Prepectoral Breast Reconstruction

A breast implant is placed on top of the chest wall muscle either at the time of mastectomy or as a second stage procedure.


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

A tissue-expander implant is covered with a biologic tissue matrix and placed in a prepectoral position OTM. The expander implant is replaced with a final implant in the same position as a second stage procedure.

DTI split plane

© Image Credit

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.

Prepectoral direct-to-implant

A final implant is covered with a biologic tissue matrix and placed in the prepectoral position OTM Immediately following mastectomy.

DTI split plane

© Image Credit

Implant OTM, completely covered with a dermal matrix (beige).

Procedure details:

  • 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.