The Journey of Prepectoral Breast Reconstruction through Time

Abstract

BACKGROUNDThe facet of breast reconstruction has evolved from complex surgery to simple implant-based breast reconstruction. Minimal invasive surgery or Prepectoral breast reconstruction has revolutionised the surgical treatment for breast cancer and became a reality due to advances in meshes and implants. In this review, we have looked at the journey of Prepectoral implant beast reconstruction through time. METHODSWe conducted a literature review on pre-pectoral breast reconstruction, emphasising types of cover, its outcomes, complications, and the effect of postmastectomy radiotherapy. RESULTSPrepectoral breast reconstruction had advanced with time and appears to be a safe and effective method of breast reconstruction and is associated with minimal morbidity whilst providing adequate cosmesis. Radiotherapy seems to be well tolerated with early favourable results. The Implant loss rates in the Acellular Dermal Matrix (ADM) to be around 5%-6% and rippling appear to be a common adverse effect of this technique ranging from 0%-35% in various studies. CONCLUSIONPrepectoral implant-based breast reconstruction has emerged as a successful method of breast reconstruction.

A Retrospective Study Assessing the Outcomes of Immediate Prepectoral and Subpectoral Implant and Mesh-Based Breast Reconstruction

“…Prepectoral reconstructions, a pectoralis-major-sparing technique where the prosthesis is placed above the muscle, usually with mesh or ADM coverage, and subpectoral reconstructions, where the breast implant is placed partially behind the pectoralis major muscle and partially behind the lower mastectomy skin flap, with or without lower pole reinforcement using mesh or ADM [5][6][7].…”

“…Prepectoral breast reconstruction also achieves favorable aesthetic outcomes and seems to limit capsular contracture. However, it significantly increases the cost of surgery due to inter alia the use of meshes and ADMs [7].…”

Prepectoral Breast Reconstruction without Acellular Dermal Matrix: Have We Come Full Circle?

“…Historically, immediate breast reconstruction was synonymous with a two-stage approach using tissue expander implantation in the submuscular plane [ 11 ]. The advantages included better control over final implant position, breast size, and shape, and there was less risk of wound-healing complications.…”

A prospective comparison of prepectoral and subpectoral methods for immediate breast reconstruction with acellular dermal matrix: the cogwheel-shaped anterior wrapping method

“…The initial approach was to insert the implant into the prepectoral pocket, directly under the mastectomy skin flap. However, the incidence of capsular contracture was high [3]. To compensate for this problem, a method was developed that dissected the pectoralis major muscle to cover the implant and position it in the subpectoral plane.…”

“…With the introduction of the acellular dermal matrix (ADM) in the early 2000s, the modified dual-plane method became popular for securing an adequate submuscular pocket, while preventing bottoming out and enabling one-staged reconstruction [3,5]. However, this method inevitably damaged the pectoralis muscle, resulting in shoulder dysfunction and animation deformity [6].…”