A New Approach: Pre-Pectoral Breast Reconstruction

Pre-pectoral breast reconstruction is an alternative approach to traditional breast reconstruction, where the implants are placed over the muscle instead of underneath it.

Prepectoral breast reconstruction resultsPre-pectoral breast reconstruction has been made possible in large part by the use of biological mesh products (called acellular dermal matrices) that can substitute for muscle to cover, protect, and support a patient’s implants.

According to a recent article in The New York Times:

“Placing breast implants under the chest muscle, a procedure called post-pectoralis or sub-muscular placement, has been the standard approach to implant breast reconstruction for decades. But now some surgeons are placing the implants on top of the muscle, in an effort to reduce complications like pain, weakness and breast deformities that can occur with sub-muscular implants when the chest muscles are flexed.”

The article goes on to interview Dr. Sbitany, an associate professor of plastic and reconstructive surgery at UC San Francisco and a consultant for Allergan, a manufacturer of the mesh products:

“Dr. Sbitany said that since he started talking about the new option, known as prepectoral breast reconstruction, he has been besieged by patients who have had submuscular implants for five, 10 or 15 years and want the reconstruction done over. Artificial breast implants are the most common method of breast reconstruction after mastectomy.

When patients want them replaced, Dr. Sbitany said, he removes the old implants, places the pectoralis major muscle back down where it used to be and inserts new implants on top of the muscle, using biological mesh to cover and support them under the skin.

‘There is no question that putting the implant below the muscle causes increased rates of pain and chronic discomfort with any physical activity — not in every woman, but in a consistent number of patients,’ said Dr. Sbitany.”

Washington, DC Area Pre-Pectoral Breast Reconstruction 

The physicians at Bruno|Brown Plastic Surgery are a part of a forward-thinking movement that challenges the traditional under-the-muscle technique. While there are many patients who still benefit from this traditional method, the number of patients eligible for pre-pectoral breast reconstruction is growing.

Dr. Brown and Dr. Bruno routinely lecture nationwide on this technique and take part in educational labs in teaching plastic surgeon colleagues.

Benefits of Pre-Pectoral Breast Reconstruction Include:

  • No muscle fatigue or chronic pain
  • No muscle animation or pull on skin
  • Quicker recovery, less pain, less downtime

Candidates for Pre-Pectoral Breast Reconstruction Include:

  • Patients undergoing mastectomy
    Previously reconstructed patients
    Active patients

The pre-pectoral breast reconstruction procedure may not be the best fit for all patients, so make sure you discuss your options with a board-certified plastic surgeon.

Contact us today to set up your consultation.



The Impact of Animation Deformity on Quality of Life in Post-Mastectomy Reconstruction Patients

From The Aesthetic Surgery Journal
By Hilton Becker, Nicole Fregosi

Background: Animation deformity after subpectoral breast implant placement has been documented; however, the actual prevalence and effect on patient quality of life has not been studied much.

Objectives: The purpose of this study was to show that all patients with subpectoral implants experience some degree of animation deformity and that it can affect their quality of life, including causing embarrassment and discomfort in reconstructed patients.

Methods: Patients who underwent breast implant surgery were contacted for inclusion in the study. Patients were obtained from a single surgeon’s practice but included patients operated on outside the practice, and those seen in the practice for a consultation. A six-item questionnaire was developed by the senior author (H.B.) and the medical student (N.F.) involved in the study, to assess quality of life related to animation deformity. Patients had their degree of animation deformity assessed by the senior author and a medical student.

Results: Of 25 patients who agreed to the questionnaire and assessment, 20% had grade I distortion, 44% grade II, 24% grade III, and 12% grade IV. Of the patients questioned, 80% were bothered by an animation deformity and 45% of those patients were bothered to a significant degree (≥6 out of 10). In addition, 48% of patients felt that the animation deformity interfered with their daily life, and 28% (7/25) of patients underwent, or were scheduled to undergo, revision of their reconstruction at the time of interview. The degree of the clinically observed animation deformity was correlated with patient dissatisfaction, with an R value of 0.47 (P value = 0.0145).

Conclusions: All patients with subpectoral implant positioning will experience some degree of animation deformity. Especially in the reconstructed breast population, animation deformity, and its severity, affects patients’ quality of life. Other approaches to reconstruction should be considered to prevent animation deformity in this population.

Read the original article here.

For more information regarding breast reconstructive surgery in the Washington DC, Maryland, Northern Virginia area, schedule a consultation with Bruno | Brown Plastic Surgery.