Thoughts on Direct-to-implant (DTI) breast surgery? (Photos)

Question

I will be undergoing a BMX for left sided invasive breast cancer and ADH, and right sided is concerning on MRI, but with extremely dense breasts concerned about unneeded bx. I have a history of a kissing stent in IVC and bilateral illiac stents due to an extensive clot post Covid. Blood flow to my abdomen is questionable. Goal is DTI to reduce number of procedures, despite a least 50% chance of axilary radiation post procedure. Surgeon and Plastic Surgeon will work side by side. Distance between areola is 7.5 inches. 5’6.5” and 120 lbs. currently A cup. Was B cup before nursing and D cup during nursing. Interested in going as large as possible, she will use ADM. Interested in thoughts about success, size in CCs and ultimate size

Ram Kalus, MD, FACS · Answer

Thank you for your query and best of luck with your upcoming surgery. It is undoubtedly a stressful time for you.

Breast reconstruction in general and DTI success specifically is dependent nearly entirely in the experience and technique and judgement of your breast surgeon and plastic surgeon. This is not always information easily obtained by patients, but if you have confidence in your team, trust their judgement and recommendations. Your own input is critical.

In general, as a plastic surgeon who performs 95% DTI, one can generally achieve a slightly larger final result than the original breast size (if  this is the patient’s wishes). The ultimate aesthetic result is primarily dependent on breast implant width being optimal.

I recommend you share “wish photos” with your plastic surgeon and get her input as to whether or not your wishes are realistic. Your plastic surgeon will always have a back up plan of inserting tissue expanders if she is concerned about the blood supply of your breast skin and nipple/areola.

Ask your questions, do your research. Best of luck to you.

Thoughts on Direct-to-implant (DTI) breast surgery? (Photos)

Answers (1)

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