Breast augmentation surgery involves the placement of an implant underneath the muscle in most cases. The pectoralis major muscle is separated from the minor one and a pocket for the implant is created between the two. In some cases, a portion of the pectoralis major muscle where it attached at its lowest point to the sternum is released to allow the implant to sit down low enough. (the lower edge of the pectoralis muscle is way above the inframammary fold, making it aesthetically undesireable to have complete muscle coverage of the implant)
Placing a breast implant under the pectoralis major raises two important muscle-related questions. First, is there any negative effect on the function of the pectoralis msjor muscle afterwards? And secondly, what is the best way to recover after this ‘muscle injury’?
I have yet to hear any patient in my Indianapolis plastic surgery practice who have had any complaints about ‘weakened chest muscles’ after breast augmentation. Most patients are not athletes however so this is not a surprise. But many do workout regularly. It is fair to say that there is no perceptible change in pectoralis function after such surgery. An interesting report has looked at more athletic women. The effects of breast augmentation on pectoralis major muscle function in athletic women was studied and reported on in 2004. In the Aesthetic Surgery Journal in May-June 2004, an assessment of twenty female athletes who spent at least 6 hours per week weight training was reported. They evaluated the ability to perform various exercises after breast augmentation. Their results showed that it required an average of around 7weeks before they could resume their normal weight-room routines, which was twice as long as those patients who had implants placed above the muscle. These data suggest a longer recovery period for implants placed under the muscle before return to preoperative weight training activity. Placement under the muscle is also associated with reports of some decreased performance in exercises dependent upon the pectoralis major muscle. Overall satisfaction with breast augmentation was high regardless of implant location.
Recovering after breast augmentation is about physical therapy of the pectoralis muscle. This consists of several types of stretch exercises.
Arm range of motion exercises (stretch) should start the night of surgery. This consists of raising your arms from your side out to 90 degrees to the shoulder level. Repeat this 10 times every two hours on the day of surgery until you go to bed that nite. The day after surgery increase the angulation of the arms from the body up to 120 degrees every three hours or so. The following day you should be able to get the arms up to 180 degrees from your side. By the fourth day after surgery begin slow wind mills of 360 degrees going forward and then back. These stretching exercises should continue for the first week after surgery.
The second type of pectoralis stretch exercise uses the help of a door way. Stand in the middle of a door way with one foot in front of the other. Bend your elbows to a 90 degree angle and place your forearms on each side of the door way. Shift your weight on to your front leg, leaning forward, until you feel a stretch in your chest muscles. Hold for 15 seconds, relax and return to starting position. Repeat this manuever 10 more times. This should be done four or more times per day during the second week after surgery. This type of stretch introduces some resistance which may be felt more down at the low sternal attachment, some of which has been partially released.
Rapid recovery after breast augmentation requires an early initiation of a pectoralis stretching program. By starting the night of surgery and continuing for two weeks, most patients can have complete and full recovery within this time period.
Dr. Barry Eppley
Indianapolis, Indiana