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PROCEDURES / BREAST RECONSTRUCTION
PREPECTORAL REVISION RECONSTRUCTION
Over the past three decades implant-based reconstruction has usually involved placement of the implant in a partial submuscular position, requiring elevation of the pectoralis muscle to cover the upper portion of the implant. This was advocated in the past because of more aggressive mastectomy techniques, which were occasionally associated with problems of mastectomy flap survival and implant exposure, and reconstructive failure.
Patients with implant reconstruction below the muscle can observe a deformity of the upper pole breast skin with muscle animation, leading to wrinkling of the upper pole breast skin. Some patients complain of a chronic sense of “tightness” or of “the constant sensation of a tight bra” after submuscular implant-based breast reconstruction. Prepectoral revision reconstruction can reliably correct these symptoms.
During a prepectoral revision reconstruction the existing breast scars are excised, and a new pocket is created in the tissue plane above the pectoralis muscle. The existing implant is removed and the pectoralis muscles are reinserted into the chest wall by suture techniques. A new implant is placed into the prepectoral space. Often, acellular dermal matrix—a sheet of collagen derived from human donor tissue from which all living cells are removed to limit tissue rejection—is used to cover or wrap the implant to act as a soft tissue reinforcement and possibly reduce the incidence of capsular contracture.
Patients notice relief of symptoms of tightness and elimination of dynamic deformity immediately postoperatively. The procedure is planned as an outpatient procedure with return to normal activities expected within 2–4 weeks.
Based on the Women’s Health and Cancer Reconstruction Act, a federal law enacted in 1998, prepectoral revision procedures are considered medically necessary and these federal mandates ensure insurance coverage.