Current status prepectoral and subpectoral breast reconstruction in the USA

Breast cancer remains the most commonly diagnosed cancer in women in the United States. In the setting of a mastectomy, implant-based reconstruction (IBR) remains the most common type of breast reconstruction performed. IBR is typically performed in two-stages (tissue expander - implant) or one stage [direct-to-implant (DTI)]. As a consequence of the limitations associated with submuscular placement of implants, prepectoral implant placement has been gaining more acceptance worldwide. The prepectoral plane eliminates the need for chest wall muscle dissection, disinsertion and manipulation avoiding the muscle related complications of the subpectoral approach such as increased pain, spasm and animation deformity. In addition, prepectoral placement shortens the recovery time and provides greater control of breast shape and contour. With the latest generation form-stable silicone implants coupled with the wide use and acceptance of acellular dermal matrices (ADMs) and other meshes to support the implant, this technique is becoming the mainstay of implant-based reconstruction, under these circumstances the subpectoral technique will continue to be the benchmark to which the prepectoral technique will be compared to. The authors sought to review the literature emanating from North America that pertains to this topic and provide an up-to-date assessment of the current practices of the prepectoral and submuscular technique.