Breast Reconstruction When You Already Have Implants

A common question: if you already have breast implants and need a mastectomy, how does that affect your risk? And do we keep the implants under the muscle if that's where they already are?

My partner and I are about to publish data from our combined series of patients over the last 10 years. We found that patients who come into surgery with pre-existing implants actually have lower rates of mastectomy flap necrosis.

• Our average rate of necrosis across all patients was less than 5% (about 4.5%)
• For patients with pre-existing implants, it was just over 2%

So they actually did better than patients who didn't have implants going in.

Where your implants end up after surgery depends on what you'd like as a patient. I move almost all of my patients over the muscle in this situation.

Over-the-muscle breast reconstruction — also called pre-pectoral — is really the standard these days, in my opinion, and among pretty much everybody I know who does a lot of breast reconstruction.

Why has under-the-muscle fallen out of favor?

• After a mastectomy, muscle movement becomes much more obvious
• We tend to release the muscle more during reconstruction, which makes the animation even more noticeable
• Patients often don't like how it looks and feels

Even if being under the muscle doesn't bother you now while your breast tissue is covering it, it may bother you more after a mastectomy when that tissue is gone.

Absolutely. I do occasionally have patients who are under the muscle and want to stay there — that's totally fine. We can do that as well.

This is something we encounter all the time. There are millions of women with breast implants. In my practice, we've found that their risk of complications — mastectomy flap necrosis in particular — is actually less than patients without pre-existing implants.

If you have implants and are facing a mastectomy, a direct-to-implant reconstruction is absolutely an option worth discussing with your surgeon.