Pre-Pectoral Breast Reconstruction
If you are considering implant-based breast reconstruction, our practice offers an advanced technique for implant placement that can shorten recovery time and deliver more natural-looking results. Pre-pectoral reconstructive surgery uses a newer technique for breast implant placement.
Unlike traditional breast reconstructive surgery, which places breast implants under the pectoralis (chest) muscle, the pre-pectoral technique places the implants over the muscle. A biologic mesh is used to help support the implant and to keep the reconstruction stable. There are many advantages to this technique. First, because there is less manipulation of the muscle during surgery, patients experience less pain during the operation and afterwards, during the expansion process, if needed.
Secondly, placement of the implant over the muscle prevents “animation deformity,” which is when the implant moves awkwardly under the muscle. Because of the lack of breast tissue, this can be seen rather dramatically sometimes and can cause patients pain, discomfort and distress.
Finally, the end aesthetic result of a pre-pectoral reconstruction tends to be much more natural than a subpectoral reconstruction. This is due to the implant not being “blunted” by the strength of the muscle. In fact, this type of reconstruction tends to hold up better after radiation as well, with less capsular contracture seen post radiation.
To provide extra support and achieve more natural contours, fat grafting can also be performed as a later part of the surgery.
Pre-pectoral breast reconstruction is an option for initial reconstructions as well as women who have previously had subpectoral (under the muscle) reconstruction and who are now having problems with pain/discomfort, animation deformity, or poor aesthetic results. Many of our patients come to us having had breast reconstruction under the muscle years ago. They have complaints not only of the “look” of the breast, but also functional issues such as pain and deformity and implant movement and malposition. Converting these patients to a pre-pectoral placement can often help to achieve a much more satisfying result.
You have an alternative to traditional mastectomy and reconstruction. If you have been diagnosed with breast cancer, or have a high risk of being diagnosed and are considering a mastectomy, it’s worth a consultation with us. Request a consultation or call us at (410) 740-9330 to schedule an appointment.
The Benefits of Pre-Pectoral Breast Reconstruction
Pre-pectoral breast reconstruction can achieve excellent outcomes for many women facing a breast cancer diagnosis. The technique:
- Can deliver a more natural-looking result
- Can decrease risk and speed up recovery time after surgery
- Uses a non-allergenic biological mesh to help hold the breast implants in place
- Can be combined with fat grafting for an even better look and breast contour
- Can be performed for patients with both noninvasive (DCIS) and invasive breast cancer
- Is covered by major insurance plans and my office can assist with the necessary paperwork
What Is "Pre-Pectoral Reconstruction"?
When performing plastic surgery using breast implants, a surgeon can place the implants either beneath the pectoralis muscle (subpectoral) or above the muscle (pre-pectoral). In a natural breast, the breast tissue mainly sits above the chest muscle. In the past, placing implants above the muscle may have resulted in an obvious or even “fake” looking result, since the implant has little tissue to cover it. The implant also would lack support, which could lead to implant movement and increased breast sagging over time.
However, modern implants and the technique our surgeons use have addressed these concerns. Today’s silicone implants more closely mimic the look and feel of real breast tissue than ever before. In addition, the supportive layer of biologic mesh used during surgery helps to “mask” the implant visually while providing added support. A further benefit of this technique compared to submuscular implantation is that the pectoralis muscle remains undisturbed, shortening recovery time and avoiding discomfort and some other complications that can occur down the road.
Under Federal law, insurance companies that cover an initial breast cancer surgery are required to cover breast reconstruction as well. Even though the pre-pectoral technique is leading edge, it is still an accepted breast reconstruction technique eligible for insurance coverage. Our office can help you with the authorizations you will need prior to surgery to maximize your insurance coverage for the procedure.
What to Expect
Pre-pectoral breast reconstruction is typically an immediate reconstruction technique, meaning the reconstruction occurs immediately after the surgery to remove cancerous tissue. For this reason, it’s important to have all testing completed prior to surgery. This may include:
- Digital Mammography
- Breast Ultrasound
- Axillary Ultrasound and Biopsy of Any Suspect Nodes
- Breast MRI
- Family History and Genetic Counseling if Necessary
We will work closely with your breast cancer surgeon to prepare for your procedure. Other factors such as the size and extent of the tumor compared to the size of the breast and your own cosmetic goals will be considered as part of the planning process.
Note that if you are having a breast reconstruction revision procedure, the number of pre-operative tests and the planning process will be reduced, since the focus is on improving the cosmetic result, not addressing cancerous tissue.
Day of Surgery
The surgical team including your radiologist, surgical oncologist, and plastic surgeon will meet with you prior to surgery, mark/prepare the surgical area, and allow time to review your procedure and answer any questions.
After your cancer surgeon completes the mastectomy procedure, your plastic surgeon begins the work of reconstructing the affected breast. If implants will be placed in both breasts, a two-team approach can be utilized to reduce total operating time. The incisions needed for the mastectomy can be used for placement of the breast implant in the affected breast, while an incision around the areola or beneath the breast can be used if an implant is being placed in the healthy breast.
Immediately after surgery, you will spend some time in a recovery suite before staying overnight or being discharged to complete your recovery at home. Our staff will be in close contact with you to make sure that you are comfortable and recovery is going smoothly. You will have a post-op appointment scheduled with your plastic surgeon and we are happy to answer questions or address any concerns as they arise.