Prepectoral breast reconstruction
Short answer is no, you're likely not a good person to try pre-pectoral implant placement on.That technique really requires a lot of tissue coverage to pull off well, and you're already rippling on your're right despite having a latissimus flap already there. You need the muscle coverage of the pectoralis to hide that. On your, left side I presume the expander is already under or partially under the muscle, but the same thing applies. Doing that technique on thin patients results in a lot of undesirable issues,
Over vs under muscle w breast recon
This is not the easiest answer. Your lat side has a lot of visibility of your implant. I think your implant is very superficial and your lat is just not covering it well medially (near your sternum), so going deeper with the implant would help. You can also try to leave it there and fat graft for coverage, which can work very well if your surgeon is very experienced with high volume fat grafting. On the prophylactic side, your tissue expander is already in the submuscular plane. It's a big deal to change plane, it can be done but it's a slightly longer recovery, but I'd advise completing the reconstruction first (swap to an implant- an easy surgery) and see how it looks. Many patients don't mind the slight pec flex, and you will often have a lat flex on the other side. The lower the boob, the looser the skin, and the thinner the mastectomy flap, the worse the pec flex is. Also have your ps raise your imc on the Lat side, it's lower than your prophylactic side.
Pre pectoral reconstruction
You are a candidate for pre pectoral (above pec muscle) reconstruction depending on the current placement of the tissue expander. Check with your operating surgeon. Best, Dr. Yegiyants