I’m Dr. Jerry Chang. I’m a board-certified plastic surgeon, and I’m a partner at Long Island Plastic Surgical Group. I’ve specialized in breast reconstruction now for 10 years. 60% to 70% of my patients are breast reconstruction patients. Implant-based reconstruction is the most common form of breast reconstruction. And typically, it’s a two stage process. And first, we put in a tissue expander, and this is pretty much a silicone shell balloon. It’s placed at the time of surgery or the mastectomy. And this is placed either below or above your chest muscle. That expander then is expanded or filled with saline until the size is reached that is appropriate for the patient or the patient’s desires. And then at a second surgery, we do an exchange where we go back to the operating room, take out the expander, and put in the permanent implant, whether that implant is saline or silicone. This is your typical implant-based reconstruction.
Direct-to-implant reconstruction is a type of reconstruction that is almost at the forefront of breast reconstruction these days. Direct-to-implant, very self-explanatory, is one stage where at the time of mastectomy, we’re putting your permanent implant at your reconstruction in one stage. A candidate for direct-to-implant reconstruction is your patient who is generally healthy. There are no other illnesses that are not very well controlled. They should be non-obese and typically a breast size that is a small to medium. There’s no really sag of your breasts. So this is typically a very good candidate for a direct-to-implant reconstruction. One thing is also the patient’s desire. If they want to be about the same size as their native breasts, then they’re a good candidate. But all those things have to align. The benefits of a direct-to-implant reconstruction is that it’s one stage surgery.
So overall, it cuts down on the amount of operations. Other benefits are basically patient satisfaction. They don’t have to travel to the office every week to get saline filled to their expanders. Again, the important thing is patient selection. In the right patient, this is a great type of reconstruction. So the timing of your direct-to-implant reconstruction obviously is at the time of your mastectomy. That can be after chemotherapy. Very rarely, it’s after radiation. So a patient who has had radiation, say, for lumpectomy in the past, because they had breast conservation therapy, they still may be a candidate for direct-to-implant reconstruction if they require a mastectomy at a later point. But that’s on a case-to-case basis, and you have to have a good evaluation by your plastic surgeon. Direct-to-implant procedure, again, it’s done at the time of the mastectomy.
So the breast surgeon performs the mastectomy. The plastic surgeon will be there to do the reconstruction. Most importantly, the plastic surgeon will evaluate the skin flop, where the skin that’s left over after the mastectomy, to make sure that it’s healthy enough, that it’s thick enough, and has enough blood flow to support placement of your permanent implant. So that’s very important. But the implant is usually supported by also a mesh, whether it be a synthetic, or most commonly, a biologic mesh. And I think of it as an internal bra to help support the implant at the time of the reconstruction. The surgery for direct-to-implant is usually about an hour in additional to the mastectomy. Patients stay at the most, usually one night, and they could be discharged. The patient can be discharged the next day. To resume normal activities, I would give the patient four weeks. It’s a forced vacation. You just got to rest, pamper yourself. These days, where it’s just running around thinking we have to do so much, but this is the time for you. Pamper yourself, recover, stay rested, and patients do well.