Direct-to-implant reconstruction: Single surgery, beautiful results after breast cancer
December 9, 2024
Women who desire breast reconstruction with implants after a mastectomy historically have faced at least two surgeries to get their desired look:
- First, after a mastectomy to remove the cancer and surrounding breast tissue, tissue expanders are placed above or beneath the muscle to create space for future implants.
- Then, after several months of inflating the expanders to the proper size, final implants are placed with a second surgery.
That means two separate recovery periods along with the emotional toll of looking different in the mirror prior to the final reconstructive stage.
Direct-to-implant breast reconstruction gives women a streamlined surgical option. This single-stage surgery combines mastectomy and final reconstruction. Instead of using tissue expanders to fit implants above or below the muscle, we position the final implants in the mastectomy envelope – the hollow space between the skin and muscle after the breast tissue is removed.
The result? A precise, single-stage breast cancer surgery and reconstruction that offers a shorter and less painful recovery, lower infection risk, and a natural, attractive outcome.
It’s no wonder that direct-to-implant breast reconstruction is growing in popularity. From 2015-2022, the number of patients in the U.S. who had the single-stage surgery nearly tripled from 10.22% to 29.98%. At the same time, the number of tissue expander procedures declined 22%.
UT Southwestern breast cancer surgeons at Harold C. Simmons Comprehensive Cancer Center work closely with breast reconstruction surgeons from the Department of Plastic Surgery to customize each patient’s care to her cancer treatment needs and desired breast appearance.
Who is eligible for direct-to-implant breast reconstruction?
Direct-to-implant reconstruction is an option for women who have a single or double mastectomy as part of their breast cancer treatment or to reduce their risk of getting breast cancer. Whether a woman chooses this surgery, another breast reconstruction procedure, or no reconstruction, she’ll have a team of experts to help her make an informed decision.
Given our deep expertise in this procedure, nearly every woman who wants implants after a mastectomy can be a candidate for direct-to-implant reconstruction. Ideal candidates have:
- Smaller breasts, with a shorter nipple-to-fold distance. This is the length from the nipple to the crease under the breast, and an ideal measurement is typically found in women with A- to C-cup breasts.
- No expected radiation therapy. In some cases, radiation therapy can impede healing after surgery and can result in asymmetry, capsular contracture, infection, or implant failure. Women who need radiation therapy may have better outcomes with autologous breast reconstruction such as DIEP flap surgery, which uses the body’s own tissues instead of an implant to reconstruct the breast.
However, women who do not meet these criteria are not automatically disqualified. UTSW breast cancer and plastic surgeons can personalize how we perform each woman’s procedure according to her unique physique and goals.
For example, women with large breasts can choose to have a breast reduction to decrease bust size or a breast lift to raise the breasts higher during the direct-to-implant procedure. The breast cancer surgeon and plastic surgeon will collaborate to plan a surgery that treats the cancer and achieves the patient’s desired appearance in a single surgery.
What should I expect with single-stage breast surgery?
Women will meet with their breast cancer surgeon to discuss their goals for treatment. If mastectomy is recommended or preferred, patients will then be referred to a plastic surgeon if reconstruction is desired. At the initial visit with the plastic surgeon, patients will explore all the breast reconstruction options available for their condition and desired appearance.
The surgical team will then collaborate to determine if a single-stage procedure is appropriate and to develop a plan to effectively treat the cancer and preserve the appropriate amount of skin during mastectomy to facilitate the reconstruction.
During the procedure, the patient will be under full anesthesia. The breast cancer surgeon will perform the mastectomy, and the plastic surgeon will place the implant in the mastectomy envelope. Acellular dermal matrix, a soft tissue replacement, is used to help support the implant by reinforcing the mastectomy envelope, holding the implant in place, and reducing implant rippling.
Related reading: Enhanced Recovery After Surgery - Breast Reconstruction
What will recovery be like?
Recovery after direct-to-implant surgery can often be easier than recovery after reconstruction with tissue expanders. And the main benefit is that patients have to do it only once.
Patients can go home the same day or spend one night in the hospital. Patients can expect some bruising, swelling, and tenderness of the surgical site and can plan for 4-6 weeks off work as well as no strenuous activities, such as exercise. Most women can shower within 24 hours after surgery. To prevent infection or tissue damage, avoid rubbing or scrubbing the incisions until the surgical team says it is safe.
Women will go home with drains attached near their breasts to reduce excess fluid and help prevent infection. Direct-to-implant surgery requires fewer drains, which helps reduce discomfort and infection risk. Doctors may prescribe a compression bra to help reduce movement, discomfort, and fluid buildup. Others may not require use of a post-surgical bra. Patients can usually resume regular activities in 4-6 weeks.
Choosing whether to have breast reconstruction after a mastectomy – and which option makes sense – is one of the most complex decisions patients face after a breast cancer diagnosis.
But patients do not have to make these decisions alone. The UTSW breast cancer team will talk through all the options, answer patients’ questions, and help every woman make an educated decision. We want every patient to be happy with her choice. Our goal is to give every woman an effective, beautiful outcome that helps her feel confident and comfortable in her life ahead.
To talk with an expert about direct-to-implant breast reconstruction, call 214-645-8300 or request an appointment online.
