One Stage Implant Reconstruction

One-stage implant reconstruction is performed during the same surgery as the breast removal (mastectomy). Having an immediate reconstruction means that your reconstruction will be complete after just one surgery with the final breast implant in place.

Only certain patients are appropriate candidates for this procedure depending on many factors including the type of breast cancer, size of the tumour, lymph node involvement and the need for radiation. Patients who have had pre-operative radiation or who will require radiation post-operatively are often better candidates for flap reconstruction if they have enough donor site tissue. If you are deemed an appropriate candidate for implant reconstruction, Dr. Yau prefers a one-stage immediate reconstruction over a two-stage delayed reconstruction as the skin of the breast is maintained, which leads to an excellent aesthetic result with fewer surgeries.

One-Stage Implant Reconstruction Procedure

The steps below outline the surgical procedure in detail. Surgery is typically 2.5 hours for reconstruction of one breast and 3.5 hours for reconstruction of both breasts. This includes the time it takes to perform the mastectomy surgery.

Step 1: During the mastectomy, the nipple is typically removed along with the underlying breast tissue.

This is the part of the procedure performed by your general surgeon.

Step 2: The pectoralis major muscle is then elevated off of the underlying chest wall. This muscle is only large enough to cover the top half of the breast implant.

Step 3: The bottom portion of the implant is covered by using one of two options.

Option 1

This is for patients with non- droopy breasts without much excess breast skin. In this case, the bottom portion of the implant is covered with a regenerative tissue matrix. One commonly used matrix is called Alloderm. Alloderm is donated human skin that has been treated to remove the cells and the top layer of the skin (called the epidermis). Once in the body, the tissue matrix develops a new blood supply and is repopulated with your own cells.

A) The tissue matrix is sewn to the chest wall at the level of the breast fold.

B) The implant is then placed underneath the pectoralis major muscle.

C) The tissue matrix is then sewn to the muscle to provide complete implant coverage underneath the skin flaps

D) The skin flaps are then closed overtop, completing the reconstruction.

Option 2

This is for patients with droopier breasts with redundant breast skin. In this case, the bottom portion of the implant is covered with the patient’s own skin after the top layer of skin (the epidermis) is removed.

A) The nipple and underlying breast tissue is removed during the mastectomy.

B) Following removal of the nipple and breast tissue, the excess skin flap on the bottom of the breast is de-epitheliazed, meaning the top layer of skin is removed.

C) The implant is then placed underneath the pectorals muscle and the de- epithelialized skin flap is sewn to the muscle, acting as a sling for the implant.

D) The mastectomy skin flaps are then closed overtop, which completes the reconstruction

Recovery after One-Stage Implant Reconstruction

Following surgery, the patient is admitted to the hospital overnight. Drainage tubes will be inserted into the breast and will be removed by Dr. Yau when the drainage has decreased sufficiently, usually by post-operative day 10-14. Scars on the breast will vary depending on existing scars on the breast as well as the size of your breast. Patients typically resume regular activities in 10 days and full strenuous exercise in 4 weeks. Nipple reconstruction typically occurs 3 months after surgery.