Nipple-Sparing Direct-to-Implant Left Breast Reconstruction in The Woodlands, TX

Procedure Details

This is a 70yo woman with left breast cancer who presented to discuss her breast reconstructive options. Her breast surgeon offered her a nipple-sparing mastectomy. The patient requested a short surgery with the least recovery time. Her goal was to match her left breast reconstruction to her natural right breast and avoid any symmetry surgery on the right breast. Considering her stated goals and exam findings, Dr. Albright felt the patient was a good candidate for prepectoral direct-to-implant reconstruction after her left nipple-sparing mastectomy. This was performed through an incision around the bottom of the areola with a lateral extension. AlloDerm was placed to help control the position of a 350 cc Mentor MemoryGel moderate plus profile, smooth, round silicone gel implant. A limited amount of fat grafting was also performed. The desired ptotic breast shape and fair symmetry was achieved. It was not necessary to perform any right breast surgical procedures for symmetry. The patient was very happy with a simple and straightforward reconstructive experience.

Direct-To-Implant Options

A direct-to-implant reconstruction means that a permanent breast implant or prosthesis is placed at the time of the mastectomy.  This certainly sounds attractive as it implies a one-stage reconstruction.  However, this does not always mean that one surgery will deliver a good symmetric outcome and patient satisfaction.  A revision procedure is often warranted to refine the reconstructed breast shape and optimize breast symmetry.  Many times this is simple, perhaps only requiring fat grafting and scar revision.  In some cases, a staged surgery will need to address the opposite breast with a breast lift, reduction, or augmentation. 

When Dr. Albright meets with a new patient referred for breast reconstruction, he provides guidance as to whether he thinks a direct-to-implant reconstruction is appropriate in her individual case.  The best candidates tend to be women having a nipple-sparing mastectomy with small to medium-sized breasts, minimal nipple ptosis (drooping), good skin quality, and desiring to be reconstructed with the same or slightly smaller breast size.  The ability to perform a direct-to-implant reconstruction will always hinge on intraoperative findings of blood flow to the breast mastectomy skin flaps.  Tissue expanders are usually ordered and reserved as a backup option if the skin flap perfusion is found to be less than ideal.


Houston Methodist Hospital

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.