Five years ago, surgeons performed almost all breast reconstruction with the implants placed under the pectoral muscle (right image). This is called sub-pectoral placement. Due to poor skin quality, surgeons usually could not place the implants on top of the muscle, called pre-pectoral placement (left image). As a result, sub-pectoral implant placement has been the gold standard for implant-based breast reconstruction for over 5 decades.
However, the significant disadvantages of sub-pectoral breast reconstruction procedures are animation deformity, tightness, functional limitations on the shoulder, and problems with implanted distortion. Therefore, patients were frequently perturbed by the physical appearance and discomfort of the deformity. Likewise, previous attempts to correct some of these aesthetic issues with fat grafting had mixed and often disappointing results, whereas their impact on functional problems had been negligible.
Now, there is a game changer that has disrupted how we perform breast reconstruction. With the advent of Alloderm™ Regenerative Tissue Matrix, surgeons can now place implants in the pre-pectoral plane with total anterior coverage. As such, performing immediate and delayed reconstruction in the pre-pectoral space eliminates many complications associated with sub-pectoral implant positioning. Moreover, numerous articles attest to the enhanced aesthetic outcomes in cleavage formation, and complete elimination of animation deformity, improved long-term comfort and reduced postoperative pain.
In a study of 142 breasts in 90 patients who had underwent elective sub-pectoral to pre-pectoral implant site conversion, postoperative resolution of animation deformity was 100%. Overall, complications are minimal with rates at 4.2% for infection, 2.1% for seroma, and 0.7% for hematoma, dehiscence, partial thickness necrosis, and explantation.
With this outstanding success rate, we have migrated to a prepectoral approach for breast reconstruction. Most excitedly, our results are similar with a dramatic reduction in animation deformity, improved cleavage formation and postoperative comfort with enhanced shoulder range of motion.
Former breast reconstruction patients who have ongoing issues with pain or deformity may eligible for breast implant conversion from under the muscle to on top of the muscle. Also, health insurance may cover this type of surgery. Our patients, who have converted, ultimately feel much better and are happier with the appearance of their breasts. Furthermore, learn about a patient’s experience with this surgery in this implant replacement video with Dr. Doubek on YouTube.
Here is what deformity looks like in these before and after photos. The first set is the patient in a relaxed pose, while the second set is the patient flexing her muscles. The deformity is obviously evident. However, six weeks after surgery, the patient can flex her muscles with no deformity.
Dr. David Janssen and Dr. William Doubek are experts in breast reconstruction. The Wisconsin plastic surgeons are helping women from places such as Green Bay, Appleton, Fond du Lac, and Sheboygan to take control and regain their lives after breast cancer. To learn more about your breast reconstruction options, request your consultation in either the Oshkosh or Appleton office using our online form or contact us at (920) 233-1540.
Not everyone is a candidate for a nipple tattoo or a reconstructed nipple. For these patients, Pink-Perfect offers realistic silicone nipples in 9 stock colors and 3 projections. Custom nipples are also offered if the nipple needs to be matched.
They look and feel amazing. We have samples in our office. Our patients and doctors love this product and get no compensation for referrals. Use code FOX25 to get $25 off your online order. Your insurance company may cover the cost of this prosthesis, but you need to personally file the claim. Our office can give our patients a prescription to cover the medical necessity of this product.
Patients deserve to feel whole again. Contact Fox Valley Plastic Surgery at (920) 233-1540 or request your consultation online. Our patients in Green Bay, Sheboygan, Appleton, Neenah, Oshkosh, Fond du Lac, and West Bend tell us breast reconstruction helps restore their body image and is an important part of their overall recuperation from breast cancer. Patients can discuss these options immediately after diagnosis of breast cancer with one of our board certified plastic surgeons, who will work closely with your general surgeon.