A direct-to-implant or “one-step” approach can make it possible for some patients to undergo immediate reconstruction of the breast mound. A mastectomy that conserves a large amount of breast skin is the most conducive to this approach. A permanent implant is inserted immediately after the mastectomy, bypassing placement of a tissue expander and the subsequent expansion process.
The implant is positioned on the chest wall behind the pectoralis major muscle. With the help of a tissue matrix such as Strattice® or AlloDerm®, an implant of the desired volume can be used during the initial surgery, provided a sufficient amount of breast skin remains after mastectomy.
In some cases, a patient may elect to undergo a second stage reconstruction that creates a more refined breast shape. This is usually an outpatient procedure, and often there is no need even to exchange the implant. The initial implant placement, and possible second stage, each take about one hour in the operating room.
“What are some of the advantages of an immediate, one-step approach?”
Reconstruction performed when the chest tissues are not damaged by radiation therapy or scarring can often lead to a better-looking final result. Also, immediate reconstruction usually means less surgery overall.
“Will normal sensation be regained in the reconstructed breast?”
Reconstruction can restore the shape of the breast, but not sensitivity to touch. With time, the skin on the reconstructed breast may become more sensitive, but it will not feel the same as it did prior to mastectomy.