Understanding Pre-pectoral Implant Reconstruction

Pre-pectoral breast reconstruction is one of the newest options in implant breast reconstruction that involves placing the implant directly under the skin on top of the chest muscle, without the need to cut or lift the muscles. The implant is typically reinforced with 'ADM' - acellular dermal matrix or "biologic mesh" to reinforce and protect it. This type of reconstruction offers a number of advantages over traditional implant reconstruction for the right patient. Dr. Oren Lerman, reconstructive breast surgeon in Manhattan, NY, can determine if you are eligible for pre-pectoral implant reconstruction. At the forefront of the latest in reconstructive approaches, Dr. Lerman routinely performs the Pre-pectoral breast implant reconstruction procedure to achieve improved results, shorter recovery, and more natural appearance.  

Traditional vs. Pre-pectoral Implant Reconstruction

In traditional implant reconstruction, the reconstructive plastic surgeon inserts a tissue expander or breast implant partially or entirely beneath the pectoralis muscle of the chest. The tissue expander is used to gradually stretch the skin and chest muscle to the desired size. A major drawback to this approach is that it can produce short- and long-term discomfort due to incisions in the muscle and a feeling of tightness or pressure because of its location under the muscle. In addition to potentially causing discomfort, traditional implant reconstruction can create an unnatural appearance as a result of the implant location and the visible movement of the muscle on top of the implant, often referred to as "animation deformity" or "window-shading"

Illustration of pre-pectoral breast reconstruction; over vs. under the muscle.
Pre-pectoral breast reconstruction involves placing the implant over the chest muscle vs. under the chest muscle

The alternative, over-the-muscle method can help alleviate the pain associated with muscle stretching. Pre-pectoral implant reconstruction has emerged in recent years as an approach that can sidestep the problems particular to sub-muscular implants.

Placing the implant over the muscle avoids the pain caused by cutting and stretching the muscles, and reduces the chance of visible deformities.

Candidacy for Pre-pectoral Implants

Pre-pectoral breast reconstruction is an option for most women who are preparing to undergo breast reconstruction, or who have previously had a sub-muscular reconstruction but are dissatisfied due to pain, discomfort, asymmetry or visible deformities. It is important to work with a breast surgeon and plastic surgeon who routinely practice as a team and are familiar with the pre-pectoral procedure.

The over-the-muscle breast implant method may also be a better choice for women who have previously undergone traditional, sub-pectoral breast reconstruction and are experiencing problems with their implants. A common problem is capsular contracture where the implants become hard due to scar tissue surrounding the implant known as a capsule. Other problems with sub-muscular implants include a feeling of tightness in the chest or visible movement of the muscle on top of the implant or unnatural movement of the implant.

Benefits of Pre-pectoral Implant Reconstruction

Patients receiving over-the-muscle implants can experience benefits when compared to traditional implant reconstruction, such as:

  • Shorter recovery
  • Less postoperative pain
  • Less long term discomfort associated with muscle tightness
  • No muscle animation or visible implant distortion
  • More natural appearance 

Learn More about Pre-pectoral Implant Reconstruction

If you are preparing for breast reconstruction surgery, or have undergone reconstruction and are unhappy with your results, learn more about a pre-pectoral implant reconstruction by scheduling a consultation with Dr. Oren Lerman today. You can also contact us by phone at (212) 434-6980.

Dr. Oren Lerman

Oren Z. Lerman, MD

Dr. Oren Lerman performs a variety of cosmetic and reconstructive procedures with a specialty in reconstructive breast surgery. In fact, he is the director of breast reconstruction at Lenox Hill Hospital's Institute for Comprehensive Breast Care as well as the Microvascular and Cosmetic Breast Fellowship. In addition to the hospital, Dr. Lerman is affiliated with:

  • The New York Regional Society of Plastic Surgeons (Past President)
  • The American Board of Plastic Surgery (Diplomate)
  • The American College of Surgeons (Fellow)
  • The American Society of Plastic Surgeons
  • The American Society of Reconstructive Microsurgery

You can schedule a consultation with Dr. Lerman by filling out our online form or calling (212) 434-6980.

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"The one thing that is most important when we're doing cosmetic surgery and aesthetic surgery of the face or the body is to make sure that the patient is happy afterwards..." Dr. Oren Lerman

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