Direct-to-implant breast reconstruction or tissue-expander breast reconstruction: how do we decide?

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Direct-to-implant breast reconstruction or tissue-expander breast reconstruction: how do we decide?

Implant-based breast reconstruction has two approaches: direct-to-implant reconstruction and expander implant reconstruction. Direct-to-implant reconstruction is exactly as it sounds: a final implant is placed at the same time a patient has a mastectomy. When we perform expander implant reconstruction, we place a tissue expander implant at the time of mastectomy. That tissue expander is then filled over the course of several office visits in order to create adequate space for a final implant.

Patients often want to know how we decide which option is best for them. The answer has a lot to do with breast skin after mastectomy. If the breast skin is of sufficient quality following mastectomy—especially with nipple-sparing approaches—we can go directly to an implant, avoiding a tissue expander. But there’s another factor that we take into consideration, and that is the patient-desired volume following her reconstruction. If a patient wants to be bigger than she was prior to surgery, then a tissue expander may be the right way to go. We place a tissue expander at the time of mastectomy. This allows us to expand the breast volume during the recovery phase, and we come back for a secondary, easier procedure to take out the expander, put in a final implant, and create a fuller-volume breast reconstruction.