Prepectoral Breast Reconstruction: Selection Criteria and Patient Considerations

The role of prepectoral breast reconstruction has evolved as the most popular method of breast reconstruction following mastectomy because of its several advantages in well-selected patients. Prepectoral breast reconstruction offers benefits from sparing the pectoralis major muscle, which remains undisturbed in its original position, thereby significantly reducing pain and avoiding animation deformity of the pectoralis muscle. Following mastectomy, acellular dermal matrices (ADM) create a suitable-adjustable breast pocket to place an implant that provides superior cosmesis. ADM also helps to reduce capsular contracture, especially following breast radiotherapy. Breast reconstruction using prepectoral implants is a safe and effective technique that offers good aesthetic outcomes; however, the placement of the breast implant just under the skin, which is relatively less vascularized, can sometimes lead to complications. Therefore, it is vital to select patients carefully for this technique, assess intraoperative mastectomy flap adequately and therefore use an established pathway specific for prepectoral reconstructions.