Bridging autologous reconstruction with pre-pectoral tissue expanders

Pre-pectoral reconstruction is steadily becoming more mainstream with recent publications showing equivalent results with traditional sub-pectoral published literature. Multiple authors have demonstrated short-term acceptable rates of infection, expander failure, success in radiated patients, and overall patient satisfaction. Some data has even shown improved outcomes in prepectoral reconstruction when compared to published subpectoral literature. For the past 4 years, our practices have utilized a “piggy-back” method of immediate pre-pectoral expander reconstruction before performing delayed immediate microsurgical free tissue transfers. This method has many advantages and has in many cases become our standard for patients wanting deep inferior epigastric perforator flaps (DIEPs) for definitive reconstruction.