Plane Change in Breast Reconstruction: Moving the implant from under the pectoralis muscle to over it

This is a letter about changing the location of the implant in Revision Breast Cancer Reconstruction from under the muscle to over the muscle. 

For many years we placed the implant under the muscle in breast reconstruction because we thought we would have better healing outcomes. It turns out that many of these patients have twitching of the pectoralis major muscle as a result. This is called Animation Deformity. (I have written a paper about the prevalence of Animation Deformity which you can find under My Publications on my website). Some of these patients also have a lot of discomfort, especially if they are athletic or if they have larger implants. This pain can be in the chest over the implants or sometimes radiating to the back. 

Starting in 2017, I began to place my implants over the muscle and was very pleased to see that the patients had much less pain post-operatively. Although an overwhelming majority of patients who had an implant placed under the muscle are not concerned with the Animation Deformity and do not have pain, there is a significant minority of patients who do. In these patients we can do a Plane Change: moving the implant from under the muscle to over the muscle. This involves separating the muscle from the mastectomy flap and stabilizing it, so it returns to its normal anatomic position on the chest wall. We then place the implant over the muscle covered by Acellular Dermal Matrix (ADM). This protects it, avoids wound healing issues and masks the contour of the implant. 

The patients in whom I have done this have been very happy, with a more natural look, less pain, and lack of Animation Deformity. This is especially true in patients who had a unilateral mastectomy and reconstruction, because this reconstruction sits in a more anatomic position and matches the other normal breast much better. Nonetheless this is a significant procedure. It involves a drain again, and about a one to two-week recovery. It is probably riskier to do in an irradiated patient because of potential wound healing issues. Finally, unless I have already fat grafted the patient in the past, I may need to go back later and fat graft the cleavage to camouflage the edges of the prothesis. 

If you are interested in a plane Change, please take a look at the photos on my website under Reconstruction Revisions. I will be very glad to discuss your options in consultation with you in person.