https://orcid.org/0000-0003-2705-2030
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Megan Fracol, Cecil S Qiu, Lauren N Feld, Wen-Kuan Chiu, John Y S Kim, Myotomy-Capsulotomy With Intramuscular Fat Grafting: A Novel Technique for Secondary Treatment of Prepectoral Upper Pole Defects in Breast Reconstruction, Aesthetic Surgery Journal, Volume 39, Issue 4, April 2019, Pages 454–459, https://doi.org/10.1093/asj/sjy305
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Implant-based breast reconstruction is the most popular mode of breast reconstruction in the United States, accounting for 82% of the 106,295 breast reconstructions performed in 2017.1 Historically, implant-based breast reconstruction was initially performed in the prepectoral plane, but due to high rates of skin necrosis, implant extrusion, and poor cosmesis, it fell out of favor.2,3 The subpectoral approach has been the preferred technique for the last 40 years.2-5 In recent years, however, interest in prepectoral implant-based breast reconstruction has reemerged given certain undesirable sequela of subpectoral reconstruction, namely animation deformity and increased postoperative pain. This interest has fortuitously been accompanied by new technologies and techniques that now make prepectoral reconstruction a viable option involving reduced complication rates and improved appearance.6-10
Although there are several putative advantages that prepectoral reconstruction has over a subpectoral approach, one key aesthetic disadvantage is the potential for hollowing and contour ledging at the upper pole. Anatomically, the conversion of implants to a prepectoral plane means that the pectoralis muscle no longer provides soft tissue bulk and buffer over the upper half of the implant, which results in an exacerbated upper pole hollowing. This aesthetic dissonance of a stark upper pole ledge is illustrated in Figure 1.
