The Real Deal on Direct to Implant Reconstruction

Hello!  Thank you for your question.  I agree with what your plastic has told you.  In most surgeons' hands, the 2-stage tissue expander to implant breast reconstruction will create better results given the more gradual stretching of the muscle/tissue, the ability to control the reconstruction not only during the expansion, but also at the 2nd stage, as well as the ability to perform other adjunct procedures at your next procedure, including possibly fat grafting, nipple reconstruction, and improving the shape/breast pocket.  A direct-to-implnat procedure is also an excellent option.  Certainly, as for all forms of breast reconstruction, the decision on which procedure, if any, will be up to you.  There are various options in breast reconstruction which you should have been educated and informed of, and your surgeon should help you decide which option will be the right decision for you and what you wish to go through.  Given your apparent petite size and small body habitus with 'A' cup breasts, without an examination, I am unsure if direct-to-implant breast reconstruction would be a reasonable decision.  Almost inevitably, you will be slightly smaller than your preoperative size, if skin/tissue (including your nipple-areolar complex) is removed.  I would discuss the various options with your plastic surgeon so that you are able to make an informed decision of which reconstructive option you choose.  Hope that this helps!  Good luck with your decision and best wishes for an excellent result! 

Direct to implant reconstruction is a great tool.  You can have almost no sag in the breast when you perform this.  It is also best for small to medium size breasts.  The reason is that you have to increase to volume you put in at the time of surgery.  It is a very good technique.Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.



If
you are interested in being seen in Austin please give us a call. I know
this is a difficult time for you. The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

As an extremely experience reconstructive breast surgeon, I completely agree with your surgeon.  Almost every patient needs that second procedure to modify (move the implants in, improve symmetry), fat graft etc.  The problem with using an implant in one surgery also is that you may not be happy with the final size.  I would not be overly concerned about "stretching" since the same volume could be put in the expander as an implant in a one stage.  The other advantage is the volume can be reduced if the skin is compromised.  Direct to implant is overrated and higher risk in my opinion. I will do it if a patient insists and it is a nipple sparing mastectomy in a patient with minimal droopiness of their breasts.