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Acellular dermal matrix has revolutionized implant-based breast reconstruction. Breast reconstruction has evolved from the traditional submuscular to the new prepectoral implant based (also known as muscle-sparing) reconstruction. The new technique is emerging as a highly popular surgery owing to its more minimal approach. We conducted a narrative review to guide prepectoral breast reconstruction, highlighting the technique, the need for appropriate patient selection, and areas for further research. We show that prepectoral breast reconstruction is safe, feasible, and has excellent short-term outcomes (cosmesis and patient satisfaction). Its main advantages are that it avoids animation deformity, prevents shoulder dysfunction, and has a lower incidence of capsular contracture. Selection for the prepectoral technique is dependent on patient factors (eg, body mass index, lifestyle), breast size, flap assessment, and adjuvant radiotherapy. Whereas the initial short-term results are promising, long-term outcomes are yet to be reported and is an area that requires further research., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Subpectoral breast reconstruction using implants and meshes have been used widely in Europe, the United States and the United Kingdom. Although this technique has several advantages, animation deformity is a well-documented problem. We propose a new grading system to classify breast animation in patients undergoing subpectoral implant based breast reconstruction. We also discuss different techniques to avoid and correct animation deformity. [ABSTRACT FROM AUTHOR]