Fig. 4.

Three months after confirmation of complete healing and the all the edema has resolved, either prepectoral or subpectoral definitive implant placement is performed. We have delayed placement of the prosthetic until the very last step in these patients to insure minimal risk of implant loss as there is now minimal chance of wound breakdown. By waiting 3 months, we can proceed with a lateral inframammary incision with minimal risk of compromise to the NAC as there has been time for collaterals to develop. If circumstances demand that the prosthetic is placed sooner, one must consider dissecting the Wise flaps off the inferior pedicle to preserve blood flow. This is tedious and puts the implant and NAC at increased risk. Here, the patient undergoes prepectoral breast reconstruction with an acellular dermal matrix. The option of a subpectoral reconstruction without acellular dermal matrix is also available. To date, we have had no instances of implant loss if we delay implant placement for 3 months after the NACs have been repositioned and the skin has been retailored and allowed to heal as demonstrated here.