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The prevalence of cosmetic breast implants is rising, so it is not uncommon to see new breast cancers arising in individuals who already have breast implants.1 Given their aesthetic concerns, and their previous choice to have breast implants, these patients frequently want to have an immediate implant based breast reconstruction if they require a mastectomy. This can be technically challenging as these individuals are generally slim with little autologous tissue cover2 (Figures 1–3). A standard implant based reconstruction in a ptotic breast uses an implant covered superiorly by the pectoralis muscle and inferiorly by a de-epithelialised dermal flap.3 There has been increasing interest recently in the use of pre-pectoral reconstruction to reduce morbidity from lifting the pectoralismuscle. This has been described with a prosthetic mesh (such as Braxon® manufactured by

Pre-pectoral breast reconstruction in a patient with prior cosmetic breast implants- an elegent modification of a previously described technique