Breast Advocate App contributor, Dr. Hani Sbitany, discusses an alternative approach to traditional implant-based breast reconstruction in this NY Times article published yesterday.
For the past 30 years, the traditional method of implant-based breast reconstruction involved placing tissue expanders and implants underneath the chest wall muscles. It has been long believed that this muscle coverage offered lower rates of both infection and heavy scar tissue formation (capsular contracture) around the implant.
However, placement of a tissue expander or implant under the main chest muscle (pectoralis major) comes with certain risks to the patient. Specifically, the dissection and stretching of the muscle to fit the implant underneath, may increase the discomfort associated with the reconstruction, due to muscle spasm and tightness. Furthermore, in submuscular reconstruction, the pectoralis muscle heals to the overlying skin of the reconstructed breast, and in some patients moving forward, each contraction of the pectoralis muscle pulls the skin of the breast with it, causing breast animation or hyperanimation. This means that the breast temporarily becomes distorted and moves in an unnatural way when the patient uses her chest muscle.
Now some surgeons are placing the implants on top of the muscle in an effort to reduce complications like pain, weakness and “hyperanimation” deformities that can occur when the chest muscles are flexed. Results so far are extremely encouraging.