Option for subfascial breast implants after a prophylactic double mastectomy in a thin patient with weak pectoral muscles?

Question

Is subfascial breast implant placement an option after a prophylactic double mastectomy (for ADH) in a thin patient with weak pectoral muscles who is otherwise healthy. I can’t find info on the internet regarding use of subfascial implants specifically for breast reconstruction after mastectomy.

Ryan Rebowe, MD · Answer

Depending on the thickness of your skin this may be an option, however following a mastectomy this is considered "prepectoral" breast reconstruction as there is no breast fascia remaining. You should find a plethora of information on prepectoral reconstruction when searching this term. I have included a link to an article that I wrote with Dr. Nahabedian on the subject. It is important to note that prepectoral reconstruction is not the best option for every patient and has its own set of risks, benefits, and alternatives when compared to submuscular reconstruction. It is normal for both types of reconstruction to include use of a dermal matrix "sling" to help support the implant.

Gary M. Horndeski, MD · Answer

The pectoralis major muscle fascia is quite thin and has really no significant benefit.  You would be better off with a totally submuscular implant with a simultaneous lift.

Best Wishes,

Gary Horndeski, M.D.

M. Shuja Shafqat, MD · Answer

Good afternoon,
Subfascial is not really a good option in a breast reconstruction. However, I do recommend pre-pectoral implant reconstruction (above the muscle) in almost all patients unless there is a specific reason, even with thin tissue. You should see a plastic surgeon with experience in pre-pectoral breast reconstruction. Best of luck!

Derek Fletcher, MD · Answer

The pectoralis major muscle fascia is very thin and is usually too damaged by the mastectomy to be used to cover and support an implant in the context of pre pectoral, implant-based breast reconstruction.

Onur Ogan, MD · Answer

Hello madamSubfascial implantation after breast sparing mastectomy is an option which should be considered carefully since you will have a very thin skin-fat and fascia(is a thin fibrous tissue) in front of the implant. That means that implants can be easily palpable, visible and open to capsular contraction complication much more then an implant placed under the muscle. Polyurethane implants reduce capsular contraction risks. Also using alloderm like scaffolds in front of the implant is another option. On the contrary i would prefer polyurethane implant under the muscle(even if the muscle is weak).Since the case is about prophylactic mastectomy i assume that there is no plan about radiotherapy. In cases which need radiotherapy, other reconstructive methods shoul be considered

Option for subfascial breast implants after a prophylactic double mastectomy in a thin patient with weak pectoral muscles?

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