Advances in Breast Reconstruction: Direct to Implant Reconstruction
Many women facing breast cancer have questions about types of breast reconstruction – “What type is best for me? What choices do I have?” Breast reconstruction takes two forms. The first type, which is known as partial breast reconstruction, can be performed after lumpectomy, to fill in a defect left by the breast cancer excision. The second type is performed after mastectomy, to recreate the breast. In either setting, tissue from a patient’s body can be used or an implant. Traditionally, implants after mastectomy are placed in a two-step process. At the time of the mastectomy, a temporary device, called a tissue expander, is placed, usually between the chest wall muscles. This is partially filled with saline, and will gradually be inflated to the full size in a series of office visits over the course of a few weeks to months. This tissue expander allows the mastectomy flaps time to heal and creates a pocket for the eventual final implant. Then a second surgery is done, which is usually in the outpatient setting, to exchange the tissue expander for a permanent implant. This implant can be silicone or saline. In a newer process, known as direct to implant reconstruction, the plastic surgeon places an implant at the time of the mastectomy, eliminating the tissue expander. Typically, a mesh such as Alloderm is used to help cover the implant. This is an advance in breast reconstruction, and can be done after either skin sparing or nipple sparing mastectomies. When comparing the results with the two-step process, the rates of implant loss and complication are similar in those patients who had direct to implant reconstruction versus those who had the traditional two-step process. When choosing a plastic surgeon, make sure that he or she has experience with this technique. By researching your options, you can be empowered to make decisions that are most comfortable for you.