Pocket work for optimising outcomes in prosthetic breast reconstruction

Implant breast reconstruction is a recommendable alternative for women who have undergone mastectomy and lack the necessary subcutaneous fat tissue for an autologous reconstruction. On the other hand, many women reject the morbidity of the donor site, prolonged recovery periods and muscular weakness associated with autologous reconstruction. Therefore, muscle and skin expansion has become one of the most popular approaches used in breast reconstruction. Nevertheless, the expansion process may be hindered by events like seroma formation, implant rotation, moving upward or downward altering the location or shape of the submammary crease, capsule contracture or extrusion. Since the advent of the anatomical expander, two-stage reconstruction with the expander/implant sequence has become the most popular choice in prosthetic breast reconstruction (PBR). The second surgical stage, in which the tissue expander is exchanged for the permanent implant, offers a unique opportunity for pocket work. Pocket work strategies and their indications should be known and applied by the surgeon who aims at optimising PBR aesthetic results.