Prepectoral Breast Reconstruction
on Long Island

If you have had or are considering a mastectomy, you might be wondering about your options for breast reconstruction. Whether you’re planning for a mastectomy with an immediate reconstruction, or you’ve already had a mastectomy and are now researching surgeons for breast reconstruction, you’re in the right place!

Previously, most breast reconstruction surgeries were subpectoral, meaning the implant was placed partially under the chest muscle. Prepectoral breast reconstruction surgery is an increasingly common technique where the implant placement or tissue expansion is placed in front of the chest muscle to improve recovery time and reduce pain after surgery.

The professionals at Harris Plastic Surgery pride ourselves on our commitment to our patients through every step of the breast reconstruction process. Call our office today for more information or to set up a consultation appointment.

Prepectoral Breast Reconstruction Technique

Prepectoral breast reconstruction occurs after a mastectomy and involves placing breast implants or tissue expanders in front of the pectoral muscles. In the past, breast reconstruction involved placing the implants behind the chest muscles, a procedure called partial subpectoral reconstruction. However, this procedure had drawbacks, including post-operative pain and the potential for reduced shoulder range of motion.

Surgeons have begun using prepectoral breast reconstruction to improve the patient experience with shorter recovery time, improved function after healing, and better aesthetic results. The reconstructive surgery involves the following steps:

Steps in a Prepectoral Breast Reconstruction

Incisions

  • Your plastic surgeon will begin by planning incisions together with the breast surgeon, customized to each patient’s surgical plan.
  • For delayed reconstruction, the incisions’ exact placement will be discussed before surgery to meet your individual needs and create the best functional and aesthetic reconstruction, often using the same incisions as the mastectomy.

Placement of Breast Implant or Tissue Expanders

  • During immediate reconstruction, after the mastectomy, the plastic surgeon will place implants in front of the pectoral muscles.
  • In some cases, the implants will be held in position by surgical mesh or acellular dermal matrix (ADM).

Placement of Tissue Expanders

  • If needed, after the mastectomy, the plastic surgeon will place tissue expanders in front of the pectoral muscles.
  • These are empty implants that will be filled gradually with saline solution over weeks or months, expanding the tissues over time to the ultimate size and shape of the final implant which is then placed during a second planned procedure replacing the tissue expanders.

Delayed Reconstruction

  • During delayed reconstruction, the plastic surgeon will recreate the mastectomy space on top of the pectoral muscles, placing the tissue expanders in that space.

Autologous Fat Transfer

  • Implant procedures may be accompanied by autologous fat grafting, taking fat from one part of your body and using it to enhance the appearance and peripheral contours of the reconstructed breasts.
  • Usually, autologous fat grafting is performed at a second stage a few months after the primary reconstruction.

Wound Closure

  • Once the implants or expanders are in place, the surgeon will place surgical drains to prevent fluid buildup and close the incision with sutures.

Recovery

  • Some individuals can leave the hospital the same day as their surgery, and most after an overnight stay, but should plan on rest for at least a few days post-op. 
    • Walking and non-exertional activities will be encouraged during the initial recovery!
  • Patients will typically be able to return to light activities within a week of their surgery.

Like all surgeries, the prepectoral breast reconstruction procedure carries some risks. However, most side effects can be managed with proper supportive care from the best plastic surgery team in New York.

Benefits and Risks of Prepectoral Breast Reconstruction

Benefits

Risks

  • Reduced post-operative pain
  • Faster recovery
  • Improved quality of life and muscle movement
  • Better breast appearance
  • A more natural feel
  • Avoids the dynamic deformity that can occur when the muscle contracts over the implant
  • Wound healing complications and implant exposure
  • There may be visible implant rippling that is more noticeable as less tissue is covering the implant (this can be corrected by autologous fat grafting)

After the breast reconstruction is finished and has had time to heal, the final step in the process is nipple and areola reconstruction. This procedure is done through a combination of skin grafting and tattooing techniques to achieve a natural look and feel.

Speaking with a board-certified plastic surgeon is important to determine the best course of action for your breast reconstruction based on your personal goals, medical history, tissue quality, and anatomy. Your plastic surgeon will help you develop a personalized treatment plan that gives you the best quality care and aesthetic outcomes for long-term reconstruction success.

Autologous Fat Grafting and Prepectoral Revision in Breast Reconstruction

Frequently Asked Questions About Prepectoral Breast Reconstruction

Prepectoral breast reconstruction involves placing the implant above the chest muscle (pectoralis), directly under the skin, after a mastectomy. This method contrasts with previous reconstruction techniques where the implant was placed beneath the muscle.

Candidates for prepectoral reconstruction typically include women who have healthy skin and sufficient tissue thickness post-mastectomy. It’s particularly suitable for those undergoing nipple-sparing mastectomy or women who want to avoid the discomfort associated with placing implants under the chest wall.

Benefits include less post-surgery pain, a more natural look, faster recovery, and the elimination of complications related to placing the implant under the muscle, such as animation deformities where muscle flexing causes the implant to move.

Risks include the standard surgical risks such as infection or capsular contracture (hardening of scar tissue around the implant). Additionally, if there’s not enough skin or tissue coverage, there could be a risk of implant visibility or rippling, these can be corrected by fat grafting at a later date.

In a prepectoral reconstruction, the implant is placed above the pectoralis muscle, while in a partial subpectoral reconstruction, the implant is placed beneath it. Prepectoral reconstruction tends to have less post-op discomfort, but a subpectoral placement may be recommended if additional tissue coverage is needed for a natural look.

Recovery from prepectoral reconstruction is typically shorter and less painful than subpectoral reconstruction. Many patients can resume light activities within a week, with full recovery usually taking 4-6 weeks.

Yes, prepectoral implants are designed to give a natural breast shape and appearance. The use of advanced techniques and support materials, like acellular dermal matrices and fat transfer, help create a smooth contour and minimize implant visibility.

Yes, however radiation therapy can increase the risk of complications with implants, such as capsular contracture or implant failure. If you need radiation therapy, you can discuss with your plastic surgeon all the alternatives which will include immediate or delayed prepectoral breast reconstruction, partial subpectoral implant placement, or the use natural tissue flaps.

Prepectoral reconstruction is generally considered less painful than traditional subpectoral reconstruction because the implant is placed over the muscle, avoiding muscle dissection and associated post-operative healing. Patients report less tightness and chest muscle discomfort post-surgery when the implant is placed above the chest muscles.

Yes! Fat grafting is often used in conjunction with prepectoral reconstruction to enhance the breast’s contour at the northern pole and provide additional tissue coverage over the implant, resulting in a more natural look and feel.

An acellular dermal matrix, or similar biologic mesh, is typically used to provide support and coverage for the implant. These materials help integrate the implant into the body and create a natural-looking breast contour.

As with all implant-based reconstructions, there is a possibility you might need future revisions or replacements, particularly if you end up with complications like capsular contracture or implant shifting. Regular follow-ups with your plastic surgeon will help monitor the condition of your implants over time.

In some cases, women who have had subpectoral implants or other types of reconstruction may be able to transition to prepectoral implants. This would depend on factors like how healthy your tissues are, what your previous surgeries were, and your overall breast shape and desired outcomes. This alternative is especially useful in women who have pronounced animation deformity or chronic tightness after partial subpectoral implant reconstruction. Contact Harris Plastic Surgery if you have more questions about revision breast reconstruction surgical options.

Harris Plastic Surgery: Extraordinary Care and Customized Treatment

Every breast reconstruction at Harris Plastic Surgery begins with a unique and personalized assessment during your initial consultation. Dr. Harris will provide details about breast reconstruction options and discuss the pros and cons of all options for your specific case, measurements, and preferences.

Dr. Harris prides himself on his strict aseptic techniques to ensure the best results of his surgeries, with the least risk of complications and the best long-term results. Harris Plastic Surgery has been known as the leading expert in breast reconstruction surgery for decades because of their whole-office commitment to patient experience and phenomenal outcomes.

From the administrative staff and Joanne Parrinello’s dedication to assisting patients in understanding their insurance coverage and supporting them in determining which treatment options are best for their needs to Dr. Harris’s distinguished career in helping women achieve their reconstructive dreams and feel like their best selves, Harris Plastic Surgery will be with you for every step of your breast reconstruction journey.

If you want more information on prepectoral breast reconstruction surgery or are ready to schedule your consultation today. Contact us online or by phone/text if you have questions for the Harris Plastic Surgery Team.

CONTACT

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.