When can Direct to implant be done

ijl

I had DCIS 12 years ago which resulted in left mastectomy with DIEP. I am very pleased with the results.

Unfortunately after a few years of finally being relaxed at mammogram time after years of stress I was diagnosed with an invasive cancer. It is not bad as far as cancers go. They termed it a lazy one , grade 1 and very slow growing. It is right under my nipple so they will remove the nipple. This will actually make my breasts symmetrical as I never got around to reconstructing a nipple on the left one.
I am still getting all the data : genetic test, MRI and Oncotype but am leaning toward a mastectomy all the stress of the mammograms. My first thought was to look for other source of fat since DIEP is taken my stomach. By reading posts here looks like SGAP is a viable option. But then the surgery is almost 11 hours and recovery is longer than DIEP. The PS at Stanford is experienced with SGAP but still the healing will take time.

Hence I am considering implants. I am especially interested in direct to implant procedure.

But I am not sure whether I can have it since they will test nodes during the surgery and will not know results till later. If I do need radiation due to the nodes , how can I have direct to plant done.

It sounds like a good option to avoid anexpander which as I understand is not very comfortable

Could those of you who had direct to implant done share when it can be done and how was your experience?

Dani444

Hello, first off I am so sorry you are going through this a second time. I had a UMX with direct to implant. I have a silicone gel implant, pre-pec with alloderm. As it is was explained to me by my PS was that she would not know if she could do the implant until she saw how my skin looked after the BS was done with the mastectomy. I had skin sparring but was not able to keep my nipple. She explained that if my skin didn’t look too stressed and blood flow was good she would go ahead with the implant. So I didn’t know until I woke if I had the expander or implant. Unfortunately I had positive nodes after all and ended up needing rads. My implant sits pretty high now and my skin is tighter. My PS said if I choose to that fat grafting could help soften things up. Best of luck with your treatment

ajminn3

I was able to go direct to implants following my BMX in January. Originally they could only find DCIS via biopsy but post pathology showed a sentinel node taken had 3mm invasive spot while the rest of my breast was DCIS. I’m a strange case...and will get rads after my chemo rounds. Like Dani444 the PS told me she would have to see what was left behind following the MX and couldn’t promise implants over expanders despite me saying I’d go a lot smaller to go that route. I knew my MX was not nipple sparing so those are both gone, but there was clear margins, enough skin and blood flow to do the implants. I am very pleased with the outcome and how they look. The PS and BS weren’t too concerned about the implants and doing rads. There’s always a chance for some side effects and changes, but they said radiation is so targeted these days that it hopefully shouldn’t impact my implant much

bcincolorado

I had expander put in place at the time mx. Then had to go have it "enlarged" over about 6 weeks before having exchange surgery for the actual implant. I did have skin sparing and nipple sparing mx. So it was 2 different surgeries but the 2nd one was not as invasive and not as much recovery for the exchange from the expander to the implant.

dtad

I had direct to implant reconstruction at the same time as my BMX. Thats actually what direct to implant stands for. It avoids expanders, fill ins and a second surgery. I was not aware it could take 2 surgeries to get it done. I'm as happy as one could be with reconstruction. I couldn't be as big as I wanted but to me that was worth it to avoid the second surgery and all that goes with it. I still have the iron bra feeling 5 years later but that's from the BMX not the reconstruction. Hope this helps. Good luck and keep us posted...

ijl

Dtad, thank you for sharing information. Can you tell more about iron bra feeling? Why do you think it is due to mastectomy and not implants

I had a masteсtomy with DIEP reconstruction and forget most of the time that it is not my natural breast. I had the iron bra feeling first 6 months but then it went away

B123

just wondering how everyone’s reconstruction is going and if you chose a route of fat grafting after implants to smooth out? Is it safe?