Catch the Latest on TwitterBecome a Fan on FacebookVisit to Our Blog
Facebook Like Button

Direct-to-Implant Breast Reconstruction

Tissue Expander Breast Reconstruction

Tissue Expander Breast Reconstruction33-year old woman with bilateral nipple-sparing mastectomy, following single-stage bilateral reconstruction with 325cc Moderate Plus Silicone Gel Implants

Tissue Expander Breast Reconstruction

Tissue Expander Breast Reconstruction31-year old woman with nipple-sparing mastectomy, following single-stage bilateral reconstruction with 500cc High Profile Silicone Gel Implants

Direct-to-implant, or single-stage, breast reconstruction refers to the insertion of a permanent implant immediately following the mastectomy, as opposed to initially placing a tissue expander, filling it over time, and then exchanging the filled expander for the permanent implant. Dr. John Kim of Northwestern Plastic Surgery performs his direct-to-implant single-stage breast reconstructions at Northwestern Memorial Hospital and Prentice Women’s Hospital in downtown Chicago.

Ideal patients for this type of surgery are undergoing bilateral prophylactic mastectomies due to a BRCA1 or BRCA 2 genetic mutation and/or have a strong family history of breast cancer. With these patients, Dr. Kim typically encounters good preservation of the breast skin after the mastectomy, since there is no cancerous portion to excise. If the post-mastectomy breast skin is fairly substantial in amount and quality, Dr. Kim may opt to place the implant in conjunction with a material called acellular dermal matrix (ADM), which acts as a sling to help support and cover the newly placed implant. The addition of ADM to the breast also commonly allows a patient to have larger implants placed than the size of her native breasts, if she so desires.

Here is a brief list of qualities that make you an ideal candidate for direct-to-implant (single-stage) breast reconstruction:

  • You have a reasonable body weight and size
  • You are having bilateral reconstruction or are agreeable to having surgery on the opposite breast to improve symmetry
  • You are having prophylactic (preventive) mastectomies due to genetic mutation and/or strong family history
  • You have not had breast radiation in the past
  • Your mastectomy skin flaps are preserved and in good condition
  • You are unwilling or unable to undergo flap-based reconstruction
  • You are willing to have a final breast size equal to or smaller than your native breast size

These qualities are not ideal for single-stage, direct-to-implant breast reconstruction:

  • You have a high BMI
  • You have more advanced stage cancer
  • You have undergone prior radiation treatment
  • You have had prior breast surgery
  • You have had prior breast complications, such as infection
  • You are a smoker or have existing medical problems

Dr. Kim’s patients who undergo single-stage or direct-to-implant breast reconstruction at Northwestern have the same implant options as those who undergo tissue expander/implant breast reconstruction. Several manufacturers create many different types of implants with variations in shape, profile, size, fill, and surface texture. Breast reconstruction surgeon Dr. Kim will assist you in choosing the correct implant to meet your goals for your breast reconstruction results. He will explain how your personal anatomy and skin elasticity will impact your implant selection.

One of the main considerations when choosing your implants is whether you prefer saline or silicone. Saline implants are made from a silicone-based outer shell that is filled with sterile saline (saltwater) solution. The saline solution is typically added to the shell during surgery, but some saline implants come pre-filled. A major benefit to saline implants is that Dr. Kim is able to adjust the final size during your surgery if adjustments are needed, since he can remove or add saline according to his clinical judgment. Another benefit to using a saline implant is that if it were to rupture, the leaked saline solution will not harm your body. Our bodies naturally absorb saltwater and can excrete it easily. In this case, Dr. Kim will surgically remove the ruptured implant and replace it with a new one.

Silicone implants consist of a shell filled with thick, elastic gel. The gel moves and feels like natural breast tissue, so it is a popular choice among Dr. Kim’s Chicago breast reconstruction patients. In 2012, a new type of silicone gel implant technology was approved by the FDA. These new implants consist of a highly cohesive, high strength gel, and thus they are referred to as “cohesive gel”, “gummy bear”, and “form stable”. When this type of implant is cut or penetrated, it retains its shape (hence “gummy bear”). As with normal silicone gel implants, these too feel like natural breast tissue and are thought to reduce the undesirable side effects of liquid-filled implants, namely folding, wrinkling, over-filling, and rippling. When a silicone implant ruptures, it is less noticeable than when a saline implant breaks. The slow leaking of silicone gel to areas outside the breast may go unnoticed for a while. Our bodies do not naturally absorb silicone as they do saline, though, so it is important to see Dr. Kim right away if you suspect a rupture, as he will need to surgically remove the shell and silicone and replace the implant with a new one.

You can visit the websites of the prominent cohesive gel implant manufacturers (Mentor, Allergan, and Sientra) here:

Mentor: http://www.mentorwwllc.com/global-us/Breast.aspx
Allergan: http://www.allergan.com/products/medical_aesthetics/natrelle_collection.htm
Sientra: http://www.sientra.com/feelgood/SiliconeBreastImplants

Tissue Expander Breast Reconstruction

Tissue Expander Breast Reconstruction33-year old woman with bilateral nipple-sparing mastectomy, following single-stage bilateral reconstruction with 325cc Moderate Plus Silicone Gel Implants

Tissue Expander Breast Reconstruction

Tissue Expander Breast Reconstruction31-year old woman with nipple-sparing mastectomy, following single-stage bilateral reconstruction with 500cc High Profile Silicone Gel Implants

The main advantage to having direct-to-implant (single-stage) breast reconstruction is that you will have fewer surgeries and visits to Dr. Kim’s offices in Galter Pavilion in downtown Chicago than if you have a tissue expander placed then subsequently expanded and ultimately exchanged for a permanent implant in a separate surgery.

Here are some useful resources for your perusal as you explore your breast reconstruction options:

www.plasticsurgery.org
www.surgery.org
www.webmd.com
www.mayoclinic.org

For more information on single-stage, direct-to-implant breast reconstruction, please contact board-certified reconstructive surgeon Dr. John Kim at his office at Northwestern Plastic Surgery (312-695-6022).

 
 
 
Galter Pavilion Suite 19-250
675 N. Saint Clair, Chicago, IL 60611
T: 312.695.3615 | F: 312.695.5672
Switch To Mobile Version
John Kim, MD
675 North Saint Clair St. #19 Chicago, IL 60611 (312) 695-3615
Terms of Use
Web Marketing powered by Ceatus Media Group LLC
Back to page top