What considerations are there for implant over muscle reconstruction after a double mastectomy? (Photo)
Doctor Answers 5
Good coverage of the implant is better and less complications.
Based on the pictures posted, the tissue expanders you have are not in the right position and may have flipped upside down. Just follow the standard well proven technique and reposition the expander, then proceed with the implant reconstruction.
Breast reconstruction above the muscle has very thin coverage, with much more complications.
Wrapping the implant with ADM is still not proven it has that great advantage, specially in preventing capsular contracture. Nor does the ADM provide enough coverage, it is very thin.
Prepectoral is gaining momentum
A lot of articles are being published on "pre-pectoral breast reconstruction". It's an easier recovery on the patients (just as an above the muscle augmentation is an easier recovery than a below the muscle augmentation) and easier/quicker for the plastic surgeon (even though the traditional way of below the muscle isn't that long). It also makes a ton of money for the companies making the ADM (Alloderm in your case) that gets wrapped around the expander (typically two pieces are used on each side instead of the traditional one piece, so that's double the profit for them). My fear is that's what is leading this trend more than anything. Those companies have deep pockets and are able to get surgeons and even institutions to put out all sorts of studies promoting their product. I think surgeons should spend more time studying and working on getting better at the gold standard, rather than trying to learn the next best thing. You should be able to get a beautiful result with the traditional two stage expander-implant approach. Just my two cents.
Hope this helps.
Thanks for your question.
These are best discussed in person during a consultation with an experienced board certified plastic surgeon. Best of luck. I am confident you can achieve an outcome with which you will be pleased.
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What considerations are there for implant over muscle reconstruction after a double mastectomy?
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