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Dr. Sbitany said that since he started talking about the new option, known as prepectoral breast reconstruction, he has been besieged by patients who have had submuscular implants for five, 10 or 15 years and want the reconstruction done over. Artificial breast implants are the most common method of breast reconstruction after mastectomy.
When patients want them replaced, Dr. Sbitany said, he removes the old implants, places the pectoralis major muscle back down where it used to be and inserts new implants on top of the muscle, using biological mesh to cover and support them under the skin.
“There is no question that putting the implant below the muscle causes increased rates of pain and chronic discomfort with any physical activity — not in every woman, but in a consistent number of patients,” said Dr. Sbitany, who operated on Dr. Cohan earlier this year. He is the author of a new study, to be published in the journal Plastic and Reconstructive Surgery early next year, looking at outcomes for women who had prepectoral breast reconstruction followed by radiation therapy.
One downside of the new procedure is the high cost of acellular dermal matrix products, which may not be covered by insurance. One doctor estimated the extra material needed to do the new implant could double the cost of the reconstruction surgery.
Dr. Sbitany acknowledged the material can be costly, but noted that the new reconstruction method can be done in one operation, at the same time as the mastectomy, instead of dragging out for months and requiring a second surgery. Patients are often able to manage with much less pain medication, he said.
Another concern about the new approach is that women who need treatment with radiation therapy could potentially experience more infections and other complications since the implants are closer to the skin.
“Radiation and reconstruction are not good friends,” noted Dr. Marisa Weiss, a radiation oncologist who founded the website breastcancer.org. Over all, one in three women who have breast reconstruction after mastectomy experience a complication within the next two years.