Revising Prepectoral Breast Reconstruction

Abstract

Prepectoral prosthetic breast reconstruction continues to gain popularity, largely due to its decreased postoperative pain, animation deformity, and operative time as compared to subpectoral reconstruction. Widespread use has led to opportunities for surgical revisions. While some techniques for submuscular reconstruction revisions, such as implant exchange and fat grafting, also apply to prepectoral revisions, others require modification for the prepectoral space. The prosthesis' unique reliance on the mastectomy flaps and acellular dermal matrix for support leads to a progressive alteration of the breast footprint, conus, envelope, and nipple-areola complex position. To date, revisions of prepectoral reconstructions have not been addressed in the literature. This article presents the senior author's (N.P.B.) techniques for (1) revising prepectoral breast reconstructions, including staged and direct-to-implant reconstructions, with a special focus on nipple-sparing reconstruction, and (2) minimizing undesirable outcomes of prepectoral reconstruction.

Association of Neoadjuvant Chemotherapy With Postoperative Outcomes in Immediate Prepectoral Prosthetic Breast Reconstruction

“…There is a growing body of literature that reports the strength of prepectoral breast reconstruction, compared with subpectoral reconstruction, including the simple, less invasive nature of the procedures, and associated relatively early recovery with less postoperative pain. 15,21 This method avoids complications related to pectoralis major muscle use, such as animation deformity, which develops frequently in subpectoral reconstruction cases. However, there are several disadvantages of prepectoral reconstruction that may be important.…”

Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion

“…Autologous fat grafting offers selective augmentation of focal deficiencies, poor breast shape, visible implant edges, capsular contracture, and radiation sequelae 11,12 . Autologous fat grafting is incorporated into more than 30% of breast procedures, and its role in prepectoral reconstruction is often necessary to achieve optimal outcomes, with rates as high as 82% 1,9,10,13–17 . Although the safety and efficacy of AFG are well established, 11,18–21 this technique continues to face several well-known challenges.…”

“…11,12 Autologous fat grafting is incorporated into more than 30% of breast procedures, and its role in prepectoral reconstruction is often necessary to achieve optimal outcomes, with rates as high as 82%. 1,9,10,[13][14][15][16][17] Although the safety and efficacy of AFG are well established, 11,[18][19][20][21] this technique continues to face several well-known challenges. Reoperation to resolve remaining contour deformity in the form of a second or third round of AFG has been reported in 8% to 18% and 3% of cases, respectively.…”