Breast Reconstruction with Implants: Is it better to go above or under the muscle?
Melissa Chefec
May 9, 2023
According to the American Society of Plastic Surgeons, 81% of women in the United States who undergo breast reconstruction after mastectomy use breast implants. As opposed to natural tissue breast reconstruction, implant-based breast reconstruction does not involve surgery on any other part of the body outside of the breasts. Patients do not have to worry about scars elsewhere on the body or additional healing and drains. In addition, the actual operation is shorter and more straightforward and does not require complex microsurgical skills. Thus, implant-based breast reconstruction is an easier surgery for both the patient and the surgeon.
One common problem with implant-based breast reconstruction, however, is that women often experience chronic pain and tightness after surgery. Usually, this is caused by breast implants placed under the pectoralis muscle - known as subpectoral breast implant placement. Since the pectoralis muscle lies flat against the chest wall, the muscle is routinely cut at its attachment to the sternum so that it can be lifted to make room for the tissue expander or breast implant. Despite this, the breast implant is a tight fit because there is no anatomical space for it under the pectoralis muscle. Additionally, when the pectoralis muscle is flexed, it pushes the implant down and out - both deforming the implant and pushing the breast implant into the armpits. Over time, the breast implants may move farther apart creating widened breasts.
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