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Pre-Pectoral Reconstruction: A New Technique for Breast Reconstruction After Mastectomy

One in 8 women will develop breast cancer in her lifetime, and many of these women will undergo a mastectomy to remove one or both breasts followed by reconstruction. 

According to one study, 56 percent of women with breast cancer undergo reconstruction after mastectomy, which involves the removal of the cancer and all surrounding breast tissue. With traditional implant based reconstruction, we insert a tissue expander or a breast implant underneath the chest muscle, which provides tissue coverage as a mastectomy removes all the breast tissue. However, this approach has drawbacks, such as pain after surgery due to stretching of the muscle with expansion or an unnatural, flat looking implant. 

Reconstruction has evolved in recent years, giving many women who have undergone breast cancer treatment more options. One approach that is gaining traction is pre-pectoral reconstruction. 

Pre-Pectoral Reconstruction

A new method of breast reconstruction is pre-pectoral reconstruction, where a plastic surgeon places the expander or implant above the pectoralis major muscle, which is part of the chest and is located directly under a woman’s breast. Since we don’t have to make an incision in the muscle, there’s less pain and a more natural look because the breast implant is placed above the muscle and under the skin.

Pre-pectoral reconstruction has several advantages, including less pain from the mastectomy and reconstruction, as the deep pain of lifting the pectoralis major muscle from the chest wall can cause severe spasm. This is why all plastic surgeons give muscle relaxers as standard post-surgery medication. Pre-pectoral reconstruction also leads to less pain from expanding the tissue and prevents animation deformity, which is apparent when a woman flexes her pectoralis muscles or moves her arms.  This can be quite alarming and embarrassing.  This procedure also maintains the breast’s normal anatomy, since the breast tissue is being replaced by an implant and/or expander on top of the muscle- this is its normal location.  A patient's body mass index (a parameter that uses weight based on height) can affect how natural the implant looks after surgery. Patients with larger BMIs will most likely get a better shape after pre-pectoral reconstruction. Patients also should be aware that pre-pectoral reconstruction does not affect the ability to detect breast cancer surveillance.

Pre-pectoral reconstruction has the same risks as traditional reconstructions below the muscle including bleeding, infection, fluid buildup around the treatment site (seroma), and post-surgical pain. In a small percentage of cases, an implant may rupture or rotate. This procedure is not right for every patient. Pre-pectoral reconstruction also requires breast surgeons to avoid mastectomy skin flap necrosis, which leads to scarring and deformity and affects anywhere from 5 to 30 percent of breast cancer patients, according to research.

Anyone considering pre-pectoral reconstruction should schedule an appointment to see a qualified, board-certified plastic surgeon who specializes in this procedure. Since this procedure is a newer approach to reconstruction, not every surgeon will offer it — right now, I am the only surgeon in central Florida doing all pre-pectoral reconstruction. 

To me, pre-pectoral reconstruction is a game-changer for women who have undergone breast cancer treatment. We’ve already seen great outcomes for many patients. I’m hopeful that as more women become aware of this procedure, they’ll discuss this treatment option with their doctor. At UF Health Cancer Center - Orlando Health, we take a multidisciplinary approach to care and our team includes doctors and care providers who all have different specialities. With this approach, we all can work together to decide which type of reconstruction is best for you and give you the best outcome.