Application of pectoralis major fascia in retropectoral breast reconstruction: the five-step method

The demand for breast reconstruction following early-stage breast cancer diagnosis has been steadily increasing. While prepectoral prosthetic reconstruction offers several advantages, its application is often limited by the necessity of acellular dermal matrix (ADM), which significantly increases costs and restricts widespread adoption. Conversely, traditional retropectoral implant reconstruction presents challenges, particularly in achieving optimal breast softness and mobility. This article aims to provide a comprehensive review of the indications and contraindications for modified retropectoralis major prosthetic breast reconstruction, based on a synthesis of literature and clinical experience. We detail the surgical technique and post-operative care involved in utilizing the pectoralis major fascia as an autologous alternative to ADM. The procedure is summarized into five key steps: (I) surgical positioning and incision design; (II) preservation of the pectoralis major fascia during mastectomy; (III) dissection of the pectoralis major fascia; (IV) creation of the implant pocket; and (V) prosthesis placement and final wound closure. We propose that this five-step approach not only offers a novel and cost-effective solution for prosthetic reconstruction in early-stage breast cancer patients but also demonstrates high feasibility and safety. By eliminating the need for ADM, this technique has the potential to enhance accessibility and promote broader clinical adoption.