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Friday, September 1 2017

What is Pre-Pectoral Breast Reconstruction?

pre-pectoral breast reconstruction

Understandably, a woman’s mind may experience tailspin when she hears the words “breast cancer” uttered in her direction. Within the swarm of thoughts may be concern that mastectomy and breast reconstruction will be necessary. The first objective of care is to remove all indications of cancer. After recovery from the initial procedure, a woman is better able to ascertain her choices in restoring the desired shape to her breasts.

There are numerous techniques to facilitate breast reconstruction after mastectomy. No single procedure is right in every situation. This is why it is important to consult with a board-certified plastic surgeon who is familiar with the nuances of reconstructive surgery. Here, we will discuss the value of pre-pectoral breast reconstruction.

Where Convention May Fall Short

A mastectomy removes the cancer by removing breast tissue. The Conventional treatment to prepare for reconstruction typically involves the insertion of a tissue expander or breast implant beneath muscle tissue. The purpose of a tissue expander is obvious; it stretches and shapes the skin to create a breast. Because muscle tissue is also stretched, this process can be uncomfortable.  Why not simplify her reconstruction if at all possible?

Pre-Pectoral Methodology

In light of the inconsistencies, deformities, and discomfort of under-the-muscle (even partially) breast implants for reconstructive purposes, there has been high demand for a better alternative after mastectomy. The pre-pectoral method of reconstruction inserts the breast implant over the muscle, just beneath the superficial soft tissue of the breast. In this location, the implant can round out the breast without being affected by muscle movements that may distort appearance.

What makes pre-pectoral breast reconstruction a possibility is the combination of technique and well-made breast implants. It used to be that over-the-muscle implants were relatively unstable. They may shift because they have no reliable pocket in which to sit (as do sub-muscular implants). The pre-pectoral reconstructive procedures that are performed today include a makeshift pocket that is formed from biologic tissue (ADM or acellular dermal matrix). This is natural cellular tissue that forms a pocket to hold the implant.

The recovery process for this procedure is lessened compared with a traditional under-the-muscle reconstruction .

There is:-

  • Less need for pain medications after the surgery. Most patients take about 1-2 days worth of oral pain meds.
  • The shape is optimized without the muscle affecting movement.
  • Long-term outcomes in terms of shape and stability is encouraging. In fact, many women with pain and discomfort from implants placed under the muscle are having a “site-change” or implants repositioned above the muscle.

Not everyone is a candidate for this type of reconstruction:-

  • Patients who need radiation or have thin skin with minimal fat are not ideal candidates.
  • Longer term data to compare outcomes are still needed and are on-going.

It may be worth while to see if you are if you are a candidate of this reconstruction . Dr. Ong performs above the muscle (Pre-pectoral) breast reconstruction either with tissue expander or direct implant reconstruction. She was the first surgeon to perform a direct-to-implant breast reconstruction at  Virginia Piper Cancer Center earlier this year. Here are examples of pre-pectoral breast reconstruction.

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