Deciding on your implant location; Subpectoral or prepectoral

meadow99:

I'm about your size and have very thin skin but went with pre pec placement. I chose pre pec because I wanted to avoid trauma to my muscles. I have the Allergan Inspira SoftTouch implants.

I have some rippling on the sides that I don't care about as it's not particularly visible and a ripple on the upper inner portion of one of them that I will try to resolve with fat grafting but I am very happy with my decision and the results and I think my PS did an excellent job.

I will say that my original breasts pre mastectomy were severely ptotic though so for me the implants were a significant aesthetic improvement. A woman starting out with perfect or conventionally shaped breasts might be more bothered by the rippling than I am.

Hi Jvfireball, great topic, thanks for posting. I had subpectoral implants for 8 years after double mastectomy, because my original PS at the time said that's the only safe location. But I had chest tightness, animation, and reduced arm range of motion the whole time, and was done with the implants. Thought about removing them completely, but met with Dr. Hani Sbitany in NYC, one of the surgeons who helped define prepectoral reconstruction. He carefully listened to all my symptoms at our appointment, and told me I needed a switch to prepectoral. He said that even while he does it now as his primary option for women at time of mastectomy, can still exchange to prepectoral in women like me, who had reconstruction years ago. In July 2020, he switched my implants to prepectoral, and I fell better than ever before. My pain and animation are gone, and I can engage in any physical activity with my arms, which I could never do before. Also, still look great aesthetically. I'm so grateful that surgeons like him are doing these procedures. There is also a NY Times Article highlighting this technique, from September 2018: "New Approach to Breast Reconstruction May Reduce Pain and Weakness for Some." You may find it helpful.

Thank you! Really appreciate it.

I recently returned to my plastic surgeon and she said that I could now lift over 45 pounds That it wasn’t forever. She suggests that we replace my implants with smaller implants, as one has dropped an inch plus below the surgical scar. The other breast is a half inch below the surgical scar. They are also uneven from the sternum, with one breast much further to the outside. I am a regular bowler and weightlifter and have been left with a reduced capacity to lift, especially for chest presses, lat pull downs, and shoulder presses. Biceps and triceps are okay. After heavy lifting, I get pain and sometimes spasms in the balls of my shoulders. I always have some not quite right feeling in my breasts, I am always adjusting my body. It’s like wearing a bothersome bra for me, even when I don’t have a bra on. The PS said we could put implants on top of the muscles but it will be a lot more bleeding for me. (On Coumadin). I will eventually get a second or maybe a third opinion this time, and do something next year. (I had a PBMX because of my BRCA2 and family history, 83 per cent lifetime risk).
But please note, this may be unique to me, my sister got under the muscle, moderate height implants following breast cancer and loves her reconstruction. Most people have no problems.

Wishing you an easy journey, ChrisJack.

Hi! I had my BMX on December 2020, and the TE were placed prepectoral. My PS and I discussed both options, and concluded that it was the best bet, as I have a 12Yo kid with autism, needed to be able to lift weight, and of course, a shorter recovery. Due to the skin being too thin after MX, a tissue net (alloderm) was needed to reinforce the area.

About one month later, the right side incision (the cancer site) opened completely, and a literal cascade of a milk-like fluid came out... and kept coming out for the 3 days until my PS were able to schedule the surgery to remove the TE, that was by that time, exposed.

After the surgery, the test for infection came back negative. No infection at all, just my body rejecting the alloderm net. The net was completely destroyed, and all the internal stitches were gone. So, I needed to wait around 3 months for the incision to fully heal, to have the silicone implants placed, now, under the muscle.

Bottom line is, yes, prepectoral is a great option: the recovery time is shorter and pretty much painless, and should be perfectly fine. My case is not typical in anyway. Just want you to have into consideration this small risk (that nobody told me about), and if you finally decide to have the prepec. and have any kind of issue, know that there's always the postpectoral option. Deciding for one wouldn't exclude the other one if needed later.

3 Days ago, I had my implants replaced for larger ones (350cc) and my PS told me that if I wanted to, we could put them prepectoral now, as the skin is already healed and thicker. I decided to keep them as they are now, as I haven't had any issue at all with them being behind the muscle