When to Consider Prepectoral Implant Conversion After Subpectoral Implant Breast Reconstruction and How to Plan It.

Many deformities occur after subpectoral implant-based breast reconstruction. Today, immediate prepectoral reconstruction with implants shows a significant increase in popularity as it has many advantages over subpectoral positioning: absence of muscle deficit, breast animation, reduced implant dislocation, less postoperative pain and easy recovery. As such, implant pocket conversion from the submuscular to prepectoral plane has become our preferred strategy for solving most problems related to the submuscular implant position. The authors performed a retrospective review (from June 2018 to December 2022) of patients who underwent prepectoral implant conversion for the correction of animation deformity, dysfunctional chronic pain, and to ameliorate poor cosmetic results. The use of acellular dermal matrix (ADM) was done in the first 7 cases, in the remaining 56 were used polyurethane-covered implants. Resolution of animation deformity, chronic pain was evaluated in addition to cosmetic results and the onset of postoperative complications. Sixty-three patients (87 breasts) underwent prepectoral implant conversion with complete resolution of animation deformity, chronic pain and improved cosmetic results. Preventive lipofilling was done in 18 patients. Complication rate included 3 periprosthetic seroma in ADMs group. All were solved after US-guided aspiration. Rippling was noted in 3 patients and edge visibility was documented in 1 patient. There are no incidences of grade III and IV capsular contracture. The prepectoral implant conversion improves functional and aesthetic results, reaching excellent outcomes. The preparation for this surgery with fat graft is considered a complementary procedure that increases the indications for prepectoral implant conversion.