Would over the muscle implants be a feasible option for my breast reconstruction? (Photo)

Due to breast cancer I've had bilat mastectomy and unilat radiation. Radiation damage led me to have a Lat flap on that side. I currently have a small implant in the latflap side and an expander in the non cancer side. My surgeon wants to put implants behind the muscle for the exchange, but I really don't like the way behind the muscle implants flex the pecs. I've seen over the muscle that are softwr, more beautiful and don't flex! Could I possibly be a candidate for over the muscle implants?

Doctor Answers 3

Prepectoral breast reconstruction

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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

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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.

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 16 reviews

Pre pectoral reconstruction

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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 

Sara Yegiyants, MD, FACS
Santa Barbara Plastic Surgeon
5.0 out of 5 stars 20 reviews

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