Implants can be placed either above (prepectoral) or below (retropectoral) the pectoralis major muscle (i.e., your chest muscle). The placement above or below the chest muscle depends on the patient’s natural body type and how much breast tissue the patient has available to cover the implant.
There are advantages and disadvantages to both “above the muscle” and “below the muscle” implants. Each approach will be discussed during your consultation.
Also called subpectoral, this is the most common positioning of the implant. A tissue expander or implant is placed into a pocket created under the chest wall muscle (pectoralis).
Prepectoral breast reconstruction involves placing the implant on top of the pectoralis muscle rather than under the muscle. This technique does not cut or compromise the chest wall. The implant is placed directly under the skin, and acellular dermal matrix (ADM) is used to act as a sling and hold the implant in place.
Women who benefit from this procedure are in relatively good shape with small to medium size breasts that are not overly saggy. Women who have thin skin are not good candidates, as the skin can be easily compromised, and there are limited options for correction if the implant becomes exposed.
Timing of your implant procedures is an important consideration in breast reconstruction. Direct to implant procedures place implants at the same time as a mastectomy, without the use of tissue expanders. If tissue expanders are used, implant placement will be delayed by several months.
If you want to combine breast implants with a natural tissue procedure, you may be a candidate for hybrid reconstruction. And if you’re concerned about having to replace implants due to complications or aging, then a natural tissue procedure such as the DIEP flap may be a better choice.