Our Summary

This research paper discusses a method of breast reconstruction after a mastectomy (breast removal surgery), known as prepectoral reconstruction. This method is increasingly popular due to its benefits for suitable patients. It allows the pectoral muscle to remain in its natural position, leading to less pain, improved strength and movement in the upper body, and prevents issues with the look and feel of the reconstructed breast.

A material known as acellular dermal matrices (ADMs) is used in this procedure to accurately shape the breast, leading to satisfying aesthetic results for patients. ADMs also help reduce complications like hardening of the tissues around the implant, which can be particularly helpful for patients undergoing radiation therapy after mastectomy.

However, in this method, the breast implant is placed closer to the skin, meaning there’s less blood-rich tissue around it. Therefore, careful selection of patients, thorough evaluation during surgery, and specific post-surgery care plans for this type of reconstruction are essential for achieving the best results.

FAQs

  1. What are the advantages of prepectoral breast reconstruction compared to retropectoral position?
  2. How does the use of acellular dermal matrices (ADMs) in prepectoral breast reconstruction contribute to the procedure’s effectiveness?
  3. What considerations are necessary for optimizing outcomes in prepectoral breast reconstruction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about breast reconstruction is to carefully follow post-operative care instructions to ensure optimal healing and long-term results. This may include avoiding strenuous activities, keeping the surgical site clean and dry, and attending follow-up appointments with your healthcare provider. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support the healing process and overall well-being.

Suitable For

Patients who are typically recommended for prepectoral breast reconstruction are those who have undergone mastectomy for breast cancer or other medical reasons and desire reconstruction of their breast(s). Good candidates for prepectoral reconstruction are those who do not have a history of radiation therapy, have minimal ptosis (drooping) of the breast tissue, have adequate soft tissue coverage, and have realistic expectations for the outcome of the surgery. Additionally, patients who are at a low risk for capsular contracture and have a healthy lifestyle are also good candidates for prepectoral breast reconstruction. It is important for patients to discuss their options with a plastic surgeon to determine if prepectoral breast reconstruction is the best choice for them.

Timeline

Before breast reconstruction:

  1. Diagnosis of breast cancer or decision to undergo prophylactic mastectomy
  2. Consultation with a plastic surgeon to discuss reconstruction options
  3. Decision on the type of reconstruction – autologous tissue reconstruction or implant-based reconstruction
  4. Preoperative evaluation and preparation for surgery

After breast reconstruction:

  1. Surgical procedure for breast reconstruction – either immediate reconstruction at the time of mastectomy or delayed reconstruction after mastectomy
  2. Recovery period following surgery, including monitoring for any complications
  3. Follow-up appointments with the plastic surgeon to assess healing and address any concerns
  4. Possible additional procedures for symmetry, nipple reconstruction, or revision surgery
  5. Adjustment to the new breast appearance and self-image
  6. Psychological support and counseling as needed to cope with the emotional aspects of breast reconstruction
  7. Long-term follow-up for monitoring of the reconstructed breast and overall breast health.

What to Ask Your Doctor

  1. What are the different types of breast reconstruction options available to me?

  2. What are the benefits and risks of prepectoral breast reconstruction compared to other methods?

  3. How long is the recovery time for prepectoral breast reconstruction?

  4. Will I need additional surgeries or treatments after the initial reconstruction?

  5. How will prepectoral reconstruction affect the appearance and feel of my breast compared to my natural breast?

  6. What are the potential complications or side effects of prepectoral breast reconstruction?

  7. How will prepectoral breast reconstruction impact my ability to undergo future screenings or treatments for breast cancer?

  8. Am I a good candidate for prepectoral breast reconstruction based on my medical history and current health?

  9. What can I expect in terms of scarring and sensation in the reconstructed breast?

  10. Can you provide me with before and after photos of patients who have undergone prepectoral breast reconstruction?

Reference

Authors: Graziano FD, Henderson PW, Jacobs J, Salzberg CA, Sbitany H. Journal: Aesthet Surg J. 2020 Nov 17;40(Suppl 2):S22-S28. doi: 10.1093/asj/sjaa214. PMID: 33202014