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DIRECT-TO-IMPLANT

 look and feel beautiful after breast reconstruction surgery

WHAT IS THE DIRECT-TO-IMPLANT PROCEDURE?

With Direct-to-Implant Breast Reconstruction, breasts are reconstructed at the same time as the mastectomy, allowing women to wake up from their mastectomy surgery with their breasts intact. The surgery is performed through small incisions, similar to breast augmentation incisions, which are hidden in the fold under the breast, and the implant is placed at the time of mastectomy, rather than placing a temporary tissue expander.

It starts with the breast surgeon performing the mastectomy through a small incision rather than the large across-the-breast scar that used to be the norm. No skin is removed, and the nipple and areola are left intact. During the mastectomy surgery, the plastic surgeon places an internal bra and the breast implant is inserted for the final result, eliminating the need for painful and prolonged tissue expansion. Our doctors use a natural collagen substance called acellular dermal matrix (ADM) to create the internal bra to support the implant. With this method, the breast can be recreated in a more natural position than typical breast reconstruction, and looks good even immediately after the surgery. Our technique yields a very symmetrical, cosmetic result, and can produce virtually any desired breast size. The final scar is minimal, or it may even be completely invsible. The results? Beautiful, natural-looking breasts.

"We are so frustrated with the bad-looking results we see. The traditional process is painful, requires multiple surgeries, and gives unattractive outcomes. We are working to change the 'standard of care' for breast reconstruction, because women deserve better. We want women to know that newer, better options exist."

- Lisa Cassileth, MD, FACS

HOW IS IT DIFFERENT FROM TRADITIONAL BREAST-IMPLANT-BASED RECONSTRUCTION?

With traditional implant-based reconstruction, the surgeon inserts tissue expanders at the time of mastectomy to stretch the skin and make room for breast implants. Over the next several months, the expanders are inflated using saline injections. Then, in a second surgery, they are removed and replaced with breast implants.

Patients ask us all the time why tissue expanders aren’t necessary in our reconstruction, and if not, why are they still so commonly used by others? The simple answer is that if there is no skin removed, there is nothing to expand. Why they are commonly still used, though, is for a different reason; many plastic surgeons work with mastectomy surgeons that have a high rate of mastectomy flap necrosis. This is when the tissue of the breast skin, areola, or nipple has low blood flow after the mastectomy, and dies, also called necrosis. If the mastectomy skin undergoes necrosis after mastectomy, then the dead skin needs to be removed, and then there is a reason to have an expander in place. In cases where there will likely be necrosis, an expander is considered “safer”. We believe it is safest to use surgeons that rarely or never cause necrosis.

Most patients are good candidates for the procedure, which treats size A to size DD breasts. Breasts that are droopy, or “ptotic”, are often also suitable for the procedure. The procedure gives a natural lift to the breast as the heavy breast is removed, and then the skin springs up to the new supported implant.

Many women find that breast reconstruction after mastectomy is one of the most demoralizing, difficult, and disappointing parts of breast cancer treatment. It means months of chest wall expansion and a mandatory second surgery to swap the expanders for permanent implants. And after two surgeries, patients may be left with large, unsightly scars.

Now there is an alternative. Performed only with nipple and skin-sparing mastectomy, the implant can be placed at the time of the initial removal of breast tissue. Since no skin is removed during the mastectomy, it is not necessary to undergo expansion with tissue expanders. And in the Direct-to-Implant procedure, an internal bra is created using acellular dermal matrix, which creates an internal pocket that holds the implant in the correct position.

This one-stage surgery makes tissue expanders and multiple surgeries unnecessary.

WHAT ARE THE ADVANTAGES OF DIRECT-TO-IMPLANT RECONSTRUCTION?

Only one surgery – lowers overall risk, decreases cost, and minimizes discomfort

Avoids months of painful tissue expansion

When you wake up from your mastectomy surgery, you will have whole breasts

The risks are the same or better than traditional tissue expander technique

Patients enjoy beautiful new breasts that look natural and full

Minimal scarring

GETTING THE RIGHT MASTECTOMY

Getting the right kind of mastectomy is critical. The best results are achieved with either a skin-sparing mastectomy or a nipple/areola-sparing mastectomy. Our mastectomy specialists, based at Bedford Breast Center in Los Angeles, perform these types of mastectomies.

NIPPLE/AREOLA-SPARING MASTECTOMY

The most superior cosmetic results are obtained with the Nipple/Areola-Sparing Mastectomy. Through the crease under the breast, the breast tissue is removed and the breast is reconstructed. Not all patients are candidates for this type of mastectomy reconstruction, as the nipple and areola can contain a small amount of breast ductal tissue. This option is often chosen by women who are deciding between mastectomy and screenings, because they have high risk factors such as BRCA+ or a strong family history of breast cancer. Women who have breast cancer further away from the nipple are also good candidates. All mastectomies are performed at our Beverly Hills Surgery Center with our mastectomy and reconstruction colleagues who are board-certified general surgeons specializing in breast and oncological surgery. Their expertise helps make your one-stage breast reconstruction go smoothly, with excellent results!

SKIN SPARING MASTECTOMY

For patients with BRCA+*, those with DCIS or LCIS only, and for breast cancer patients where the tumor is not directly adjacent to skin, Skin-Sparing Mastectomy is safe and cosmetically superior to traditional mastectomy.

*BRCA Definition: The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited (from a family member) mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer compared with the general population. Often women that test positive for the BRCA gene opt to have bilateral mastectomies and breast reconstruction to prevent possible future breast cancer.

With Skin-Sparing Mastectomy, only the nipple and areola skin are removed. The breast tissue is removed through the hole left by the areola. The reconstruction is then performed through the same small incision. In a later surgery, the nipple and areola are reconstructed, and placed so that the incision is hidden in the areola, producing a scarless resul

Direct-to-Implant Breast Reconstruction Before & After

Age: 40, from San Clemente, California. Underwent bilateral skin-sparing mastectomy with Cassileth One-Stage/Direct to Implant Breast Reconstruction. The patient had nipple/areola reconstruction as a second surgery and had a tummy tuck as a separate procedure. 397cc implants.

DR. CASSILETH

BREAST SPECIALIST

DR. KILLEEN

BREAST SPECIALIST