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Surgeons place a final breast implant at the time of mastectomy.

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Direct-to-implant breast reconstruction allows surgeons to place a breast implant immediately, without using a tissue expander. This “one-step” approach suits patients who have adequate healthy breast skin after mastectomy. Candidacy often depends on the type of mastectomy a patient undergoes. This approach is most often suitable for patients who undergo skin-sparing or nipple-sparing mastectomies. Once the breast surgeon has completed the mastectomy, a plastic surgeon places breast implants.

Types of Direct-to-Implant procedures

Prepectoral breast reconstruction

This approach places the implants in a more natural position, over the pectoralis muscle (OTM). Patients must have adequate skin quality to accommodate this newer technique.

DTI split plane

© Image Credit

Implant OTM, completely covered with a dermal matrix (beige).

Subpectoral breast reconstruction

This more traditional approach places breast implants under the pectoralis muscle (UTM). It allows for additional soft tissue beneath the reconstructed breast skin. The muscle covers the upper part of the implant and a dermal matrix is usually used to support the lower half of the implant.

DTI split plane

© Image Credit

Implant partially UTM with pectoralis muscle above (red) and dermal matrix below (beige).

Procedure details:

  • Doctor and patient work together to choose a type of breast implant
  • The surgeon places implants over or under the pectoralis muscle
  • A biologic tissue matrix placed around the implant helps secure the implant position
  • Patients awaken from their mastectomy with a well-defined breast shape

Risks & Benefits

Implant breast reconstruction allows for a shorter early recovery period compared with natural-tissue reconstruction. Risks include breast skin rippling over the implant and issues with implant position. The natural capsule that forms around a breast can also thicken over time. This may result in firmness or capsular contracture. Most implant related issues can be corrected through minor, outpatient revision procedures. Implant reconstruction risks and difficulties tend to be greater for patients who have undergone radiation therapy, those with obesity, and in patients with a very large breast size before mastectomy.