Dynamic Contour Irregularities in Implant-Based Breast Reconstruction: Long-Term Aesthetic Outcomes After...

Background: Animation deformity (AD) is a well-known complication of submuscular implant placement. However, dynamic contour irregularities have also been reported in prepectoral reconstructions, but their mechanisms and classification remain unclear. Methods: In this prospective, single-center study, 67 patients underwent either direct-to-implant (DTI, n = 33) or tissue expander (TE, n = 34) reconstruction. Among these, 56 patients had subpectoral and 11 patients had prepectoral implant placement. Patient-reported outcome measures (PROMs) were assessed using the BREAST-Q. Aesthetic outcomes were rated by four plastic surgeons using the Breast Aesthetic Scale. Breast animation deformity was evaluated clinically and photographically by an expert panel using two distinct classification systems. Results: The mean follow-up period was 78 (±45) months. No significant differences were found between DTI and TE groups in BREAST-Q scores or overall aesthetic outcomes. Bilateral reconstructions showed significantly higher aesthetic ratings (p = 0.001). AD was observed in 61.2% of patients, with significantly higher prevalence in the DTI group (p = 0.02). Six patients with prepectoral reconstruction demonstrated dynamic contour irregularities distinct from classical AD. A new definition for this phenomenon is proposed. Conclusions: DTI and TE reconstructions achieve comparable long-term patient satisfaction and aesthetic outcomes. The observed cases of dynamic implant contour irregularities (DICI) in prepectoral implant placement underscore the need for a more nuanced classification of contour irregularities in implant-based breast reconstruction beyond the established concept of AD.