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Direct-to-Implant Breast Reconstruction

While a tissue expander remains the most common first step in breast reconstruction with implants, some patients may be candidates for a direct to implant breast reconstruction. This means that patients can bypass a preliminary surgery where temporary breast tissue expander implants are inflated over time to stretch the overlying skin and muscle. Rather, the fully filled breast implant is placed in the beginning while the patient is still under general anesthesia to have their breast removed during mastectomy.

The obvious advantage is that patients can reduce the number of surgeries and office visits required with other forms of breast reconstruction. However, several factors determine whether a patient is a good candidate, or even eligible for a direct-to-implant breast reconstruction:

  • Patient must be willing to have reconstructed breasts be the same size, or often smaller than the original breast size.
  • There must be enough remaining breast skin following mastectomy relative to the desired volume of the breast reconstruction. Often, this limits eligible patients to those able to undergo a nipple-areola sparing-, nipple sparing-, or skin-sparing mastectomy
  • The remaining breast skin must be healthy. Patients with underlying medical conditions like lupus or diabetes or who smoke cigarettes or use other recreational drugs are more predisposed to wound healing problems and are rarely candidates for direct-to-implant breast reconstruction.
  • Absence of previous radiation. Previous radiation, for example in patients who had a lumpectomy and radiation, developed a recurrent breast cancer and now require mastectomy are not usually good candidates for a direct-to-implant breast reconstruction due to concerns over tissue quality and wound healing problems.
  • Use of acellular dermal matrix. The supportive components of the breast tissue are removed following a mastectomy. In order to support, pad, and control the position and shape of a breast implant placed at the time of a mastectomy a material known as an acellular dermal matrix is used. The use of alloderm, the most commonly used version of this product, is an important step in direct-to-implant breast reconstruction. This material, however, is derived from the deep layer of human skin know as the dermis. It is treated with a proprietary process that removes cells and treats it with antibiotics to help reduce the risk of infection. Based on significant research and extensive experience, this innovation is an important component of direct-to-implant breast reconstruction. Still, patients uncomfortable with the use of this product may not wish to consider a direct-to-implant breast reconstruction.

To learn which form of breast reconstruction is right for you, review photos, or testimonials please visit us online at westcountyplasticsurgeons.wustl.edu.

Breast Conservation

It’s something many don’t know – federal law mandates insurance companies cover reconstruction after breast conservation surgery. Find out more in this "Cancer Connection" podcast with Terry Myckatyn, MD, Washington University plastic and reconstructive surgeon at Barnes-Jewish Hospital and Barnes-Jewish West County Hospital. More information about lumpectomy after breast cancer.

 

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