Why Not Use the Split Muscle Technique for Breast Augmentation?

What's different between the two techniques?

Occasionally when I am explaining the split muscle technique and how it reduces animation deformity with breast implants under the muscle, the patient asks “If this is such a good method, why doesn’t everyone use it?” Implants are placed under the pectoral muscle for several reasons, including a smoother transition into the breast over the upper portion. The coverage provided by the muscle makes for a more natural look. The most commonly used technique is called the dual plane, which involves detaching of a portion of the muscle. This is what causes a problem known as animation deformity, distortion of the breast when the muscle is flexed. The problem occurs to some degree in the majority of cases, and in about one in seven or eight it is severe. I developed the split muscle method more than 10 years ago to correct and prevent animation deformities, and have used it in more than a thousand patients.

If the split muscle technique reduces animation deformities, what's the hold up?

So, why doesn’t everyone use it? It’s not like I haven’t shared the idea; I have published it twice – here and here – in major plastic surgery journals, and presented the technique at regional, national, and international conferences from Montreal to Las Vegas to New Delhi, even Walla Walla. My colleague and friend Umar Khan, a plastic surgeon in London who independently developed the technique at about the same time I did, has similarly published and lectured on it around the world. So the only thing I can think of is that plastic surgeons have a sort of a blind spot when it comes to a complication that they are taught should not occur with conventional techniques (but does anyway.)


In the Q&A session at one meeting after I presented the technique, another well-known plastic surgeon had presented a large series of breast augmentation patients in the same section. When someone asked about the incidence of animation problems in his patients, his reply was something like “Well, I just tell the gals not to use their pectoral muscles.” I suppose that is a satisfactory answer for some, but the problem isn’t limited to athletic women (or any others who wish to use their chest muscle on occasion.) It can be visible in a modest swimsuit and bothersome with routine activity, not just in the gym.

Are there other benefits to the split muscle technique?

Beyond the goal of minimizing animation, a significant advantage of not cutting the muscle attachment for the dual plane technique is that full muscle function is preserved. The split muscle technique has the benefit of upper pole coverage with muscle but without detaching any portion so function and strength are not impaired. So why doesn’t everyone use it? Your guess is as good as mine.

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