During Direct to Implant (DTI) breast reconstruction, implants are placed after mastectomy during the same operation. This procedure immediately restores the structure and volume of the breast without the need for additional surgeries. While tissue expander placement is an option for most women, a smaller number of patients can safely undergo single-staged DTI reconstruction.
Candidates for DTI breast reconstruction:
- Have a skin-sparing or nipple-sparing mastectomy
These conservative surgical techniques remove the breast tissue while leaving enough skin to adequately cover and support the implant. The type of mastectomy performed depends on specific factors (i.e., cancer stage and development or placement, size, and/or kind of tumor).
- Have a smaller breast size before surgery
After the breast tissue is removed from within large and/or drooping breasts, the excessive amount of remaining skin can make performing DTI reconstruction difficult. Insufficient blood flow to this skin often increases the risk of postoperative complications.
- Want a similar breast size after reconstruction
There is often enough skin remaining after mastectomy to cover an implant that is the same size as or slightly smaller or larger than the original breast. Tissue expanders will likely be needed for to achieve a significantly larger breasts size after reconstruction. For substantially smaller breasts, a mastopexy or breast reduction may be needed to remove excess skin.
- Have not had radiation therapy before mastectomy
When radiation therapy is used to treat breast cancer, it also damaged the treated area. The injured skin loses elasticity and cannot stretch to accommodate the implant; the use of a tissue expander is required to create a tissue pocket for the implant.
When DTI reconstruction is performed, the surgeon first covers the implant with acellular dermal matrix (ADM) before inserting it into the breast pocket. ADM is a biologically derived surgical material used to reinforce the surrounding tissue and reduce the risk of certain complications, including implant rippling, implant displacement, and capsular contracture. The additional support provided by ADM also allows for pre-pectoral placement of the implant which preserves the chest muscle.
The decision whether to perform DTI breast reconstruction or tissue expander reconstruction is ultimately made during surgery based on the results of the mastectomy. DTI surgery requires vigorous blood supply to the skin immediately after mastectomy, so a tissue expander may be needed if the blood flow is inadequate.