Superomedial coverage with pectoralis muscle on completely wrapped, underfilled breast implant to achieve minimal rippling and dynamic tear-drop shaped appearance: A retrospective cohort study

Abstract

Although prepectoral reconstruction has many benefits over subpectoral breast reconstruction, incidence of rippling can significantly reduce patient satisfaction. The authors devised a refined surgical technique for implant pocket dissection, aiming to reduce rippling by utilizing the muscle action and inherent thickness of the pectoralis major muscle. A total of 80 patients (92 breasts) who underwent prepectoral direct-to-implant (DTI) reconstruction between January 2019 and July 2023 by a single surgeon were included in this retrospective cohort study. Only patients with a minimum follow-up of one year were analyzed. The surgical technique used for the experimental group (n=48) involved elevating pectoralis muscle starting from the xyphoid process in the superomedial direction, parallel to the fiber alignment of the pectoralis muscle, using a harmonic scalpel, whereas the control group (n=44) underwent conventional prepectoral reconstruction. All implants were fully wrapped with acellular dermal matrix (ADM) to ensure precise fit. Multivariate analysis showed that superomedial coverage with the pectoralis muscle was the only independent factor associated with lower risk of rippling. The experimental group demonstrated a more natural teardrop-shaped contour with minimal rippling than the control group. This technique may assist breast reconstruction surgeons in achieving more esthetically satisfying outcomes for their patients. (c) 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.