ABSTRACT
Nipple-sparing mastectomy is the ideal scenario for one-stage implant breast reconstruction, usually along with an acellular dermal matrix sling. The single-stage, direct-to-implant approach overcomes the limitations of a two-stage, expander approach and represents the ultimate simplicity in breast reconstruction. Preoperative assessment to determine whether the patient is a candidate for direct-to-implant reconstruction focuses on the patient’s body habitus, the ablative component of the surgery, and the specific desires of the patient for contralateral breast symmetry. Critical for immediate reconstruction with a direct-to-implant technique is utilizing acellular dermal matrix to extend the submuscular plane, support the implant in its anatomic position, and define the inferior and lateral folds of the breast. On completion of the mastectomy, if the skin flaps are healthy, then it is safe to proceed with one-stage reconstruction. Direct-to-implant reconstruction can be an alternative reconstruction option based on levels of patient satisfaction and aesthetic results provided costs can be contained and patients are carefully selected.
