title: Outcome assessment of breast distortion following submuscular breast augmentation.
abstract: BACKGROUND
  Animation deformity or breast distortion during pectoralis muscle contraction following subpectoral breast augmentation is a known entity, but its prevalence and significance remain unclear. The purpose of this study was to identify the incidence and severity of animation deformity as well as its effect on patient satisfaction and interference with certain activities.
  
  
  METHODS
  All procedures were performed by the senior author using a variation of a previously described dual-plane technique. The first part of this study was an evaluation of breast distortion by a group of independent observers in a series of 40 consecutive patients who underwent primary subpectoral breast augmentation. The second part of the study was a questionnaire sent to 195 consecutive patients asking about overall satisfaction, degree of animation deformity, and whether there was interference with any activities.
  
  
  RESULTS
  Of the 40 patients' photographs that were evaluated, 9 (22.5%) had no distortion, 25 (62.5%) had minimal distortion, 4 (10%) had moderate distortion, and 2 (5%) had severe distortion. Of the 195 questionnaires, there were 69 responses, a 35% response rate. Fifty-six (82%) described mild to no distortion, 7 (10%) were moderate, and 5 (7%) were severe. According to the survey, the most common activities that were problematic were lifting weights and exercising (24 and 19%, respectively). Only one (1%) patient stated that she would not recommend subpectoral positioning.
  
  
  CONCLUSIONS
  Although animation deformities do exist, nearly all patients in this study would still choose subpectoral positioning. Patients who may be better candidates for subglandular placement are those for whom exercise is central to their daily living. As a result of this study, surgeons and patients should have more accurate and reliable information regarding the significance of animation deformity after subpectoral breast augmentation.
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, 1st Floor PHC Building, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. spears@gunet.georgetown.edu
authors.forename: Scott L
authors.initials: SL
authors.lastname: Spear
authors.forename: Jaime
authors.initials: J
authors.lastname: Schwartz
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Dayan
authors.forename: Mark W
authors.initials: MW
authors.lastname: Clemens
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects* / Q000379:methods*; D015331:Cohort Studies; D003286:Contracture / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004954:Esthetics; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010369:Pectoralis Muscles / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult