Table 1. Strengths and limitations of plane of implant placement.

	Total submuscular coverage	Dual plane—subpectoral + ADM sling	Pre-pectoral—subcutaneous + full ADM coverage
Preservation of natural breast shape	+	++	+++
Muscle spasm	+++	++	–
Animation deformity	+++	+++	–
Postoperative pain	+++	++	+
Cost	–	++	+++
Operative time	++	++	+
Initial fill volume	+	++	+++
Number of fills (time to complete expansion)	Many	Few	Fewest
Indications	Thin mastectomy flaps with near complete resection of skin envelope; mastectomy flaps with questionable perfusion	Healthy mastectomy flaps without areas concerning for ischemia	Healthy, thick mastectomy flaps with excellent perfusion

ADM, acellular dermal matrix; –, none; +, some; ++, more; +++, most.