Direct-to-Implant Breast Reconstruction

Direct-to-Implant Breast Reconstruction

Is Direct-to-Implant Breast Reconstruction Right for Me?

Common options for breast reconstruction after mastectomy include implant-based reconstruction and autologous reconstruction using a woman’s own tissue.  Traditionally, implant-based reconstruction is done in two-stages, with a temporary implant called a tissue expander placed at the time of mastectomy followed by a second surgery several months later to exchange the expander for a permanent implant. The question arises that is direct-to-implant breast reconstruction a good idea?

However, many plastic surgeons are now realizing that selected patients may be able to have one-stage surgery with an implant placed at the time of mastectomy, which is known as direct-to-implant reconstruction or a “One and Done” approach.  The benefits of this approach are that women can avoid the need for a second surgery for the exchange and get to their final reconstructive outcome more quickly.

Who are the ideal candidates for direct-to-implant reconstruction?

The best candidates for direct-to-implant reconstruction are women with small-to-medium sized breasts who either want to stay the same breast size or be only slightly larger following reconstruction. Direct-to-implant reconstruction can be done with either nipple-sparing or non-nipple-sparing mastectomies. This approach is ideal in women undergoing prophylactic mastectomies for a genetic mutation or strong family history of breast cancer, though can also be done in women who have breast cancer, depending on their type of cancer and other cancer treatment.

What happens during the surgery and what is the recovery like?

Once the mastectomy and lymph node dissection (if needed) is complete, the permanent implant size is determined and the implant is placed underneath the pectoralis major muscle. A surgical drain is placed in each breast to make sure that fluid doesn’t build up after the surgery. Patients stay overnight in the hospital and typically go home the following day.  Post-op visits usually occur at 1 week and 2 weeks after surgery, with drains coming out at the 2-week visit.  While walking is encouraged immediately after surgery, no heavy lifting or strenuous activity is recommended for at least 4 weeks, with most patients returning to their usual activities and exercise regimens by 6 weeks after surgery.

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