Prepectoral implant-based Breast Reconstruction
Prepectoral breast reconstruction is a safe, less painful, and more aesthetic alternative to submuscular implant reconstruction following mastectomy. Dr. Goldberg is of only a few experts who offer this newer technique in breast reconstruction.
What is a prepectoral implant-based breast reconstruction?
Traditionally, the tissue expander or implant is placed completely under the chest muscle (pectoralis major muscle) or partially submuscular/partial acellular dermal matrix (Dual-plane). Both the pectoralis major muscle and serratus anterior muscle or fascia are used in these techniques to cover the implant.
Although these submuscular techniques offer excellent soft tissue coverage, they require alteration and manipulation of a patient’s native chest wall. The pectoralis major muscle requires elevation and release of the pectoralis major muscle from its natural attachment during the reconstruction. This manipulation results in significant pain postoperatively. Furthermore, placement of the implant underneath the pectoralis major muscle often results in animation deformity, an unnatural movement of the entire breast when a patient moves her chest muscle. Animation deformity results from the adherence of the pectoralis major muscle to the overlying mastectomy skin. Animation deformity can be painful and unnatural for a lot of women. Often, correction of animation deformity requires converting the submuscular reconstruction into a prepectoral reconstruction.
Aesthetically, placement of implant directly under the mastectomy skin flaps allow for re-shaping of the skin over the implant resulting in a much more aesthetic and natural reconstructive results.
*Individual Results May Vary
Patient is a 53-year-old woman who was diagnosed with left breast invasive ductal carcinoma. The tumor located behind her nipple which necessitate the removal of the nipple. The patient desires to have prophylactic mastectomy on the right at the same time. She underwent 2 stage breast reconstructions with implant
Stage 1 – Skin sparing mastectomy and immediate reconstruction with tissue expander in a preopectoral space (Above the muscle)
Stage 2 – 4 months after stage 1 surgery. – She underwent bilateral breasts removal of tissue expander and placement of permanent implant and nipple reconstructions
Implant – Natrelle smooth round silicone implant cohesive gel 605 cc
Dr. Goldberg also use mesh products are called acellular dermal matrix or ADM or bio-absorable mesh such as vicryl mesh or Galaflex in her prepectoral breast reconstruction. Acellular dermal matrix is a biotechnological tissue prepared from human from which the cellular components that cause rejection and inflammation have been removed. The resulting structurally intact tissue matrix provides the biological scaffold necessary for a the patient’s natural tissue to grow into the matrix and incorporate into their body.
Breast Reconstruction Revision
Dr. Goldberg also offer breast reconstruction revision in patients who have submuscular breast reconstruction and are experiencing significant animation deformity or pain. Your insurance will cover all breast reconstruction revision procedures.