Breast reconstruction is surgery that involves recreating a breast which has been removed in part (lumpectomy) or in its entirety (mastectomy). It can be done either in an immediate setting (same time as mastectomy/lumpectomy), delayed setting (after the mastectomy/lumpectomy) or in the prophylactic setting (preventative mastectomy in patients at high risk of cancer).
There are many types of breast reconstruction, and many options to consider and discuss with your surgeon ahead of the procedure. One such decision is whether the reconstruction will be sub-pectoral (where the implant is placed under the muscle), or pre-pectoral (where the implant is placed above the muscle).
Pre-pectoral breast reconstruction was popularized in 2016-17, and has quickly become the gold standard. Most breast reconstructions performed by our surgeons at FORM Face + Body today are pre-pectoral. We sometimes see patients who previously underwent sub-pectoral breast reconstruction asking us about the possibility of converting to pre-pectoral. The reasons for these inquiries often include:
- The sub-pectoral implant placement is causing issues such as animation, which is described as the implant being displaced upwards as the muscle is contracted.
- The patient has undergone radiation, which can cause the muscle to become constricted or tight thus causing implant malposition. The result is often discomfort, pain, and an aesthetically displeasing breast.
These issues can usually be partially—if not completely—resolved by changing the placement of the implant from below to above the muscle. This will require the use of an acellular dermal matrix (ADM).
ADM is a type of surgical mesh developed from human skin, from which the cells are removed and the support structure is left in place. The tissue is safely sterilized and processed so that all of the donor’s native immunogenic cells are removed. This is an important part of the process as it will allow the ADM to be used without causing a reaction in patients.
The use of ADM is not new to breast reconstruction—it has been used for decades in other reconstructive techniques. Over the years, we’ve realized that ADM can actually be used to wrap the implant and place it above the muscle—obviating the need for the muscle to support the implant, and reducing the chances of the previously mentioned long-term issues. ADM allows us to minimize rippling or visibility of the implants, and it provides some protection against radiation. In addition to these benefits, ADM is not something that will ever need to be replaced.
When converting sub-pectoral breast reconstruction to pre-pectoral breast reconstruction, one of our primary goals is to repair the pectoralis muscle by restoring its original anatomy, form and function. Secondary benefits include the ability to remove scarring from the old implants (capsular contracture) while also updating/replacing the patient’s current implants to newer implants for improved shape and feel.
If you’re interested in learning more about converting sub-pectoral breast reconstruction to pre-pectoral breast reconstruction, contact us to schedule a surgical consultation.
