Treatment of breast animation deformity: A systematic review. Issue 5 (May 2019) - Alnaif, Nayif
Summary: Introduction: Animation deformity (AD) is a known complication of subpectoral implant placement and results from the contraction of the pectoralis major muscle with resultant movement of the underlying implant. This can lead to a poor cosmetic result, with the implant becoming distinctly visible postbreast reconstruction and augmentation. The prevalence and clinical significance of AD remain unclear. To date, there exists no published review outlining the treatment modalities for AD and their effectiveness. The objective of this study is to appraise the effectiveness of various treatment options through a systematic review of the literature. Methods: The MEDLINE search tool was used to carry out a search of the PubMed. Two separate reviewers independently assessed the initial resultant papers based on strict inclusion and exclusion criteria. Factors evaluated included patient demographics, publication information, study design, number of patients, preventative/treatment technique, and type and size of implant. Results: The search strategy yielded 504 articles, of which eight articles met all the inclusion criteria. This represents 214 individual breasts that underwent surgical correction for AD. Of the 214 included breasts, 151 were postmastectomy and reconstruction, while 63 were primary augmentation. Of the reconstructed breasts, 5.6% ( n = 12) received radiation. Overall, interventions for treating AD were successful in all ( n = 214) of the documented cases, with an overall complication rate of 11.6% ( n = 25) reported in the studies after treatment. The techniques used to treat AD included subfascial plane change ( n = 8), prepectoral (subglandular/subcutaneous) plane change ( n = 187), and muscle-splitting techniques ( n = 19). Conclusion: In conclusion, AD is likely an underestimated complication that is increasing in incidence with the growing number of breast implants being placed in the subpectoral plane. This review successfully identified the highly effective treatment modalities to combat AD. Patient characteristics and surgical technique must be tailored on a case-by-case basis to allow for optimum esthetic outcome given the substantial complication rate of these treatment modalities.