pre-pectoral vs. sub-pectoral breast reconstruction

Compare: pre-pectoral vs. sub-pectoral breast reconstruction

Apr 25, 2024

Yesterday I spoke to the main nurse care coordinator for the primary breast surgeons in Vancouver.


She mentioned surgeons increasingly opt for pre-pectoral implant placement in breast cancer surgery for reconstruction over sub-pectoral placement, which is a switch from what they used to recommend.


Pre- or sub-pectoral refers to the place surgeons secures the breast implant in relation to pec major muscle. Pre-pectoral is on top of the muscle, superficial, while sub-pectoral is deep to pec major, sitting snuggly in the pocket made between pec major and the chest wall.


They're finding that placing the implants sub-pectoral is creating too much compromised muscle activity in pec major for the women following the surgery.


So now they're giving patients a choice as to whether they want their breast implants pre-pectoral or sub, and the ramifications for each.


Pre-pectoral implants show more visibly without breast tissue on top (the glandular and adipose tissue are removed during breast cancer surgery), so patients also need fat grafting for better camouflage, which requires a harvest site. Donor site care is needed, but chest strength stays more intact, so there's a benefit for long term torso and arm functionality.


Sub-pectoral placement utilizes pectoral muscles for camouflage and a snugger fit, so no fat grafting may be required. But the ability to regain strength through out the chest needs more work, as the pec major is partially detached from the abdominal aponeurosis as well as serratus anterior, which can compromise strength and mobility.


So a trade off either way, but it's good to see they're taking another step to evolve women's comfort and functionality after breast cancer surgery 🦋✨🙌🏽


Eryn Price RMT has been in the healing arts for the past 25 years, has taught internationally on progressive women's and trans post-surgical recovery practices.  She offers live courses and educational events to help spread awareness, education and hope for breast cancer, gender affirmation and women's health.  To see the latest course offerings, please click here.

#breastcancercare #massageeducation #mastectomy #breastreconstructionsurgery

Image: Sobti, N., Weitzman, R.E., Nealon, K.P. et al. Evaluation of capsular contracture following immediate prepectoral versus subpectoral direct-to-implant breast reconstruction. Sci Rep 10, 1137 (2020).


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