Revisiting Total Subpectoral Breast Reconstruction: Technical Refinements for Improved Outcomes

Area of Science:

• Plastic Surgery
• Breast Reconstruction
• Implant-Based Reconstruction

Background:

• Prepectoral direct-to-implant breast reconstruction is increasingly popular but not universally suitable.
• Subpectoral reconstruction is necessary for select patients, but traditional methods have limitations like animation deformity and restricted lower-pole expansion.

Purpose of the Study:

• To evaluate the safety, reproducibility, and clinical outcomes of a refined, mesh-free total subpectoral breast reconstruction technique.

Main Methods:

• Retrospective analysis of 119 patients (181 breasts) undergoing immediate implant-based reconstruction with a standardized subpectoral technique.
• Preservation of key anatomical structures (inframammary ligament, serratus anterior fascia, intercostal perforators).
• Controlled fascial releases and limited superior dissection for optimal implant positioning and lower-pole expansion.

Main Results:

• Mean follow-up of 28.1 months.
• Minor complication rate of 28.6%, major complication rate of 6.7%.
• Revision surgery required in 7.6% of patients, primarily for contour irregularities, successfully managed with single-stage correction.
• Mean BREAST-Q score of 76.6 ± 15.1 among 100 patients.

Conclusions:

• The refined mesh-free total subpectoral technique ensures stable implant positioning, enhanced lower-pole projection, and reduced animation deformity.
• This technique is a safe, reproducible, and cost-effective alternative to conventional submuscular breast reconstruction for appropriately selected patients.