly the same thing. Although I can't believe you were able to get it back down yourself. Ouch!

Yes, my left one was much larger for quite some time. It's still larger, but beginning to go down some now. Is yours discolored at all?

I'll put my link to my pics on here. You can see that I don't have what appears to be any pooled blood, but just an all-over discoloration of the left breast since this happened. I'm wondering if it's bleeding of some type, or just a weird kind of bruising.

The flat area you mention is what I believe to be where the muscle attaches at the center. As I said before, I'm not sure if this was something that tore loose after the surgery, allowing the implant to pop up. But I'll certainly ask a lot of questions on Monday. I only began to notice it as the swelling subsided. In my pics, you can kind of see it in the 5.5 week pics, in the pic with my arms raised.

I did have trouble flexing the left pec more than the right. That now seems to be getting a little more normal, though. My implant popped up six weeks ago now, though. Yours still sounds pretty fresh.

YES, you should get in before July. When was your BA?

I'll keep you up on what happens with me Monday. I probably won't post until Tuesday, though, as I don't get back from Anchorage until late at night. Having to fly to see your PS is a pain in the butt!

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Postby YourOwnChoice » Sun May 11, 2008 10:51 am

Here is an interesting post from a couple of years ago:
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Here are excerpts from a PS's article I found online about this issue:

"When implants are put behind the muscle, the inner attachment of the muscle must be cut to allow space for the implant. Not only does this increase the risk of bleeding, but also it severely weakens the pectoralis major, the main chest muscle. In the past year and a half I removed five sets of implants placed behind the muscle by other surgeons and put them in front of the muscle because they looked so abnormal. In all these instances, the pectoralis muscle was paper thin, having been destroyed either by the pressure of the implant beneath it, or by the detachment of the muscle. A muscle that is not attached at both ends cannot contract, cannot be exercised, and thus atrophies. Cutting the muscle also increases the risk of bleeding after the surgery.....

To summarize the disadvantages of putting the implant under the muscle (sub-pectoral): it virtually destroys the muscle; it can appear very unnatural; there is increased risk of bleeding; it is very painful for a week or two; the implant is only about half covered by the muscle. And in my opinion, it does not make the breast feel softer or prevent rippling. "

http://www.breast-expert-new-york.com/b ... plant.aspx
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Postby Doreen627 » Sun May 11, 2008 11:55 am

Actually mine didn't get red. I feel on the far side (towards armpit) it looks whiter and feels stretched I forgot to mention it is also numb on left side of left breast from nipple over to side and gets really hard if I lay on my right side. It almost feels as if the implant itself flipped sideways if that makes any sense because I don't feel any part of the implant on the right side of left breast actually it's quite soft, could that be possible? Oh I had my sx about 4 1/2 months ago. That's why I feel this is really strange. but I have always had soreness with my left PS always says this is normal no 2 breast are alike they heal differently. I am now more concerned since Miki mentioned muscle atrophy that scares me knowing that maybe my muscle is drying up. If this is what is happening can it come back in time? I am calling my PS tomorrow. Please let me know what your says on Tuesday Good luck
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Postby TC316 » Sun May 11, 2008 12:05 pm

I don't know how much I agree with the pectoralis muscle being destroyed. I had unders for 6 months before switching to overs. It took awhile, but now I can certainly keep up with the rest of my pilates and body sculpt classmates in any pec exercise. I can even do push ups from my toes as well as any of them. So, I don't know if it takes a significant amount of time for this "destruction" to occur or not. I only had mine submuscular for 6 months, but my PS said the exact SAME thing, that the muscle would most likely be atrophied, paper thin, and destroyed. If so, I've been able to "repair" mine through exercise.
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Postby Doreen627 » Sun May 11, 2008 12:12 pm

My DH said to me to have them removed and put on top of muscle can this be done at the same time or do they need time to heal first. also did you keep the same implants? and how was the recovery for this my stomach is in a knot right now. what was the reason you had yours switched?
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Postby Forca » Sun May 11, 2008 1:27 pm

I have never heard of the pectorals being destroyed by this surgery--indeed, my PS does work on many fitness competitors and always goes under the muscle and they continue to compete, so I assume they have gained back all strength. Submuscular implants go BENEATH the muscle and fascia, above the chest wall. They do NOT cut muscle to place them, just stretch them. This is why it takes so long for the implants to get into final position and why they put you completely out to do the surgery--it would be impossible to do it with any tension in the pectoral muscle.

My muscle feels completely intact and usable; I'm just not supposed to till next week (though I can put on quite a show for dh currently, LOL!). I can easily see how this surgery could damage the insertion points of the muscle, and I don't know how well those can be repaired. That's most likely why we have to be so careful the first 6 weeks so those muscles can stretch and not yank out of their insertion points.
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Postby thatgirljennyt » Mon May 12, 2008 12:36 pm

hi boogaloo,

sorry, i have not heard of this condition you describe. i hope it all goes well. i was just curious as to whether you have pics of the 'dent' in your cleavage. sounds like what i had at around 3.5 mos. po. mine has pretty much gone away, or filled in, but i still see a little of it if i look close enough. it doesn't show when i have a bra on though.
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Postby TC316 » Mon May 12, 2008 1:42 pm

Doreen627 wrote:My DH said to me to have them removed and put on top of muscle can this be done at the same time or do they need time to heal first. also did you keep the same implants? and how was the recovery for this my stomach is in a knot right now. what was the reason you had yours switched?


I had distortion with my unders. My saline unders were removed and the silicone overs were placed in one surgery - I did have to wait 6 months from the time I had saline unders to switch to silicone overs.
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Postby mirabella » Mon May 12, 2008 3:29 pm

Yes, it's true... the pectoral muscle is indeed cut where it meets the sternum. At least, some docs do that - the first PS I met with told me that he does that. They cut the muscle, just a little (several inches, I think), along the line of the sternum, presumably to make a pocket for the implant.
The second PS I met with did not mention having to cut the muscles, but I assume it's probably routine procedure?
So, it would make sense that this is a possible complication - that a muscle could separate from the sternum if there is too much pressure.

Boogaloo, I tried finding some info by searching different terms right after I read your email, but no luck. : ( I did try the word "torn" instead of "tear." Let us know how your appointment goes.
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Postby Boogaloo71 » Mon May 12, 2008 5:28 pm

So I had my appointment this morning. My PS had me do various different flexing exercises of the pecs, and she said it's not detached. After she pointed it out to me, I did see the muscle pulling there where the dent is.

Her explanation is that when my implant popped up on day 2, it came up behind the pectoral muscle, pulling the muscle loose up to the collar bone. She suggested that perhaps the dent has to do with some adhesion scarring from that injury. Her suggestion was to massage, wait and see. She stated she has seen dents early on before, and they've always gone away.

She stated the general redness of the breast still has to do with the trauma, and this could take quite some time to go away.

I do feel better now after visiting with her. I could see the muscle pull when flexed in the dented area.

So thatgirljenny, once again, like you, I'm hoping it all comes out all right in the end. You really inspired me early on with the crooked nipples. Mine are really beginning to straighten out now as my swelling to the injured breast decreases. Every time I've gotten stressed about them being crooked, I've gone back to look at your pics, and it's really made me feel better that all will be all right. The difference in yours in four months was phenomenal.

Doreen, I'll be interested to hear if you contacted your PS, and what he says.

So after the good news, I went to the store and treated myself to two new bras and four tight t-shirts.

Good news, I don't have to wear the strap anymore!!!!!!!! She said unless I notice any swelling on the top of the injured breast, don't worry about it.

So I'm relieved, through my frustration. I'm so frustrated that tomorrow will be seven weeks since my surgery, and I still hurt like this. My right breast almost feels normal, but that left one really is sore. Waiting, waiting, waiting.

I do have a great deal of trust in my PS, which helps the waiting.

Thanks for everybody's input.

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Postby Forca » Mon May 12, 2008 7:33 pm

mirabella wrote:Yes, it's true... the pectoral muscle is indeed cut where it meets the sternum. At least, some docs do that - the first PS I met with told me that he does that. They cut the muscle, just a little (several inches, I think), along the line of the sternum, presumably to make a pocket for the implant.
The second PS I met with did not mention having to cut the muscles, but I assume it's probably routine procedure?
So, it would make sense that this is a possible complication - that a muscle could separate from the sternum if there is too much pressure.

Boogaloo, I tried finding some info by searching different terms right after I read your email, but no luck. : ( I did try the word "torn" instead of "tear." Let us know how your appointment goes.


Changing my post ;) Some do cut, some do not, but if some are cut, it is not along the sternum--the pectorals have insertion points along the sternum and around to about halfway across your BWD. The muscle is held in place with fascia and such and this is cut or dissected (spread like with a c/s and your abdominal muscles--they do not cut your abs anymore in a c/s) with implants placed via inframammary incision--they do not at all cut along the sternum--that is the middle of your chest and there is no need to do so with an incision along the bottom; perhaps you mean the formation of the pocket under the muscle--in that case, they aren't cutting muscle, they are forming a pocket under the muscle, between muscle groups--there is a layer of facia that is shaped (much like that stuff in a chicken breast). Any cuts are often sewn back together or allowed to heal--they do not stay cut and severed indefinitely. No cutting of the muscle is involved with a transaxillary incisions. http://www.justbreastimplants.com/place ... unders.htm has some great illustrations so you can see how your muscles look, as well as descriptions of the various ways of placement.

Miki--I went to that link posted from an earlier post and it was pretty inaccurate with how he describes the sub-muscular placement--it's very biased as he obviously prefers an over the muscle approach. I've found his description of how an implant placed under the muscle completely untrue: 1) Aesthetically pleasing: Most importantly, done correctly, an implant looks perfectly natural over the muscle, as that is of course where nature put the breast. Placement behind the muscle often gives too much upper pole fullness that not only looks unnatural, but can sometimes cause the nipples to appear to point downward. This deformity is more likely to appear when the implants are placed from an incision under the arm.

Yes, that certainly happens at first, but as the implants settle, they look very natural. Mine look amazing at the moment, as do all of the unders my PS has placed. I have not seen unders placement that looked like he described once everything has settled, so it may be an East Coast thing, or simply a bias. My PS is for sure biased against silicone, and yet many PS's will use it with great success.

Honestly, i think we could find articles all over the internet to back up any claim we want to make, but when I see fear start on a board over something like this, I have to dig deeper, LOL! I did the same thing on the TT board when everyone was CONVINCED their muscle repair had failed, or thought the binder their PS had them in was dangerous b/c someone else's PS said so, KWIM?

I just want to ask my PS now--but I have to wait till my next appt. I can always go in to ask, but I sort of feel stupid going in just for questions!
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Postby thatgirljennyt » Tue May 13, 2008 9:41 am

boogaloo,

that's great news! i know, we always wonder if what we're experiencing is normal or if something has gone wrong. i have photos of my "dent" in an album called "ripples" (i thought i was rippling). i don't know if you saw it. my ps had said to give it at least a year to allow full healing of the muscle and for the membrane to grow around the implant and then the dent and rippling would go away....something like that.

forca, thanks for the information you found and shared. it's very insightful.
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Postby Forca » Tue May 13, 2008 9:53 am

I wonder, too, if the 'dents' are just seeing the normal striation of the pectoral muscle? I see my muscles now in certain positions and they look sometimes like ripples, but I know it's the pectoral muscle. Looks just like when I would flex before surgery, but it's now over a big bump!

Boogaloo--how wide are the dents (just curious about my new theory ;))? I'm very glad you are doing well and that your PS soothed your fears! I hope the rest of your recovery is smooth and peaceful!
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