What is a direct-to-implant breast reconstruction? Also known as an immediate implant breast reconstruction, this is a procedure in which a breast implant is placed at the time of a mastectomy in a single stage without a tissue expander or flap procedure. Only patients who meet the specific criteria for this operation are candidates:
- patients with moderate-to-large breasts who will tolerate smaller breasts after reconstruction\
- patient undergoing nipple-areola, nipple- or skin-sparing mastectomies
- patients who do not require radiation therapy
Immediately following the mastectomy, a pocket is made under the pectoral muscle of the chest. The top part of the implant is placed underneath this muscle, while the bottom part of the implant is supported by a material known as an acellular dermal matrix or AlloDerm®. Breast implants placed during a direct-to-implant breast reconstruction are the exact same breast implants used in other forms of breast cosmetic and reconstructive surgery. They can be silicone or saline. They can be textured or smooth. They are often referred to as permanent implants, but in reality they last for an average of 10 to 15 years before they require replacement. The main reasons for replacement are a leak or the formation of uncomfortable scar tissue around the implant that is known as a capsular contracture.
Reconstructive timeline with direct-to-implant breast reconstruction:
- First operation: Mastectomy + Immediate implant / alloderm breast reconstruction(s).
Office visits: Drain removal and wound checks.
- 4 months: Nipple reconstruction. Possible fat grafts to optimize breast contours. Possible “touch up” procedures to improve cosmetic appearance of breast reconstruction.
- 5 months: Areola (pigmented circular area that surrounds the nipple) reconstruction with tattoo.
- 9 -18 months: Laser or IPL scar therapy.
Anesthesia: Direct-to-implant breast reconstruction is performed with the patient under general anesthesia.
Length of procedure: 60 minutes for one breast, 90 minutes for both breasts.
Estimated recovery time: Hospitalization is usually 1 to 2 days. You can return to work after 2 to 4 weeks and should avoid vigorous activities for 4 to 6 weeks. Visible bruising and swelling should begin to improve within 3 weeks. To learn how to prepare for a direct-to-implant breast reconstruction and what to expect afterwards, click here to download our patient instructions.
Side effects: Common side effects include bruising and swelling. The breast may have some irregular contours after surgery. Delayed wound healing and infections may occur. Click here to download a detailed consent form from the American Society of Plastic Surgeons that lists the risks and benefits of breast reconstruction with permanent implants.
Before-and-after photos of breast reconstructions with DIEP and TRAM flaps: Click here