Direct to Implant

Single stage breast reconstruction consists of the immediate insertion of a permanent breast implant post mastectomy. This “one step” approach forgoes the placement of a tissue expander which would require subsequent expansions prior to the final breast implant being introduced. Therefore, reconstruction patients undergoing a mastectomy would wake up in the recovery room with their breast mound positioned on the affected side with the implant surgically in place. The implant is supported by a tissue matrix acting as a hammock at the base of the implant. This surgical option, as compared with the tissue expander method would minimize the total number of procedures and general anesthetics required to complete the overall breast reconstruction.

Who is a candidate?

Normal body weight (BMI under 30) and reasonable breast size selected/matched
Having a skin sparing mastectomy
No previous radiation to breast or chest
Agreeable to balancing procedure on opposite breast if necessary
Have no available flap options/ or do not desire an autologous reconstruction
Having bilateral mastectomies (prophylactic also)

Contraindications for Patient Selection: (guideline only)

Autoimmune disease
Advanced disease
BMI 30+
Previously radiated
Compromised flaps at the mastectomy site: (infection, previous surgery, scarring, etc.)

Preparation for surgery

It is very important that Dr. Van Laeken is aware of the state of your general health prior to surgery. Please let her know of any allergies you have, medications, herbal supplements, or vitamins you are taking as well as the reasons for taking them. It is also important that you inform Dr. Van Laeken if you have a tendency for keloid scarring (thick, wide, or raised scars). It is important that you avoid taking vitamin E, anti-inflammatories or aspirin products for 2 weeks prior to surgery. These products are anti-coagulants, and could lead to hematoma formation and bleeding during the surgery.

If you are a smoker you must quit prior to proceeding with any reconstruction options. Smoking can interfere with the blood flow to the skin, and will inhibit the healing of the incisions.

Depending on your age as well as your general health pre-operative tests may be ordered, such as blood work, an ECG (electrocardiogram) or a mammogram (for delayed procedures). You may be asked to attend the Pre- Admission Clinic at the hospital before your surgery. The nurse in the clinic will provide you with specific instructions and prepare you for your upcoming procedure. The Pre-Admission (Pre-Assessment) clinic will call you directly with your appointment time.

Procedure

After your General Surgeon has completed the mastectomy, Dr. Van Laeken would commence the reconstruction by introducing a breast implant, positioned beneath the pectoralis major muscle on the chest wall. The breast implant that Dr. Van Laeken will select for you is based on her examination of you during your consultation. There are hundreds of shapes, sizes and profiles of implants for her to choose from. Both smooth and textured implants are available. It is suggested that textured implants decrease the risk of capsular contracture. Today, both saline and silicone implants are used.

The objective is to select an implant that will provide the best symmetry based on your body type. After the implant is in place, a dermal matrix (Alloderm, Allomax, SurgiMend, Veritas) is introduced. These products are derived from donated tissue and are anchored with sutures into place between the pectoralis muscle and the chest wall at the lower pole of the breast to support the implant. This device serves a “hammock” and becomes an integral part of the patient’s body.

Recovery

Patients may go home the same day as their procedure or stay one night, following their surgery. They should avoid strenuous activity and heavy lifting for 4 - 6 weeks. Swelling and bruising may take up to 8 weeks to subside and should be accommodated with a supportive bra.

Potential Complications

While offering faster reconstruction, DTI carries a higher rate of complications—such as wound healing issues and implant exposure—compared to two-stage reconstruction, often requiring revision surgeries or re-operation.

Complications that may arise from direct to implant breast reconstruction can include;

Haematoma

Blood can gather under the skin and cause a blood clot. If this does occur, Dr. Van Laeken can drain the area. Indications of a haematoma are a firm, painful lump that causes colour change in the skin. This rarely occurs after 48 hours post operatively.

Implant Loss

Complete failure of an implant to maintain its position and function, requiring surgical removal.

Infection

Signs of infection are localized heat, redness, fever, and pain. Dr. Van Laeken can prescribe antibiotics to treat the infection. Occasionally the area will need to be drained.

Necrosis

Tissue loss that can occur when blood supply to the skin and tissue is compromised.

Seroma

Serum can accumulate underneath the skin. On occasion it is necessary to have the fluid drained.

Before & After Photos