Can Breast Reconstruction Be Done with the Implant on Top of the Pectoral Muscle?

I am facing a right mastectomy with reconstruction. I am small busted, A cup or smaller. I am not interested in being larger at all. Can I choose to have the implant placed on top of my pectoral muscle, similar to regular augmentation? I have read about "bottoming out" but I do not want a big or heavy implant. Will my skin be able to hold this up. I am hoping I qualify for a skin sparing mastectomy. I have DCIS and will not need chemo or radiation.

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12 Doctor Answers | Asked by 2456anon in Tulsa, OK

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Implant reconstruction

Implant based reconstruction can be done single stage or double stage. Most commonly, implant reconstruction is performed in two stages where tissue expander is placed under the pec muscle with Alloderm/Strattice as a sling for the first stage and tissue expander is exchanged to final implant for the second stage. Tissue expander/implant should be placed under the muscle because after the mastectomy, the remaining breast skin is very thin (unlike breast augmentation that has... more

Implant Based Breast Reconstruction

I am sorry to hear of your diagnosis and hope the answers here help you make the most educated decision. First off, I do not believe it is safe to place an implant above the muscle. Patients with little to no breast tissue are at unacceptably high rate of capsular contracture (scar formation) and infection by over the muscle implant placement. The pectoralis muscle has a wonderful blood supply that can not only reduce complications, but... more

Generally NOT Advisable to Have Reconstrcuction with an Implant Above the Muscle

Breast implants used in reconstruction cannot generally be placed directly in the space created by the removal of breast tissue. This is because an implant placed directly below the skin will generally not produce cosmetically desirable results and will be at high risk for eroding through the surgical incision, or through the skin itself. Consequently, breast implants used for breast reconstruction are almost always placed below the pectoralis muscle. Preparation of the mastectomy... more

Implant reconstruction after mastectomy

I'm sorry you are dealing with breast cancer, but it sounds like you are doing your research and really taking ownership of your reconstruction options. Good for you! You can certainly have a small implant for your reconstruction, which will minimize many of the potential complications (bottoming out, wrinkling, rippling, extrusion, etc). However, I would not do a reconstruction with an implant above the muscle. The implant needs as much coverage as possible,... more

Carmen Kavali, MD

11 reviews

Atlanta Plastic Surgeon

Breast reconstruction

Breast implants need good coverage to minimize complicatins. Skin sparing mstectomy leaves thin skin. therefore the implant need to be under the muscle in the upper part and Alloderm in the lower part, or a flap. Your plastic surgeon should be in the operating room at the time of themastectomy and see the thinness of the skin and be in contact with your oncologist before surgery to discuss the need for radiation. If radiation is contemplated then another form of reconstruction should... more

Breast Reconstruction Using Implants

Implant reconstruction can be performed on top of the muscle BUT is not recommended or routinely performed. The reasoning in my mind is that if implant is place above the muscle then there is very little protection for the implant and the wrinkles in the implant surface can be easily seen. More importantly, there is decreased chance for capsular contracture if the implant is placed beneath the muscle. Dr. ES

Breast Reconstruction Be Done with the Implant on Top of the Pectoral Muscle

Your request is possible but not advisable because of the thinness of the skin and sub cutaneous tissue needed to cover the implant/expander. I have done this requested placement with success but I ALWAYS advise to have good muscular coverage. PLEASE discuss with the reconstructive plastic surgeon. Best of luck.

Breast reconstruction

If you are having breast reconstruction after a mastectomy, you will not have any breast tissue to cover the implant. This will not look natural and there will be an increased risk of implant extrusion due to lack of soft tissue coverage.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast Reconstruction with an Implant over the muscle / Under the Skin is a BAD Idea

Regarding:"Can Breast Reconstruction Be Done with the Implant on Top of the Pectoral Muscle? I am facing a right mastectomy with reconstruction. I am small busted, A cup or smaller. I am not interested in being larger at all. Can I choose to have the implant placed on top of my pectoral muscle, similar to regular augmentation? I have read about "bottoming out" but I do not want a big or heavy implant. Will my skin be able to hold this up. I am hoping I qualify for a skin... more

Subglandular breast Reconstruction not recommended

I can not in good conscience even recommend a subgland reconstruction after a skin sparing msctectomy. It is an entirely different animal than a breast aug. The tissue is removed and there is virtually no tissue remaining other than a very small amount of fat on the skin. If you are very thin I would absolutely recommend going sub pectoral and using a dermal substitute like Strattice or Alloderm to supplement the result. I hope this helps you and I suggest getting... more

Breast reconstruction implant should be under the muscle

Following a skin sparing mastectomy you will need to put the implant under the muscle. The breast skin is too thin to provide adequate coverage over the implant. Even with the implant under the muscle you will have visibility of the implant in a couple of years. Best Wishes Dr. Peterson

Marcus L. Peterson, MD

4 reviews

Saint George Plastic Surgeon

Suprapectoral breast reconstruction

A cosmetic subglandular augmentation is not the same as a suprapectoral breast reconstruction since there is no gland after a mastectomy. Most plastic surgeons would recommend putting the implant under the muscle for safety as well as appearance. Since the implant will be essentially only under skin after the mastectomy, you will see the outline of the implant and the rippling more if it not under the muscle. Also, there may be more risk of complications with wound healing if the nipple and... more