Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Evolution of the Surgical Technique for “Breast in a Day” Direct-to-Implant Breast Reconstruction: Transitioning from Dual-Plane to Prepectoral Implant Placement

Antony, Anuja K. M.D., M.P.H., M.B.A.; Poirier, Jennifer Ph.D.; Madrigrano, Andrea M.D.; Kopkash, Katherine A. M.D.; Robinson, Emilie C. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1547-1556
doi: 10.1097/PRS.0000000000005627
Breast: Original Articles
Watch Video
Patient Safety CME
Journal Club

Background: Direct-to-implant breast reconstruction offers the intuitive advantages of shortening the reconstructive process and reducing costs. In the authors’ practice, direct-to-implant breast reconstruction has evolved from dual-plane to prepectoral implant placement. The authors sought to understand postoperative complications and aesthetic outcomes and identify differences in the dual-plane and prepectoral direct-to-implant subcohorts.

Methods: A retrospective review of a prospectively maintained database was conducted from November of 2014 to March of 2018. Postoperative complication data, reoperation, and aesthetic outcomes were reviewed. Aesthetic outcomes were evaluated by a blinded panel of practitioners using standardized photographs.

Results: One hundred thirty-four direct-to-implant reconstructions were performed in 81 women: 42.5 percent were dual-plane (n = 57) and 57.5 percent were prepectoral (n = 77). Statistical analysis was limited to patients with at least 1 year of follow-up. Total complications were low overall (8 percent), although the incidence of prepectoral complications [n = 1 (2 percent)] was lower than the incidence of dual-plane complications [n = 7 (12 percent)], with the difference approaching statistical significance (p = 0.07). Panel evaluation for aesthetic outcomes favored prepectoral reconstruction. Pectoralis animation deformity was completely eliminated in the prepectoral cohort.

Conclusions: The authors present the largest comparative direct-to-implant series using acellular dermal matrix to date. Transition to prepectoral direct-to-implant reconstruction has not resulted in increased complications, degradation of aesthetic results, or an increase in revision procedures. Prepectoral reconstruction is a viable reconstructive option with elimination of animation deformity and potential for enhanced aesthetic results.


Patient Safety CME. for #Prsjournalclub Discussions: for #Prsjournalclub Discussions: Read & Watch Related “Classic” Content and Listen to the Podcast at

Chicago and Evanston, Ill.

From Plastic and Reconstructive Surgery, Research Design and Statistics, and Surgical Oncology, Department of Surgery, Rush University Medical Center; and Surgical Oncology, Department of Surgery, Northshore University Health System.

Received for publication March 27, 2018; accepted September 27, 2018.

Presented at Plastic Surgery The Meeting 2017, Annual Meeting of American Society of Plastic Surgeons, in Orlando, Florida, October 6 through 10, 2017, and awarded Outstanding Paper Presentation in the Breast Track.

Disclosure:Dr. Antony has a consultant agreement with Allergan Medical, Inc. She received no compensation or support for this study. The authors have no financial interest or disclosures to declare related to the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (

By reading this article, you are entitled to claim one (1) hour of Category 2 Patient Safety Credit. ASPS members can claim this credit by logging in to Dashboard, clicking “Submit CME,” and completing the form.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch.

Anuja K. Antony, M.D., M.P.H., M.B.A., Division of Plastic and Reconstructive Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 425, Chicago, Ill. 60601,, Instagram: @Chicagoplasticsurgeon, Twitter: @AnuAntonyMD

Copyright © 2019 by the American Society of Plastic Surgeons