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"Direct-to-implant," (sometimes called "one-step") reconstruction is a type of implant reconstruction where the surgeon places the permanent implant in the breast during the initial reconstruction surgery. Unlike "expander-implant" reconstruction, which requires 2 surgeries, the direct-to-implant option often allows women to avoid a second surgery. Direct-to-implant surgeries typically are used with nipple-sparing mastectomy so there is no need to reconstruct the nipple or areolar complex during a second surgery.
Two common methods are used for direct-to-implant reconstruction.
Direct-to-implant using permanent expanders
This reconstruction involves a special type of implant known as a "permanent expander." Like traditional expanders, permanent expanders can be gradually filled with saline over time. Unlike traditional expanders - which are replaced with a new implant during a second surgery - once permanent expanders are filled to the desired volume the surgeon can remove the port and the expanders remain in place as the final implant. Because permanent expanders are a type of saline implants, they are not as soft or comfortable as silicone implants and some women end up exchanging their permanent expanders for silicone implants later.
Non-expansion using tissue
Direct-to-implant reconstruction completes reconstruction in a single operation. The implant is placed over or under the chest muscle, secured into place with an acellular dermal matrix (a supportive tissue substitute material made from collagen), eliminating the need for expansion.