9 - Immediate Implant Breast Reconstruction – One-Stage

Abstract

The most commonly performed method of breast reconstruction is implant-based reconstruction. Within implant-based breast reconstruction, two-stage reconstruction using a temporary tissue expander followed by exchange for a permanent implant is the most common technique utilized. However, in appropriately selected patients, immediate placement of a permanent device offers the potential for one-stage implant-based breast reconstruction with excellent outcomes. One group of optimal candidates for one-stage immediate implant reconstruction is those with small to moderate-sized breasts who desire postoperative breast size that is similar or slightly larger than preoperative size and qualify for nipple-sparing mastectomy. The second optimal group for one-stage implant reconstruction is those with larger breasts who desire smaller breasts and who qualify for skin-sparing mastectomy. Healthy, viable mastectomy flaps are required for successful immediate, permanent implant breast reconstruction. Technical considerations include, most frequently, creation of a partial submuscular pocket with elevation of the pectoralis major muscle with inferior disinsertion and utilization of an adjunctive scaffold for inferolateral implant coverage and support. Immediate placement of a permanent implant will place greater initial stress on the breast skin envelope, potentially increasing complications. However, overall outcomes with one-stage immediate implant-based breast reconstruction have been demonstrated to be safe and reliable.