Direct to Implant Breast Reconstruction
“Single-Stage” Breast Reconstruction
Direct to implant reconstruction, also known as “single-stage” breast reconstruction, is used for immediate breast reconstruction (same time as with a mastectomy) and is for women who are interested in implant reconstruction or who do not have enough donor tissue elsewhere on their body to make a breast.
Some women who choose implant reconstruction can avoid the expander phase by using AlloDerm™ — a product made of specially-treated human skin that has had all the cells removed, leaving only the framework of the skin behind. Your body would incorporate the product over a few months, replacing it with your own framework and cells. AlloDerm™ acts as a sling to support and provide coverage for the implant, allowing its placement under the muscle. Unlike the expander, which can be filled after surgery until the desired size is reached, there is a limit to what size can be placed with one-stage surgery and there is more reliance on surgeon judgment as to the final size.
This can be done as a unilateral (one breast) or bilateral (both breasts) breast reconstruction. It is a good option for thinner women with smaller breasts who don’t want very large breasts after surgery. It may also be a good choice for women who have a lot of other health problems precluding them from being a candidate for the longer surgery times required with autologous reconstruction. To qualify for direct to implant breast reconstruction, you must have enough skin after the mastectomy is done to cover the desired size of the implant chosen. Often less skin needs to be removed with the mastectomy for women who have small, less invasive tumors that are closer to the nipple or women who are breast cancer gene carriers (e.g. BRCA) seeking prophylactic mastectomy. The pathology results from the mastectomy surgery often take up to 2 weeks to get back. You will see your general surgeon to review these and discuss what the results mean.
- One operation
- No donor site morbidity
- Shorter operative time vs. autologous (flap) option
- Shorter recovery vs. autologous
- Can always be changed to autologous flap option at a future date if complications arise
- Implant location does not camouflage any local recurrences of the tumor
- Sensation of native skin flaps preserved
- Limit to size of implant that can be used
- Requires good quality skin
- Higher rates of complications in patients who have had radiation
- Increased risk of infection or implant exposure
- May make skin resistant to expansion
- Potential for capsular contracture (hard scar that forms around the implant because it is foreign)
- Potential for device failure or leakage (very low)
- Higher risk of need for future operations compared to autologous reconstruction
- Reconstructed breast will not develop natural drop with advancing age compared to a natural breast (this is important for single-sided reconstructions)
Preparing for Surgery
If you are a smoker, you should try to quit before surgery, as the risks of complications are higher in smokers. You should also stop taking all over-the-counter pain or fever medicines (except Tylenol) and blood thinners for two weeks prior to your procedure. Many herbal medicines can also cause bleeding and so need to be stopped before surgery, including ginkgo biloba, St. John’s Wort, and high doses of fish oil, flax seed oil, and vitamin E.
Direct to Implant Recovery
Most patients stay overnight in the hospital following single-stage direct to implant reconstruction. You will have drains in place after the surgery but your surgeon usually removes these in the office within 1-2 weeks. You cannot shower as long as you have drains. It is common for patients to keep a bandage over the incision for 1-2 weeks after surgery for comfort and to collect any small bits of drainage until the incisions have healed. Most sutures will be absorbable. You can wear a bra if comfortable after surgery but this is not necessary.
To learn more about how you may benefit from direct to implant reconstruction or to schedule a consultation with one of our board-certified plastic surgeons, please contact our Surrey office today.