Direct-to-Implant breast reconstruction at Beverly Hills' Cassileth Plastic Surgery allows for the breasts to be reconstructed at the same time as a mastectomy. Dr. Lisa Cassileth developed this one-stage technique, which makes tissue expanders unnecessary and allows women to wake up from their mastectomy surgery with normal-sized breasts. This makes the reconstruction process shorter and more comfortable, and no further surgery is required.
Many women have found that the traditional approach to breast reconstruction after mastectomy is one of the most demoralizing, difficult, and disappointing parts of their breast cancer treatment. The process usually consists of months of chest wall expansion and a mandatory second surgery to swap the expanders for the implants themselves. After two surgeries, patients may technically have reconstructed breasts, but also be left with large, unsightly scars that mar the results. Traditionally, the goal is to look acceptable in clothes. With more women than ever choosing to undergo mastectomy for the treatment or prevention of breast cancer, the desire for an alternative to traditional reconstruction has grown.
Now, with Direct-to-Implant breast reconstruction, there is a better alternative.
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I do not have enough wonderful words for Dr. Cassileth and her staff! After finding out I was BRCA 1 positive at age 37, I immediately knew I wanted preventative surgery to decrease my cancer odds. Dr. Cassileth was able to perform Direct To Implant surgery on me and I am thrilled with the results. It is amazing that my mastectomy breasts look better than they did before. She is truly the best at what she does and I can't say enough great things about her nurse Carollee as well, who is there the entire time. Thank you Dr. Cassileth and team!!
"We were so frustrated with the bad-looking results we were seeing from typical reconstruction procedures. The traditional process is painful, requires multiple surgeries, and gives unattractive outcomes," Dr. Cassileth explained. "With Direct-to-Implant breast reconstruction, 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. The standard outcome of mastectomy should be ‘walk naked in the gym!'"
Formerly, breast reconstruction was performed in stages. During or just after mastectomy, the plastic surgeon would place a flat, fillable type of implant, called a tissue expander, into the chest. Over a period of several months, this expander was gradually filled via saline injections. The ever-increasing volume stretched the chest muscles to make room for the implants of a desired size. Then, a second surgery was required to remove the expanders and replace them with implants.
Direct-to-Implant breast reconstruction is performed through a small incision hidden in the crease below the breast. Unlike traditional reconstruction, the implant is inserted through this incision at the same time as the mastectomy—which is why it's called the "one-stage" procedure—so that patients wake up from surgery with their new breasts.
The Direct-to-Implant breast reconstruction technique minimizes discomfort and does away with the need for patients to endure months of painful tissue expanders.
The ultimate result of the one-stage procedure is a beautiful, natural-looking silhouette. Many of our Direct-to-Implant breast reconstruction patients say that they like their newly reconstructed breasts more than their prior breasts.
Before deciding on a one-stage reconstruction procedure—or any specific course of action—Dr. Lisa Cassileth and Dr. Kelly Killeen conduct a detailed examination and have a thorough conversation with each patient to decide implant size, incision type, and implant placement. The Direct-to-Implant breast reconstruction procedure is custom tailored to each patient, with exact procedure details and implant placement location determined on a case-by-case basis.
Direct-to-Implant breast reconstruction starts with a mastectomy performed through a very small opening under the crease, rather than the large, across-the-breast incision that used to be the norm. Both the reconstruction and the mastectomy are performed through this incision.
Women undergoing Direct-to-Implant breast reconstruction also have the option to have the implants placed under or over their chest muscle. The benefits of positioning the implants over the muscle (prepectoral breast implant placement) during a one-stage procedure include a faster recovery, less movement of the breast when the pectoral muscle moves, and less altering of the normal breast structure. Some women with larger breasts and loose skin may be do better with a subpectoral reconstruction (under the muscle), as the pectoral muscle can help support the implant.
Dr. Cassileth and Dr. Killeen use a natural collagen substance called acellular dermal matrix (ADM) to create an internal bra to support the implant, whether over or under the muscle. As breast specialists, they have used ADM for more than a decade in both Direct-to-Implant breast reconstruction and capsular contracture treatment and repair. With this method, the breast can be re-created in a more natural position during a one-stage procedure than typical breast reconstruction allows. Natural post-operative stretch gives a more realistic result.
The scar resulting from Direct-to-Implant breast reconstruction is minimal—or it may even be completely absent due to the location in the natural crease. The results are beautiful, natural-looking breasts.
Most mastectomy patients are good candidates for Direct-to-Implant breast reconstruction, which treats size A to size DD breasts. Women with previously droopy breasts are often also well suited for the one-stage procedure, since Direct-to-Implant breast reconstruction gives a natural lift to the breast. As the heavy breast is removed, the reduction in weight allows the skin to "spring up" to the new, supported implant.
Good candidates for the pre-pectoral technique, specifically, are women who choose the one-stage procedure, but who want to avoid change in the pectoral movement or muscle after their Direct-to-Implant breast reconstruction surgery. Patients opting to undergo fat grafting in addition to using a breast implant are also ideal candidates for this type of placement.
Women who want breast reconstruction without implants can still enjoy the benefits of one-stage surgery with Dr. Cassileth's "no implant" technique. The SWIM breast reconstruction method is carried out at the same time as a mastectomy, but involves creating a breast from the patient's own existing tissue and fat. This is ideal for women who want natural-looking smaller breasts, as well as those who have undergone radiation treatments for cancer, who have multiple risk factors and health issues, who do not want to have implants, who have significant breast size to start with, or who have been informed by their doctors that implants would not be a good choice.
The Cassileth Plastic Surgery team performs more than 400 reconstruction cases each year. This includes Direct-to-Implant breast reconstruction, nipple reconstruction, reconstruction revisions, SWIM flaps, and fat grafting. Many of those cases are one-stage procedures—primary breast reconstructions done at the same time as the patient's mastectomy—in our Beverly Hills surgery center.
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