Post mastectomy reconstruction with a direct to implant, or “one-step” approach allows for a single-stage reconstruction of the breast mound in select patients. This approach is best suited for patients with good preservation of the breast skin after mastectomy. A permanent implant is inserted immediately following the mastectomy, forgoing the initial placement of a tissue expander and subsequent expansion process.
Placing the Implant
At the time of the initial post mastectomy reconstruction operation, the implant is positioned on the chest wall behind the pectoralis major muscle. Today, with the use of a dermal matrix (such as AlloDerm), Dr. Sonderman can frequently use a permanent implant of the desired definitive volume during the initial surgery, provided the amount and quality of the breast skin remaining after mastectomy can accommodate the volume. The patient will have the definitive breast volume and approximate shape after the first operation.
Depending on the quality of the result after allowing the initial reconstruction to settle and heal for a few months, a second stage reconstruction creating a more refined breast shape may still be desirable. This is an outpatient procedure that involves minor refinements in contour and symmetry potentially without exchanging the implant. The initial implant placement, and possible second stage, each take about one hour in the operating room.
You are an ideal candidate for direct to implant post mastectomy reconstruction if you:
- have no available flap options
- do not desire a flap operation, have sufficient breast skin, and do not have compromised tissue after the mastectomy site
- have no history of previous radiation to the breast or chest wall
- are having prophylactic mastectomies
- want bilateral reconstruction
- are of a reasonable size and body weight
- agree to have an operation on the opposite breast to help improve symmetry
You are not an ideal candidate for expander implant post mastectomy reconstruction if you have:
- compromised tissue at the mastectomy site (numerous surgeries or infection)
- been previously radiated
- advanced disease
- autoimmune disease (may be a contraindication for gel-filled implants)
- a Body Mass Index greater than 30
The above mentioned characteristics are considered relative contra-indications for the use of direct to implant reconstruction because each is associated with a higher risk of complications. This does not rule out the use of implants in all patients with these conditions.
You may refer to the Post-Operative Expander Implant section of breastreconstruction.org to learn about care after direct to implant reconstruction.