Direct to Implant

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Direct to Implant breast reconstruction (also known as "single-stage" or "Alloderm one-step") involves placing the final breast implant at the same time as the mastectomy. Unlike traditional 2-stage implant reconstruction using expanders, the reconstruction is completed in one surgery. 

The breast implant can be placed either below or above the pectoralis muscle (main chest muscle) depending on various patient factors, the quality of the tissues after the mastectomy, and surgeon preference.

An acellular dermal matrix (ADM), such as Alloderm, is a biological sheet-like material which is also used in most implant reconstructions. The ADM is used inside the breast and is not visible. When the implant is placed under the pectoralis muscle, the ADM covers the lower part of the implant that is not covered by muscle. It also acts as a sling to help secure the implant in position. When the implant is placed on top of the muscle (known as the "pre-pec" technique), the ADM is used as a wrap or drape over the implant, which provides an extra layer of coverage over the implant under the skin.

The direct-to-implant procedure is also sometimes referred to as "single-stage" or "one-step" breast reconstruction. These terms can be misleading as an additional revision procedure, usually involving fat grafting, is often needed for the best cosmetic results. Fat grafting helps fill in contour defects created by the mastectomy and thickens the fatty layer under the skin. A thicker tissue layer over the implant decreases the risk of being able to see the waves in the implant shell, known as "rippling", and greatly improves the final cosmetic results.

Patients having prophylactic, nipple-sparing mastectomy are the best candidates for Direct-To-Implant breast reconstruction. These patients are the most likely to achieve excellent results with one surgery and have the lowest risk of needing a revision procedure.

To learn if you are a candidate or to schedule a consultation, please contact us here or call us at (800) 692-5565.

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​With Direct to Implant, the patient avoids the use of an expander and the whole expansion process.

PRMA Plastic Surgery