What sub-pectoral placement means
Sub-pectoral means below the pectoralis major muscle, the large chest wall muscle that runs from your breastbone to your upper arm. In this approach, the breast implant is placed in a pocket created behind this muscle. The muscle, together with the overlying skin, covers and supports the implant from above.
This is the traditional position for implant-based breast reconstruction and has been used for decades. It gives the implant additional soft tissue coverage, which is valuable in patients where the skin flap after mastectomy is thinner.
When it is recommended
Sub-pectoral placement is often chosen when:
- The patient has thinner skin or less subcutaneous fat after mastectomy
- A skin-sparing mastectomy has been performed and the skin flap needs additional support
- Radiotherapy is planned or has already been given, though this requires careful case-by-case assessment
- A tissue expander is being used as a first stage before the final implant
Two-stage vs one-stage reconstruction
Sub-pectoral reconstruction can be done in one stage (direct-to-implant, where the final implant goes in at the time of mastectomy) or in two stages. In the two-stage approach, a tissue expander is placed first. Over several weeks or months, the expander is gradually filled with saline to stretch the skin and muscle. A second operation then replaces the expander with the permanent implant.
Two-stage reconstruction is common when the final implant size needs to be planned carefully, or when radiotherapy is being considered after surgery. The two-stage process allows more control over the final result.
Benefits of sub-pectoral placement
- The muscle provides an extra layer of coverage over the implant
- Lower risk of implant visibility or rippling in patients with thinner skin
- Well-established technique with a long track record
- Suitable for most patients undergoing mastectomy with reconstruction
Limitations compared to pre-pectoral placement
Placing the implant under the muscle has some drawbacks compared to placing it in front of the muscle. The most notable is animation deformity: when you flex the pectoralis muscle (for example, when using your arm for pushing or lifting), the implant can move or distort temporarily. This happens because the muscle is sitting directly over the implant.
Recovery is also slightly longer than pre-pectoral reconstruction, as the muscle takes more time to settle. Some patients experience more discomfort in the first few weeks.
The choice between sub-pectoral and pre-pectoral placement depends on your skin thickness, body type, and whether you need radiotherapy. Dr. Shruthi will discuss both options and explain which suits you before surgery.
Recovery
Most patients go home after two to three days in hospital. Light activities can resume within two to four weeks. Overhead arm movements and heavy lifting are restricted for four to six weeks while the muscle heals around the implant pocket. Physical therapy may be recommended to maintain shoulder and arm mobility.