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What is direct-to-implant reconstruction?

Direct-to-implant reconstruction is an alternative to staged tissue expander reconstruction. While tissue expander reconstruction requires that the breast be gradually stretched over time, direct-to-implant reconstruction is a procedure in which permanent implants are inserted directly into the breasts after a mastectomy. The implant is typically placed behind the pectoralis major muscle.

Not every woman is a candidate for direct-to-implant reconstruction; this procedure is performed when the patient’s anatomy allows for it.

Types of implants

There are two types of implants for this procedure: saline (salt water)-filled and silicone (gel)-filled. You will determine with your doctor which type of implant is best for you.

What to expect

Direct-to-implant reconstruction typically takes a single surgery to complete. In some cases, a quick outpatient procedure may be desired after healing to further refine the breast shape.

During your consultation, you and your doctor will discuss all options, as well as timing of the procedure, recovery and your preferred size of the breasts. Our plastic surgeons will work with you to ensure you are informed, comfortable and happy with your results.


Tobacco use and radiation are often associated with increased risk of complications after tissue expander surgery. Your doctor will discuss your unique risk factors with you during your consultation.

There are a number of risks of having this procedure, including:

  • Bleeding, infection and scarring
  • Asymmetry of the breasts
  • Wound disruption
  • Numbness and/or pain
  • Capsular contracture (hardening of the implants)
  • Implant exposure or leakage

If there are complications with your tissue expander placement, you may be at increased risk for complications with a permanent implant and reconstruction.


After the procedure, patients are typically hospitalized overnight. It is recommended that patients avoid stress, heavy lifting, excess physical activity and any friction or abrasion at the incision site during recovery. Drains are inserted and kept for one to two weeks.

We pride ourselves on our aftercare following mastectomies. Our specialists provide our patients with a supportive bra to improve appearance and comfort during recovery, as well as post-mastectomy exercise and rehabilitation programs. Our expertise goes beyond just the surgery - we work to get you back to your everyday life as quickly and comfortably as possible.

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