If you are preparing for a mastectomy, you may already be considering your reconstruction options. One popular approach is direct-to-implant reconstruction, which allows you to undergo mastectomy and breast reconstruction in a single procedure. Unlike traditional methods that require temporary tissue expanders and multiple surgeries, this technique enables you to wake up from surgery with your final breast implants already in place.
This advancement in breast reconstruction offers significant emotional and aesthetic benefits. At the New York Group for Plastic Surgery, our board-certified plastic surgeons are leaders in this technique, having performed it successfully on many patients. In this article, we discuss what might make you a good candidate for direct-to-implant reconstruction—and, just as importantly, factors that might indicate another approach would be better suited for you.
What is direct-to-implant reconstruction?
Direct-to-implant reconstruction is a surgical technique that allows you to receive a breast implant at the same time as your mastectomy—eliminating the need for a tissue expander and a second surgery. Instead of undergoing a staged process, you wake up from surgery with your breast reconstruction already complete. This approach offers a faster physical and emotional recovery, as well as immediate cosmetic results.
You may be a candidate for direct-to-implant reconstruction if…
You are not a smoker
Smoking can significantly impair healing and increase the risk of complications during and after surgery. Because direct-to-implant reconstruction requires your skin and tissue to heal well after a mastectomy, being a non-smoker is a key requirement. If you are a smoker, your surgeon will likely recommend quitting well in advance of your procedure to improve your candidacy.
You have healthy breast skin
The success of direct-to-implant reconstruction depends heavily on the condition of your remaining breast skin following a mastectomy. If your skin is thick, pliable, and has good blood supply, it is more likely to heal properly and support the implant without tissue expanders. Your surgeon will assess skin quality as a primary factor during your consultation.
You have small to medium-sized breasts
This technique tends to be most successful in patients with smaller to moderately sized breasts who desire similar post-operative volume. Larger implants may place more strain on the healing tissue and increase the chance of complications. If you’re looking for a modest or natural result, direct-to-implant reconstruction may align perfectly with your goals.
You are undergoing a skin-sparing or nipple-sparing mastectomy
Patients who are candidates for skin-sparing or nipple-sparing mastectomies often have excellent outcomes with direct-to-implant reconstruction. These procedures preserve the outer breast envelope, allowing for a more natural shape and better aesthetic results when the implant is placed immediately without tissue expanders.
You are in good overall health
Good physical health is always a priority when planning for any type of surgery. If you are free from chronic illnesses that could interfere with wound healing—such as uncontrolled diabetes or autoimmune diseases—you may be a stronger candidate. At the New York Group for Plastic Surgery, your full medical history will be reviewed to ensure your safety and suitability.
You may NOT be a candidate for direct-to-implant reconstruction if…
You are planning to undergo radiation therapy
Radiation can compromise the skin and tissue used in reconstruction, making direct-to-implant surgery riskier. If radiation is part of your treatment plan—either before or after surgery—your plastic surgeon may advise a staged reconstruction approach instead. This can help reduce the risk of complications such as implant exposure or capsular contracture.
You have insufficient skin or tissue after mastectomy
In some cases, the skin remaining after mastectomy may be too thin or tight to accommodate a permanent implant safely. If your surgeon determines that your tissue coverage is not adequate, a two-stage reconstruction with a tissue expander may be recommended instead.
You have large or ptotic (sagging) breasts
Women with larger breasts or significant sagging may not be ideal candidates for immediate implant placement. In these cases, skin and tissue rearrangement or a reduction may be needed first, or the patient may be guided toward an autologous (flap-based) reconstruction technique for a more natural and long-lasting outcome.
You are currently smoking or have poor wound-healing history
Even occasional smoking can limit your body’s ability to recover properly after surgery. If you smoke or have a history of wound healing issues, your surgeon will likely recommend smoking cessation and further evaluation before determining candidacy.
Determine your candidacy for direct-to-implant reconstruction today
Direct-to-implant reconstruction can be an excellent way to complete your reconstruction journey in one go—but it’s not right for everyone. Whether you’re a candidate depends on various personalized factors, including your health, breast size, skin quality, and treatment plan.
At the New York Group for Plastic Surgery, our surgeons are pioneers in the field of breast reconstruction and specialize in the direct-to-implant approach. We take the time to evaluate each patient thoroughly and guide you toward the safest, most effective reconstruction method for your unique situation. If you’re considering breast reconstruction, we encourage you to schedule a consultation to explore if direct-to-implant reconstruction is the right path for you.
