Muscle Flex Deformity

[mom3]

Dear Dr. Mele,
You have answered several of my posts in the past, so I want to thank you in advance for reading/responding to another; in addition, I apologize if my questions seems redundant. You have answered a post(s) on muscle flex deformity in the past.
I saw my ps Friday @ 2.5m post-op. Everything looks great, but what I thought was righty not dropping, is really a muscle flex issue (per ps). When I am relaxed, there is hardly a noticeable difference in the 2 breasts. When I flex, right becomes quite distorted compared to the left. There is a slight difference in how they fill the pocket, but my creases are as close to 100% even as I could ask. My ps was brain storming ideas about how to correct the issue/make it better. We both discussed this being one of the side-effects of under the muscle placement. I accepted that risk prior to breast augmentation, and I still am ,overall, very happy with my results; however, there are some days that the distortion really bothers me. I know you work with body builders, and I was wondering if there is anything one can do to alleviate some of the distortion? I am not a good candidate for over the muscle placement (thin & little breast tissue). I don't understand why the 2 sides are so different when flexing (although I am right-handed)? Any exercises/massage I can do to lessen this deformity? Also, I was wondering if botox has ever been used to paralyze some of the pec muscle? My ps did not suggest we do this, but I have been thinking too.
Again, I thank you for your time and always informative responses.
Mom3 (Kelly)

[Dr. Mele]

Dear mom3:

From your post, it seems that you are considering all your options. It may seems odd that the two sides are different, but many times the two pectoralis muscles have asymmetrical origins from the ribs.

You are not losing any options by waiting. The fact that everything looks good when you are relaxed complicates the decision making process a little by adding the option of doing nothing. What I am saying is that if the was noticeable asymmetry at rest then the decision to operate and take on the risks associated with surgery is easier.

The only way to reliably eliminate the flexion deformity is to place the implant in front of the muscle. This will likely not look as good as you do now at rest. So it comes with a cost.

Results from operating to reinsert the muscle or release the muscle are difficult to predict and could even make the situation worse. Injecting Botox into the pectoralis is not something I have experience with. It would be an off label use and would require doses larger than those used for wrinkle reduction. If it works, the results would be temporary at best.

I can't really give you any specific guidance other than to say that you and your plastic surgeon seems to be considering the right options.