Is prepectoral placement of a tissue expander a better option for breast reconstruction in a patient who wants to continue lifting weights and performing bench press?

Prepectoral Tissue Expander Placement for Breast Reconstruction in Active Patients

Yes, prepectoral placement of tissue expanders is definitely a better option for patients who want to continue lifting weights and performing bench press exercises after breast reconstruction.

Anatomical Considerations and Functional Outcomes

Prepectoral (above the muscle) placement offers significant functional advantages over the traditional subpectoral (under the muscle) approach:

• Preservation of pectoralis major function: By avoiding muscle dissection entirely, prepectoral placement preserves normal chest muscle function 1
• Faster return to normal activities: Patients with prepectoral placement return to full active shoulder range of motion in half the time compared to submuscular placement 1
• Reduced postoperative pain: Significantly lower inpatient pain scores and reduced need for opioid medications 1, 2
• Elimination of animation deformity: No visible breast movement during pectoralis muscle contraction 3

Procedural Benefits

Prepectoral reconstruction also offers several procedural advantages:

• Shorter operative time: Significantly less anesthesia time for both unilateral and bilateral procedures 4
• Faster expansion process: Patients complete the expansion process twice as fast and often require fewer clinic visits 2
• Earlier definitive reconstruction: On average, definitive implant placement occurs 71.6 days earlier than with subpectoral placement 4

Safety Profile

Modern prepectoral reconstruction techniques have demonstrated comparable safety to traditional submuscular approaches:

• Similar overall complication rates: No significant difference in overall perioperative complications (32% vs 31%) 2
• Equivalent major complication rates: Similar rates of complications requiring operative treatment 2
• Comparable infection rates: No significant difference in infection rates between approaches 2

Important Considerations and Patient Selection

While prepectoral placement offers significant advantages for active patients, proper patient selection remains crucial:

• Body habitus: Best results in patients with normal BMI (18.5-24.9) 5
• Smoking status: Non-smoking patients have better outcomes; smoking significantly increases wound healing complications 6
• Mastectomy flap quality: Well-vascularized, adequately thick mastectomy flaps are essential for successful prepectoral reconstruction 6
• Radiation therapy plans: If post-mastectomy radiation is planned, this may affect reconstruction approach and timing 7

Technique Evolution

The prepectoral approach represents an evolution in breast reconstruction techniques:

• Complete tissue coverage: Modern prepectoral techniques utilize acellular dermal matrix (ADM) or synthetic mesh for complete prosthesis coverage 5, 3
• Muscle-sparing approach: By eliminating pectoralis muscle disruption, the prepectoral technique preserves normal chest wall function 3

Conclusion for Active Patients

For patients specifically interested in maintaining their ability to lift weights and perform bench press exercises, prepectoral placement offers clear advantages by preserving pectoralis muscle function, reducing postoperative pain, and allowing faster return to physical activities while maintaining comparable safety to traditional submuscular approaches.