A breast implant can be placed over or under the chest wall muscle (pectoralis) after mastectomy. Implants placed over the muscle (OTM) are called prepectoral implants. This implant placement keeps the muscle in its natural position, which decreases pain after surgery. It also helps patients avoid an issue called implant animation, which is when a breast implant that is placed under the muscle (UTM) visibly moves or changes shape when the pectoralis muscle contracts during normal activity.
Types of Prepectoral Breast Reconstruction procedures
Prepectoral tissue expander
Expander OTM, completely covered with a dermal matrix (beige). Saline is injected into the expander through the expander port in the office to achieve final volume.
Implant OTM, completely covered with a dermal matrix (beige).
- A surgeon assesses breast skin quality immediately following mastectomy
- In patients with healthy skin and adequate blood supply, a tissue expander or implant is placed OTM and covered with biologic tissue matrix for support
- If a tissue expander is used, the final implant is placed in the same position in a second stage procedure
Risks & Benefits
Since the implant is not covered with muscle, the implant edge may be more apparent, and breast skin rippling related to the implant may be more visible. The newer generation of more cohesive breast implants can help minimize these problems. Implant related problems can also be corrected with secondary outpatient revision procedures, such as fat grafting.
The benefits of prepectoral reconstruction outweigh its potential drawbacks for most patients. This position alleviates animation of the breast implants after surgery for a more natural-looking, comfortable breast reconstruction. The implant’s more natural position OTM typically results in an easier, less painful recovery than breast reconstruction with implants UTM.