Implants: Prepectoral Breast Reconstruction Vs. Subpectoral Breast Reconstruction

Plastic Surgeon and patient comparing prepectoral breast reconstruction vs subpectoral breast reconstruction options
There are so many things to consider when getting a breast reconstruction. You’ll need to consider the timing of your surgeries – if you get an immediate or delayed reconstruction, the type of reconstruction – implant-based or autologous tissue flap, your nipple and areola reconstruction options, and you’ll also need to decide if a prepectoral breast reconstruction or subpectoral breast reconstruction is the right choice for you. These are important discussions to have with your plastic surgeon, but I’ll provide you with more information on your prepectoral vs. subpectoral reconstruction options in this post. The Harris Plastic Surgery team is here to provide you with all the answers you need to make the best decision for you. Each breast reconstruction journey is different, and so is the woman making these choices. We are here to help you every step of the way!

Prepectoral vs. Subpectoral Breast Reconstruction

In breast reconstruction surgery, many individuals choose implants to rebuild the volume of the tissue that had to be removed. When it comes to implant placement, there are two options: you can place the implant in front of or behind the pectoralis muscle in the chest. Both options have unique benefits and risks, as listed in the table below.

Pros and Cons of Breast Reconstruction Methods

Prepectoral Breast Reconstruction

An image showing a breast implant above the muscle.

Subpectoral Breast Reconstruction

An image showing a breast implant above the muscle.
In prepectoral breast reconstruction, the pectoralis muscle is left alone, and the implant is placed on top of the muscle and then held in place by an acellular dermal matrix or biologic mesh. Subpectoral breast reconstructions have become less common in recent history. In this method, the breast implant is placed partially under the pectoralis muscle. Acellular dermal matrix is then used to cover the lower pole of the implant from the edge of the pectoral muscle down to the chest wall.
Pros Cons Pros Cons
  • Typically, it does not interfere with muscle function
  • Eliminates dynamic deformity
  • More natural look and feel
  • Fewer post-surgical complications
  • Less pain and discomfort during recovery
  • Faster recovery time
  • Implants are closer to the surface and might be more noticeable
  • Possible rippling (where the skin or implant surface wrinkles because there is less tissue between the implant and the skin)
  • Potential for long-term maintenance
  • Possible implant displacement over time
  • Softer upper pole transition because of increased soft tissue coverage over implant
  • Lower risk of rippling
  • Better implant stability
  • Longer recovery time
  • More pain and discomfort during recovery
  • Potential for dynamic deformity
  • Impacts upper body muscle use – an essential consideration for athletes
If you’re contemplating prepectoral vs. subpectoral breast reconstruction, there are more factors to weigh in addition to the pros and cons. The two surgical procedures also involve different steps, although both surgeries begin with general anesthesia and incisions.

Breast Reconstruction Surgical Techniques

Plastic surgeons generally use different locations for breast reconstruction incisions, depending on whether you have previously had a mastectomy and are doing reconstruction later or you’re looking into doing a mastectomy with immediate reconstruction. Incision location is something you should discuss with your plastic surgeon during your consultation appointment. After making the incision, the plastic surgeon creates a pocket for the implant or tissue expander. Tissue expanders are empty implants filled with saline solution over a period of time to make room for a final implant. For the two options, the position of the pocket and implant placement will differ. In prepectoral breast reconstruction, the pocket is created between the pectoral muscle and the skin of the chest wall. The implant is then placed above the chest muscles, under the skin, and held in place by an acellular dermal matrix or biologic mesh. During subpectoral breast reconstruction, the plastic surgeon will create the pocket, often using a “dual-plane” surgical technique that places the implant partially beneath the pectoralis chest muscle and partially beneath the skin of the chest, usually with acellular dermal matrix covering the lower pole of the implant. In this surgery, the muscles of the chest cover the upper pole of the implant, creating a more natural transition from the chest wall to the implant. For both surgeries, after the implant is placed, the plastic surgeon will evaluate the placement, make any adjustments necessary, and close the incision. You will be given post-op instructions specific to your type of surgery, implants, and incisions, and will often be released from the hospital the same day or the day after your surgery to recover at home. To recreate a more natural contour transition around the upper pole of the implant, autologous fat grafting is often used after the initial implants are placed and have healed. For this procedure, fat from other areas of the patient’s body is removed by liposuction and grafted  around the breast implant to give a more full and soft breast mound with better peripheral contour.

Are You Considering Prepectoral vs. Subpectoral Breast Reconstruction Surgery?

Getting breast reconstruction surgery can seem like a daunting task full of unknowns and important decisions. That’s why our team is here to help you get all the information you need to feel confident and secure in your choice. At Harris Plastic Surgery, we believe getting to know you is the best way to ensure great outcomes not only during your surgery but for your life after! Our expert medical team will spend time getting to know you, why you need breast reconstruction, what your goals are, and how we can meet those needs. Our excellent administrative team is also here to help you walk through all the practical aspects of insurance coverage that accompany surgery.

Bringing Patient Advocacy to Breast Reduction and Reconstruction

If you are ready to discuss your surgical options or need help deciding if a prepectoral vs subpectoral breast reconstruction is right for you, contact us today!

Stephen U. Harris, MD FACS

Dr. Stephen U. Harris is a board-certified cosmetic surgeon and recognized expert in breast reduction and reconstruction surgeries, having performed thousands in his career. When it comes to patient care, his philosophy is that every surgery should improve his patient’s overall quality of life, not just their appearance. Dr. Harris stays up-to-date on all the latest advancements in breast augmentation, reconstruction, and reduction and is a recognized innovator in the field. In fact, he was the first surgeon at Good Samaritan Hospital to offer primary prepectoral implant breast reconstruction, as well as secondary prepectoral revision surgery.

Dr. Harris also serves as Chief of Plastic Surgery at Good Samaritan Hospital in West Islip, New York and is an active staff surgeon (and former Chief of Plastic Surgery) at South Shore University Hospital in Bay Shore, New York.

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