For nearly four decades, the main option for breast reconstruction for women who had to undergo a mastectomy was to place implants under the main chest muscle – a procedure that often results in chronic pain and muscle weakness in the chest and arms.

It also creates a strange unsightly contraction of the breasts and chest whenever the main muscle – the pectoralis major – contracts, called animation.

“Whether it’s loss of strength, whether its chronic pain or whether animation deformity – there are drawbacks to putting these implants under the muscle,” said Hani Sbitany, MD, a plastic and reconstructive surgeon at UCSF Health.

Now, Sbitany is one of a handful of surgeons who are pioneering and studying the outcomes of a new approach that is less invasive, has a less painful recovery and results in more natural looking breasts.

Significant Improvement for Patients

The procedure is called a prepectoral reconstruction, and involves placing the implants on top of the pectoralis muscle, just under the skin where breast tissue naturally resides.

For women, the difference is significant. Just ask Deborah Cohan, MD, MPH.

Cohan was diagnosed with breast cancer in 2013. Within a few months she had a complete mastectomy, followed by chemotherapy and later breast reconstruction. At the time the prevailing method was still to place the implants under the pectoral muscles.

“After the reconstruction I was having tingling symptoms in my hands and arms … when I would raise my arms, my hands would go white,” said Cohan, a physician at UC San Francisco. She also developed left shoulder pain and felt substantial pain in her chest.