Pre-Pectoral Implants

Abstract

Pre-pectoral implant-based breast reconstruction (IIBR) is a relatively new technique in the armamentarium of oncoplastic breast surgery. This chapter provides a summary of pre-operative considerations, surgical approach and steps and outcomes of pre-pectoral implant-based reconstructions. Patient selection is probably the most important step that dictates the success of pre-pectoral IIBR. A detailed pre-operative clinical assessment is necessary and should include examination and planning for implant-based reconstruction. Pre-pectoral technique avoids muscle detachment, resulting in less post-operative pain, avoiding animation deformity and possibly less capsular contracture. Patients with a pre-pectoral reconstruction had a higher body mass index and implant size as compared with the sub-pectoral group, with comparable complications and implant loss rates. Comparative results of pre-pectoral reconstructions using different acellular dermal matrices or meshes are lacking and a recent prospective study from the UK, looking at short-term, long-term and patient-reported outcomes using various pre-pectoral reconstruction techniques has completed accrual, with results awaited.