Breast reconstruction involves a procedure most commonly performed as a result of a mastectomy (full breast removal) or lumpectomy (partial breast removal) due to breast cancer. In all cases, it is a procedure to help restore a more natural breast appearance.
Direct-to-implant breast reconstruction surgeries are performed at the time of mastectomy, and require that the General Surgeon (who performs the mastectomy) and the Plastic Surgeon (who performs the breast reconstruction) work in tandem as part of the same procedure. The direct-to-implant procedure is sometimes also referred to as single-stage breast reconstruction or immediate breast reconstruction. For many women, the greatest benefit of this approach is that it does not require any additional surgeries. In contrast to the traditional approach to implant-based reconstruction, which uses tissue expanders and requires 2-4+ procedures to complete the reconstructive process, direct-to-implant patients most commonly have their breast reconstruction completed in one surgery. In fact, for most of Dr. Hunsicker and Dr. Nguyen's patients, post-surgical restrictions are lifted about six weeks after the direct-to-implant procedure. Plus, patients talk about the benefit of emerging from surgery with fully reconstructed breasts as having a hugely positive emotional impact on their recovery.
Many women decide to undergo bilateral mastectomies, and thus bilateral reconstruction is appropriate for them. Others prefer to treat only the breast with the cancer diagnosis, and so they have reconstruction on a unilateral basis. In the cases where patients undergo unilateral mastectomies, they can elect to have breast lifts or augmentation on the healthy opposite breast to achieve symmetry with their treated breast. While there are certainly many positive benefits to this type of breast reconstruction, it isn't necessarily the best option for all women. The key is to become as informed as possible regarding the procedure and its expected outcomes. Be sure to discuss whether you are a good candidate for direct-to-implant breast reconstruction with a surgeon who performs the procedure successfully on a regular basis. If you are a good candidate for direct-to-implant breast reconstruction, and its expected outcomes meet your personal health and body image goals, it may be a good option.
How We Perform Direct-to-implant Breast Reconstruction
Before undergoing mastectomy surgery, it will be important to work closely with Dr. Hunsicker and Dr. Nguyen who will help determine whether or not you are a good candidate for direct-to-implant breast reconstruction. Important factors to consider will include the:
- Type of cancer treatment and if you will continue receiving treatment
- State of your skin and other tissue in the areas undergoing the surgery
- Breast volume prior to mastectomy
- Health history
If you are likely to continue chemotherapy or other radiation treatments, and your breast skin demonstrates good elasticity, direct-to-implant breast reconstruction will likely be recommended. Similarly, if you lack the skin and tissue needed for a successful flap reconstruction, you may also be considered a strong candidate for direct-to-implant breast reconstruction. Direct-to-implant breast reconstruction occurs immediately following mastectomy, while the patient is still under general anesthesia or IV sedation. After the original breast tissue has been removed by the general surgeon, Dr. Hunsicker and Dr. Nguyen then reconstruct the pocket, building an internal sling out of Alloderm®, which acts like an internal bra to support the weight and volume of the new, permanent implant. After carefully ensuring that the implant is positioned correctly, the chest skin is placed over the implant, and all incisions are sutured shut. The implant will either be a smooth, round cohesive silicone gel, or a textured, anatomic cohesive silicone gel, and you and your reconstructive surgeon will determine which type of implant will be best for you.
After direct-to-implant breast reconstruction, expect soreness, tenderness, tightness, or possibly tingling sensations throughout your chest and arms. Many patients feel fatigued and sore for a few weeks following surgery, although you should be able to return to most normal activities within six weeks. The Revalla staff will thoroughly review your aftercare instructions, which include post-op assignments such as physical therapy and acupuncture, and will ensure that you return to full physical strength and range of motion as soon as possible after surgery. Throughout your recovery period, avoid extreme movement, stress, or abrasion at all incision sites. It is important to follow all directions for postoperative care provided by Dr. Hunsicker and Dr. Nguyen. Although extensive, patients are usually overwhelmed by how successfully they recover from surgery when they are compliant with her requirements. Because she has honed this process for more than a decade, Dr. Hunsicker and Dr. Nguyen are very aware of the factors necessary to thrive following direct-to-implant surgery.
Because direct-to-implant breast reconstruction represents the final step of a mastectomy, and is performed during the same procedure, general anesthesia or IV sedation is required. Women receiving direct-to-implant breast reconstruction will stay in the hospital overnight following their surgery. Usually all patients are discharged within 23 hours after their procedure.
The actual reconstructive surgery typically lasts approximately 4-5 hours.
After recovering from the operation, you will meet with Dr. Hunsicker and Dr. Nguyen to determine the overall effectiveness of the reconstruction. In some cases, you may choose to undergo secondary procedures that enhance the results of your reconstruction. If a woman has chosen to do a unilateral mastectomy, then surgeries such as a breast lift, reduction, or augmentation on a woman's healthy breast may achieve better balance with the reconstructed breast. Usually this will be performed at the same time as reconstruction, although in some cases patients choose to wait. In some cases, patients consider fat grafting on their reconstructed breasts to help achieve a softer, more natural appearance. In cases where nipple-sparing mastectomy hasn't been an option, most patients consider revisionary surgeries for nipple and areola reconstruction, or decide to have 3D tattooing performed to create the nipple-areola area.
This is one of the most common misconceptions that Dr. Hunsicker and Dr. Nguyen hears about whether or not a patient is a candidate for direct-to-implant breast reconstruction. Patients are typically still candidates for direct-to-implant reconstruction, even if their oncologists are suggesting radiation as part of their cancer treatment. Dr. Hunsicker or Dr. Nguyen will make adjustments for her surgical plan when radiation is part of a patient’s cancer treatment, and in many cases can avoid subsequent surgeries to address asymmetry after radiation. For women who are considering direct-to-implant after having radiation to treat a previous breast cancer diagnosis, it is important to consult with Dr. Hunsicker and Dr. Nguyen to determine whether you would be a candidate for the procedure. Because of her extensive experience operating on radiated tissue and reconstructing breasts as part of a breast cancer diagnosis, she understands the complexities of the situation and sometimes is able to offer solutions with which other surgeons may not have experience.