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As an alternative to staged expander-implant breast reconstruction, the direct-to-implant approach allows the possibility of placing a breast implant immediately at the time of the mastectomy. In most cases, this direct-to-implant approach is made possible by the use of a dermal matrix such as AlloDerm®, allowing immediate results in a potentially single-stage or “one-step” breast reconstruction procedure. To schedule a consultation, please feel free to contact us.

Breast Implant Placement at the Time of Mastectomy

Patients who have sufficient breast skin remaining following mastectomy may be well suited for direct-to-implant breast reconstruction. With skin-sparing and nipple-sparing mastectomy techniques gaining popularity, more and more women are now good candidates for this approach. The determining factor is whether the remaining skin, typically in conjunction with the use of a dermal matrix such as AlloDerm®, can accommodate the volume of the breast implant. For patients that are good candidates, direct-to-implant post-mastectomy breast reconstruction allows our surgeons to place a breast implant immediately, avoiding the use of a tissue expander. This “one-step” approach can potentially allow patients to awaken from their mastectomy with a well-defined breast shape.

In the direct-to-implant procedure, the implant is positioned on the chest wall and placed behind the pectoralis major muscle immediately after mastectomy. To provide additional soft tissue support, AlloDerm® is secured to the chest wall along the lower and outer folds of the breast. Over a period of several months, the reconstructed breast is allowed to heal and the breast implant will settle into place. At that point the breast reconstruction is complete, unless the patient decides that she would like to further change or improve her reconstructed breast shape. While direct-to-implant breast reconstruction avoids the use of a tissue expander, secondary procedures may still be desired to improve symmetry, breast size or breast contour. Also, unless the initial mastectomy was done using a nipple-sparing approach, most women will proceed with reconstruction of the nipple areola.

Choosing the Right Breast Implant

For the plastic surgeon, choosing the right breast implant in direct-to-implant breast reconstruction may be more challenging than it is in staged expander-implant reconstruction. This is because the surgeon must determine the approximate breast volume before mastectomy without having the benefit of knowing the volume that is in a tissue expander. The proper implant choice is determined by estimating the patient’s breast volume and by making measurements of the breasts and chest wall prior to mastectomy. Breast shape and patient desires are also taken into account. There is currently a wide selection of breast implant sizes and shapes to choose from. In the operating room, immediately after mastectomy, the breast can be weighed and additional chest wall measurements can be made in order to narrow down the choice to a proper implant shape and size.

In addition to selecting the appropriate implant shape and size, pre-operative decisions need to be made regarding the type of implant – saline or silicone, smooth or textured, round or shaped. Both saline and silicone implants are approved by the FDA and can provide high quality breast reconstruction outcomes. The type that is right for any given woman will depend in part on what they are looking for in an implant. Both saline and silicone implants are available with either a smooth or textured shell as well as with a round or anatomic shape. Unrelated to the type of external shell or the implant shape, there are some unique characteristics associated with each type of implant that make them distinct choices. Silicone breast implants tend to be softer, potentially providing a more natural look and feel. The newer generation silicone implants have become an increasingly popular choice since their FDA approval in 2006. Some women still prefer having saline implants, although they may be more prone to skin rippling. One important difference is that a leak in a saline implant can be easy to diagnose as the implant deflates. On the other hand, a silicone gel implant rupture might require an MRI study to be diagnosed. After a comprehensive evaluation, including a detailed discussion regarding you goals and desires, Dr. Tamburrino can help you determine which type of implant will meet your needs.