title: A Muscular Etiology for Medial Implant Malposition Following Subpectoral Augmentation.
abstract: BACKGROUND
  Implant malposition is becoming an increasingly recognized complication following subpectoral breast augmentation. Although several causes of medial malposition have been previously demonstrated, medial implant malposition secondary to unintended pectoralis muscle slips has not been previously described.
  
  
  OBJECTIVE
  The goal of this study is to describe a form of medial implant malposition caused by pectoralis major and minor musculature vectors on the implant.
  
  
  METHODS
  The primary investigator performed a retrospective review of all patients who underwent revisional breast surgery for the diagnosis of symmastia or medial implant malposition following subpectoral augmentation. Those patients with muscular-type etiology for medial implant malposition were identified.
  
  
  RESULTS
  Five patients with pectoralis muscle slips causing medial implant malposition were identified. The pectoralis muscle slips were successfully diagnosed on preoperative exam and corrected with specific surgical procedures aimed at balancing surrounding forces and thus correcting malposition.
  
  
  CONCLUSIONS
  Pectoralis muscle slips contributing to medial malposition can be found in some patients after subpectoral breast augmentation. The etiology of this deformity is unknown, but theorized to be caused by anatomic predisposition, with slips inadvertently formed during subpectoral pocket formation arising from the pectoralis minor and/or incompletely released or accessory pectoralis major muscles.
authors.affiliation: Dr Moliver is a Clinical Professor of Plastic Surgery, Dr E. Sanchez is a Resident, and Mr Kaltwasser is a Medical Student, Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas. Dr R. Sanchez is a Resident, Department of Surgery, Division of Plastic Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Clayton L
authors.initials: CL
authors.lastname: Moliver
authors.affiliation: Dr Moliver is a Clinical Professor of Plastic Surgery, Dr E. Sanchez is a Resident, and Mr Kaltwasser is a Medical Student, Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas. Dr R. Sanchez is a Resident, Department of Surgery, Division of Plastic Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Erick R
authors.initials: ER
authors.lastname: Sanchez
authors.affiliation: Dr Moliver is a Clinical Professor of Plastic Surgery, Dr E. Sanchez is a Resident, and Mr Kaltwasser is a Medical Student, Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas. Dr R. Sanchez is a Resident, Department of Surgery, Division of Plastic Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Kyle
authors.initials: K
authors.lastname: Kaltwasser
authors.affiliation: Dr Moliver is a Clinical Professor of Plastic Surgery, Dr E. Sanchez is a Resident, and Mr Kaltwasser is a Medical Student, Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, Texas. Dr R. Sanchez is a Resident, Department of Surgery, Division of Plastic Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Ruston J
authors.initials: RJ
authors.lastname: Sanchez
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000379:methods*; D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000033:anatomy & histology* / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies