Deciding on your implant location; Subpectoral or prepectoral

I have sub-pectoral silicon implants. I had the surgery almost two years ago, as a pbmx, as I am BRCA2. I had my surgery done by a top plastic surgeon, at a top cancer center in Philadelphia. I never knew I had another choice, Even though I told the doctor that I lifted weights six days a week and bowled three to four days a week. I was assured I would have no problem continuing my lifestyle. After surgery, I was told not to lift or press upper body over 45 pounds. Meanwhile, I have lost so much upper body strength. This Spring, I began having pain in my shoulders and sometimes spasms. It feels like I am wearing an uncomfortable bra even when I have none on. I may someday switch my implants to pre/pec or try a diep flap. Unfortunately, I am on Coumadin, and had life threatening complications after the first surgery, so I am frightened to change. Beesie also has a point, cancer could be hard to spot under implants, but I can’t imagine living with this discomfort for too much longer. My sister has sub-pec with silicon and moderate profile and ADM following her cancer diagnosis. She has no discomfort and Is very happy with her reconstruction. My implants are high profile and over 600 ccs and no ADM was used for me. I have a constant feeling of tightness across my chest muscles. It is a difficult decision to be sure. I will be reading your answers with great interest. Good luck.

I have had both. I would choose over the muscle any day of the week. My experience with under the muscle implants was similar to Snowflake’s. I really hated them.

jvfireball I spent some time researching this issue. Check out the thread: TE/Implant OVER pectoral Can exercise, comfortable &NO RIPPLES! Typical of all my Drs., my PS told me nothing and put pre-pectoral expanders in, his choice. I lost them due to infection and had a lot more time to research the options. For the short time I had them, they looked and felt ok. I have thick skin. I had iron bra syndrome and a lot of pain, but I was still healing. My Drs said it would not mask a reoccurrence. I believe them that "most" reoccurences would occur in the skin/scar area and be easy to find, but I can't help but think that sub pectoral is still safer regarding finding a reoccurence. I chose to try and avoid implants and go for DIEP, which I suppose is similar to putting an implant above the muscle. and if I want a small implant after, two Drs. said it would have to be over the muscle after DIEP. One of those Dr.s would have put the initial implant under the muscle. Too many choices, too much stress. I'm scheduled for 1/7/21 for DIEP. Good luck with your decision.

Judy

I have sub-pectoral. Pre-pectoral was rather uncommon when I had my PBMX. I did have tightness for a while but at some point (a long time ago) I stopped noticing any tightness. I can still kayak, swim, haul around heavy scuba tanks, lift weights, do burpees, and all that other stuff. I don’t have iron bra or any other discomfort. I did have some issues with the 410s I had just due to their firmness (not due to being sub-pectoral) but I had those exchanged about a year ago.

I have very thin skin according to my PS and initial BS, and my BS was also good about removing as much tissue as he could which is great for risk reduction but did not help leave much cushion; I don’t think I would have been happy with results at all with pre-pectoral for me. As it is I am going for another fat grafting. I originally switched from round silicones to Allergan 410s to deal with rippling but now that I am back to smooth rounds I am going the fat grafting route - had one already and planning for next.

For me, I have had a couple opportunities to switch and it just isn’t worth it to me given my lack of issues.

My sister went pre-pectoral and is happy as she lifts very heavy weights, but she also has quite a bit of rippling and had to go back for an exchange to quite a bit larger plus fat grafting to try and address it.

I am pre-pec as well. PS recommended because you don't animate the tissue when you engage your pectoral muscles. I don't think risk of capsular contraction or iron bra feeling is dependent on type of surgery you have, rather it is your body's response. I just recently completed a revision surgery as I had a tremendous amount of scar tissue that needed to be released. I am very thin skinned so we tried some fat grafting this time as well. I can still see edges a bit, and some rippling, but nothing is going to be absolutely perfect. My sister did sub pec, but she wasn't even offered pre-pec and this was a year ago. She is very happy as well with her surgical direction. I guess I am not much help here. Perhaps the takeaway is that both surgeries are being performed frequently now so go with whatever choice feels right to you.

I had sub pectoral with lat flaps and implants. That is what my surgeon suggested for me, so I went with it. It turned out that I needed additional skin removed because of a close margin, so the extra skin afforded by the flap ended up being helpful in the healing process. I am very pleased cosmetically with my outcome. I'm also comforted by the knowledge that a recurrence would be more quickly noticeable to me, particularly because of the close margin (hopefully addressed completely by the surgery), as well as the fact that I am an incredible worrier.

I occasionally have some tightness/iron bra feeling, but it is typically eased by stretching. I'm not particularly strong in my upper body anyway, but I have noticed some loss of strength, although it gets better all the time. If I had actually worked to regain the strength, I'm sure that would have speeded up the process!

Just wanted to share my experience. Best wishes as you move through this process- these are hard choices

Hello ladies

Anyone with more than 1 year with tissue expander? I had my tissue expander last July 2020 and after that I had my radiation from early October till end October 2020 yesterday December 10 2020 my plastic surgeon told me to wait to heal first , and I asked him when to have my implants he said I m going have an appointment with him on March 2021 from there he said will plan for my permanent implants I also currently under target therapy..so this tissue expander is so uncomfortable 😓..so anyone same as me that's have longer time with tissue expander?

Anyone have TE sub pec, and then go DIEP pre-pec?

NancyGC - that is a good questrion! I have NO idea what my current is nor what my previous were.

Well, oddly enough I have one of each. There was a failure to heal on left side and they had to go back in and put that one under so as to have more blood flow under the skin graft, the other they left over pectoral. I do not notice any difference, they look balanced and feel the same. They may have done more fat grafting on that side but all is well,,,,,, for now!

I had pre pec done one year ago. (Unfortunately the radiated breast got infected, so the implant was removed, and I am waiting for reconstruction on that side - but this had nothing to do with the placement of the implant.) I can speak about the implant that is still in. It is amazing, gorgeous, no pain, no mobility issues, no iron bra. Just a rubber ball under your skin - which is weird for sure - but looks so good and causes no hinderance at all. My understanding is that many plastic surgeons, often older ones, were never trained in this procedure as it is relatively "new" (not really) and so they encourage sub pec which is how they were trained and what they have been performing for years. I can't say enough, in my case, how gorgeous, unrestrictive, and easy peasy pre pec has been.

Hi Mountain lover,

Thank you for your post. Currently, I have perpectoral TE. My PS does prepectoral only. Got a consult who said the best cosmetic outcome is subpectoral. Have you had your exchange, yet? If yes, how would you rate your cosmetic result? I am thin and have thin skin. I will have fat grafting. I just want to be able to wear a low cut top without the upper pole of my breasts looking like a shelf. Looking forward to hearing from you. Best.