Introduction: A New Standard in Breast Reconstruction
For decades, most implant-based breast reconstructions were done under the chest muscle (subpectoral). While effective, this method often caused pain, spasms, and animation deformities — where the breast moves unnaturally when the chest muscle contracts.
Today, a new approach has become the preferred method for many women: prepectoral breast reconstruction. Instead of placing the implant under the muscle, it is positioned above the muscle, directly under the skin and mastectomy flaps.
At Jandali Plastic Surgery in Trumbull, CT, we specialize in prepectoral tissue expander and implant reconstruction with fat grafting to achieve soft, natural results.
What Is Prepectoral Implant Reconstruction?
In a prepectoral reconstruction:
- A tissue expander is placed above the chest muscle at the time of mastectomy, along with acellular dermal matrix that acts like an internal bra.
- Over weeks to months, the expander is gradually filled to stretch the skin.
- At the second stage, the expander is exchanged for a permanent implant.
- Fat grafting is always performed at the second stage to add natural softness, improve contour, and camouflage the implant.
Benefits Over Subpectoral Reconstruction
Patients often ask, “Why choose prepectoral over subpectoral?” The benefits are clear:
- Less pain after surgery (no muscle cutting and stretching)
- No animation deformity — the breast doesn’t move with arm or chest exercises
- More natural appearance and feel
- Faster recovery and return to activity
- Reduced risk of chronic spasms or tightness
- Better breast symmetry in many cases
The Role of Fat Grafting
At the second-stage implant surgery, we always perform fat grafting.
- Fat is gently liposuctioned from the abdomen, flanks, or thighs.
- It is purified and injected around the implant.
- This adds softness, volume, and natural contour, while reducing implant rippling or visible edges.
For thin women with less fat, Renuva adipose matrix can be used as an alternative or in addition (covered in another in this series).
Who Is a Candidate?
You may be a candidate for prepectoral reconstruction if you:
- Are undergoing mastectomy (preventive or for breast cancer)
- Previously had subpectoral implants and want revision
- Are active and want to avoid animation deformity
- Want less pain and a more natural look after surgery
Insurance Coverage
All forms of breast reconstruction — including prepectoral implant reconstruction and revisions — are fully covered by insurance.
- Covered at the time of mastectomy
- Covered anytime after mastectomy, even years or decades later
- Covered for revisions of previous reconstructions
This is guaranteed under the Women’s Health and Cancer Rights Act (WHCRA).
My Experience
I’m Dr. Shareef Jandali, a board-certified plastic surgeon with 15 years of experience. The majority of my practice is devoted to breast reconstruction. I have performed hundreds of prepectoral reconstructions and strongly believe this approach provides women in Fairfield County and Southern Connecticut with:
- Better long-term comfort
- Natural results
- Fewer complications
Common Questions About Prepectoral Breast Reconstruction
Is prepectoral reconstruction safe after radiation?
Yes, but higher risk as radiation can thin the breast skin and increase the chances for complications. Careful planning can improve outcomes.
Will my implant look natural above the muscle?
Yes — with fat grafting and modern implants, prepectoral breasts look and feel natural.
Is there more risk of implant rippling?
There can be, but fat grafting helps smooth and camouflage these areas.
How long is recovery?
Most women resume light activity within 3-4 weeks and return to full activity within 6-8 weeks.
Can I switch from subpectoral to prepectoral?
Yes — many women choose revision to prepectoral for less pain and to correct animation deformity.
Patient Testimonial
“I had my first reconstruction years ago with implants under the muscle. The pain and spasms were terrible. Dr. Jandali revised me to prepectoral implants with fat grafting. I can finally exercise without discomfort, and my breasts look so much more natural.”
— K.P., Norwalk, CT
Serving Fairfield County & Southern Connecticut
We proudly serve women seeking breast reconstruction from:
Trumbull, Fairfield, Bridgeport, Stratford, Milford, Shelton, Norwalk, Westport, Weston, Wilton, Easton, Monroe, Oxford, Derby, Ansonia, Seymour, Newtown, Bethel, and Southbury.
Why Choose Jandali Plastic Surgery
- Board-certified plastic surgeon with 15 years of breast reconstruction experience and over 150 breast reconstructions performed yearly
- Majority of practice devoted to reconstruction
- Expertise in both implant-based and DIEP flap reconstruction
- Personalized care, insurance navigation, and long-term follow-up
Related Articles in the Breast Reconstruction Blog Series
- Prepectoral Tissue Expander and Implant Reconstruction
- Implant Exchange for Recalled Allergan Textured Implants
- Implant Exchange for Animation Deformity
- Delayed Reconstruction & Revision for Capsular Contracture, Asymmetry, or Poor Results
- Delayed Reconstruction After Lumpectomy & Radiation
- Oncoplastic Reconstruction at Time of Lumpectomy
- Free Nipple Grafts in Implant Reconstruction
- Goldilocks Breast Reconstruction with Free Nipple Grafts
- DIEP Flap Breast Reconstruction
- Renuva Adipose Matrix for Reconstruction
Call to Action
If you are considering breast reconstruction, learn more about the benefits of prepectoral implant reconstruction with fat grafting.
Jandali Plastic Surgery
5520 Park Ave, Suite WP-2-300, Trumbull, CT 06611
203-374-0310
