Direct to implant reconstruction has frequently been called “single stage” breast reconstruction. A permanent implant is placed at the time of mastectomy, avoiding the need for a tissue expander. However, many women still require a revisional surgery to optimize breast shape, scars, or symmetry. Once the mastectomy is complete, the patient is evaluated to ensure they are an appropriate candidate for immediate reconstruction. The criteria to undergo immediate reconstruction include complete removal of the cancer, an adequate amount of skin to perform the reconstruction, and healthy mastectomy skin with a good blood supply.
Candidates for direct to implant reconstruction include women with small to moderate size breasts that want to have the same breast size or smaller breast size post-operatively. Large implants can cause strain on the breast skin after the mastectomy which may lead to implant failure. In addition, patients who want to have the possibility of one surgery are also good candidates, although a small revision surgery may still be required.
There are many similarities between the two stage reconstruction described above and the direct to implant reconstruction except the implant is placed at the time of the mastectomy rather than the tissue expander. Acellular dermal matrix (ADM) is placed around the implant, which is inserted into the breast. The ADM is used as an internal bra that provides an additional layer of protection and support to the implant. The implant can be placed under the muscle or above it. One or two drains are placed on each side of the mastectomy, depending on whether or not you have a lymph node dissection.
The surgery usually takes 1-1.5 hours depending on whether you are having single or double mastectomies. This time is in addition to the time it takes to complete the mastectomy. Patients are usually hospitalized for one night after a mastectomy with direct to single stage reconstruction.