Subpectoral versus Prepectoral Breast Reconstruction
Breast implants are used in both subpectoral and prepectoral breast reconstruction. The difference between the two is the location of the breast implant in relation to your chest muscle.
The breast tissue naturally sits above your chest muscle, or your pectoralis muscle. After a mastectomy, the breast can either be reconstructed in its natural position, above the chest muscle, or the chest muscle can be elevated and the breast can be reconstructed under the chest muscle.
Prepectoral Breast Reconstruction
- The breast implant is placed above the pectoralis muscle in the area directly where the breast tissue was removed
- A dermal matrix, or internal brassiere, is placed to support the implant and provide soft tissue coverage. This also decreases the risk of capsular contracture
- Tissue expanders are not always required when reconstructing the breast above the muscle and a one-stage direct to implant reconstruction is possible
Subpectoral Breast Reconstruction
- Chest muscle is elevated, and a tissue expander is placed below the chest muscle
- This reconstruction requires a staged reconstruction where the tissue expander creates a pocket for an implant to placed during a second stage surgery
- The muscle is used to support the breast implant and provides soft tissue coverage over the implant
What is pectoral animation?
Pectoral animation is a complication of subpectoral implant placement. It is a deformity that results from the contracting of the pectoralis muscle over top of the implant that results in movement and disfigurement of the underlying implant.
Prepectoral Implant Conversion
Prepectoral Implant Conversion is a procedure that reverses a prior subpectoral breast reconstruction. This procedure is performed by removing the previously placed implant and repairing the chest muscle back down to its original and natural position on the chest. The breast is then reconstructed above the muscle with the placement of an acellular dermal matrix. The result is a soft breast reconstruction that moves and behaves like a native breast because it is positioned naturally on the chest.
This procedure is offered to patients who had prior breast reconstruction with implants below their chest muscle and as a result are experiencing chest discomfort, lateral displacement of the implants, pectoral animation, breast asymmetry, and/or have a firm and unnatural reconstruction.
You may be a candidate for PREPECTORAL IMPLANT CONVERSION if you are in good general health and:
- You previously underwent breast reconstruction with implants placed under your chest muscle
- You are experiencing pectoral animation and/or chest discomfort, tightness, or breast asymmetry
- You desire a natural reconstruction where the implant feels soft and moves like a natural breast
Things to consider:
- This reconstruction is typically performed in two stages:
- The first stage focuses on converting your implants from the subpectoral to prepectoral plane
- The second stage is not always required but involves fat grafting to camouflage the breast implant and smooth out any mastectomy irregularities.
There are multiple benefits of converting your breast implants to the prepectoral plane including:
- Natural feel and appearance of the breast
- Prepectoral breast reconstruction eliminates pectoral animation deformity and results in a soft and natural reconstructed breast
- Decreased risk of capsular contracture
- Prepectoral breast reconstruction is performed by placing a dermal matrix to support the breast implant. Along with providing breast support, this internal matrix has the added benefit of decreasing the risk of capsular contracture.
In order to perform a subpectoral to prepectoral conversion, Dr. Spiegel will evaluate your mastectomy skin in clinic to ensure it is safe to proceed with this reconstruction. Mastectomy skin that is very thin can result in complications such as delayed wound healing and infection.
General complications of implant based breast reconstruction may include infection, seroma (fluid developing around the breast implant), capsular contracture (contracted scar tissue causing breast discomfort and firmness), and implant rupture. These complications are reduced by surgical technique, the placement of breast drains, intraoperative antibiotics, patient activity restrictions, and post surgical oral antibiotics.
Subpectoral to Prepectoral Implant Conversion is an outpatient procedure, so you will go home the same day as your surgery. You will be sent home with drains. Two drains are placed to each operated breast. Drains are typically removed within 2-3 weeks, depending on the drain output.
Your arm range of motion will be restricted during your initial recovery. We ask that you do not perform repetitive motions with the arms or household chores for the first few weeks after surgery. Limiting your arm range of motion decreases the amount of fluid that accumulates are the breast implant, allowing for drains to be removed sooner.
One of the main factors in healing after implant reconstruction is decreasing fluid accumulation around the breast implant. This leads to a quicker recovery and decreases the risk of infection. Most patients will be released to full arm range of motion at 3 weeks and can return to light daily activities 4 weeks after surgery. Most patients can resume all activities without restrictions, including lifting, at 2-3 months.
For a detailed layout of what to expect after your implant reconstruction please click here for the Implant Week by Week Guide.
Advances in implant based reconstruction have allowed for excellent short and long term results. Prepectoral implant placement has allowed for a natural contour, shape, and feel to the breast, where patient’s note their breasts feel similar to how they felt prior to having a mastectomy. Our conversion patients also commonly note instant relief of chest tightness and discomfort.