Direct to implant one step reconstruction w/o tissue expanders

firebird25
firebird25 Member Posts: 5
edited December 2014 in Breast Reconstruction

Hello, my 58 y.o. mother is considering the direct to implant reconstruction following a bilateral mastectomy. This is a one step process without using tissue expanders and without a 2nd, replacement surgery using alloderm. Has anyone had this done? we're in NYC, and for some reason there's only one Dr. in NYC that does this procedure and only one group of plastic surgeons in Westchester that invented this approach in the first place that perform it. All the other plastic surgeons are reluctant to perform it.  Apparently the issue is that if too much alloderm is used there might not be enough blood supply to keep this donor tissue alive long enough until your body "grows" into it and it might turn to necrosis and will then need to be taken out, together with implants. Anyone know anything about it?

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  • MaiTai
    MaiTai Member Posts: 491
    edited March 2011

    Hi,

    I had this procedure with success. I don't know about NYC because I did it in Israel.

    My PS talked to me about the risks very openly but did not say any thing about blood supply. As I understand it, the alloderm serves as support for the implant. He spoke about the skin being too fine to support the implants (I left them the same size I had but with no nipple). He spoke about the normal risk infection.

    My outcome looks really nice for a reconstruction. It is a real advantage for me that I only had one surgery.

    There is a thread here called: one step reconstruction with alloderm.

    Maybe you should check it out as well.

    Good luck to your mother. 

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  • PB22
    PB22 Member Posts: 315
    edited March 2011

    Mai Tai,

     I had the nipple/skin sparing BMX with direct to implant.  The general surgeon is key in performing the mastectomy leaving behind enough skin to work with and making sure it is not too thin.  This is done through experience, because it is not something he can see and measure.  Mine has done the nipple sparing for over ten years.  There is a thread called Where are the nipple skin sparing mastectomies done.  There are plenty of referrals in the NYC area.  The other threads are the immediate one step with alloderm and the nipple sparing one step thread.  On the nipple sparing one step thread read the older discussions as there are a few of us who documented our recovery in the one step.  Alot of the gals who joined in the discussion later, had expanders but were interested in the nipple sparing as a common topic. 

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  • barbe1958
    barbe1958 Member Posts: 19,757
    edited March 2011

    I had a BS say he could just put in the implants under the skin of my bilateral without adding anything else! He said it could be done in half an hour. So why does all the TE's have to be used, and muscles moved and that kind of stuff, if he just has to tuck it under the skin? Needless to say, I didn't get any recon....

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  • MaiTai
    MaiTai Member Posts: 491
    edited March 2011

    barbe1958,

     I think that they really don't know going in.

    My PS, brought 2 alloderm sheets to the surgery and ended using only one. He said they could not know the real condition of the skin (after chemo in my situation) until they started working.

    I guess it is the same regarding the muscles and how they are built.

    The skin for sure is not enough to support the implant. They need the muscle and the alloderm to help support it. Some times as my GS told me, even that is not enough.

    The GS and PS both met with me before the surgery and talked about the amount of skin they could work with. Needless to say that if the GS had decided to cut more the PS would have to live with that (and me too...). I told them both that very straightforward.

    I still am undecided about nip reconstruction. I don't know why I'm so afraid of infection and that the recon will be ruined.

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  • Catherine1
    Catherine1 Member Posts: 3
    edited March 2011

    Hi Firebird25

    I am 57 and just had a double mastectomy

    with one step recon with Alloderm and Silicone implants - 5 weeks ago today.

    Unfortunately last Thursday - as I was getting up - I felt a sharp pain under my left breast and

    the whole implant dropped. I went to my PS on Friday and he has to redo the left breast

    with new implant and Alloderm - when he gets back from holidays in 2 weeks.

    He had done many of these procedures without problem. We aren't sure if the Alloderm

    failed or it came apart where it was sutured to the muscle.

    I will be happy to get it redone!

    Best wishes to your Mom

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  • barbe1958
    barbe1958 Member Posts: 19,757
    edited March 2011

    Yikes! That's another thing...Alloderm is skin from a corpse/cadaver.....kind of creeps me out, but I know it's a necessary part of the process.

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  • Bella_YT
    Bella_YT Member Posts: 95
    edited March 2011

    Hi all,

     I will be doing a UMX and immediate implant reconstruction. I will be seeing my PS this Friday to see whether I am a good candidate for a immediate stage one implant reconstruction. I am really new to the implant world (I had been planning to do a DIEP flap before), so I have multiple questions:

    1. What are different stages of implant reconstruction?

    2. What are the requirement for someone who is a good candidate for immediate stage 1 reconstruction?

    3. How long is a UMX with breast reconstruction with implants?

    4. What are the follow up surgeries that need to be done with implant reconstruction?

    5. What are some of the problems you encounter with a implant reconstruction during surgery and recovery?

    Many thanks,

    Bella 

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  • Sandy105
    Sandy105 Member Posts: 216
    edited September 2011

    I had NS/PBMX performed in NY on March 18 of this year. I experienced no problems during surgery and my recovery was fairly easy.

    At 6 months post-op, my PS and I decided I needed minor revision surgery to correct a couple of minor imperfections. This was performed last week, September 14, and I am feeling quite well one week out. I am hopeful I will need no additional surgery and hope my speedy recovery continues.

    If any of you ladies have questions about direct to implant, feel free to send me a PM and I will be happy to answer any questions you may have.

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  • Funclassygal
    Funclassygal Member Posts: 105
    edited December 2014

    Hi Sandy, reaching out as I will be getting a bilateral with direct implants on 1/13/15. I am so scared as I have never had a thing wrong with me or been in a hospital. I am also in NY and have Dr. Dwight DeRissi as my surgeon, do you know of him? I am very anxious! Very grateful that I sailed through chemo, only hope this will be the same. Thanks, VeraAnn BTW, you can email me , I am always on there! Thanks

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited December 2014

    funclassygal - this is an old thread - the person you asked the question of has not been on this site for a couple of years. You cn always check that by clicking on the member's name and looking at when they last logged on. There are some newer threads on this subject:

    https://community.breastcancer.org/forum/44/topic/736507?page=109#post_4169763

    https://community.breastcancer.org/forum/44/topic/826992?page=1#post_4250980

    Also, not a great idea to put your email address on here - this is a public site, you never know who might be seeing it.  I would suggest removing it, and if you are needing/wanting info from an individual member, just send them a PM with your email.

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  • cheryl56
    cheryl56 Member Posts: 1
    edited December 2014


    I am having surgery on 1/26/15  A double mastectomy.  My right breast had the tumor it was removed my left breast is clear.  I chose to do the double mastectomy so as not to worry about it going into left breast and coming back.  I am stuck on whether to do reconstruction or not.  I am 57 and really dont need the girls anymore LOL.  Any one have any info or advice.  Where is the best place if I choose no recontruction to get accessories 

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  • Moderators
    Moderators Member Posts: 25,912
    edited December 2014

    Dear cheryl56, Welcome to the BCO community. We are very glad that you reached out here. As SpecialK notes above this is an older thread. Try reading on this forum for those not opting for reconstruction. Perhaps you can post your question on one of these threads or start a new one. Keep posting. The Mods

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  • NurseShark
    NurseShark Member Posts: 176
    edited December 2014

    I am having this surgery in February at MGH in Boston

    . Stalking this thread to see responses.

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  • Funclassygal
    Funclassygal Member Posts: 105
    edited December 2014

    Thank you SpecialK - guess I didn't pay attention to when she was on last - it was one of those ranting moments. So nice of you to let me know. Hoping all is well with you, VeraAnn

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited December 2014

    funclassygal - glad you checked back in, and removed the address!  I am in the middle of some reconstruction challenges, but I will get there eventually, lol!  I regard the current situation as an annoyance and the larger issue of remaining cancer free is what is important - so, as long as I am NED I am good!  Hope your holiday was good and glad that chemo went well for you.  I know surgery is scary if you don't have experience with it, but I am hopeful that you will be well taken care of and have a great result! 

    I would recommend the other threads to those who have posted on this thread lately as they seem to be more recent and active.

    Cheryl - your BS should be able to point you in the direction of local resources for shopping, and this thread is also helpful:

    https://community.breastcancer.org/forum/82/topic/781208?page=38#post_4254175

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