Direct-To-Implant Breast Reconstruction Overview

Before or after a partial or complete removal of the breasts (a mastectomy), you might consider surgery to reconstruct the original appearance of your breasts. Implant breast reconstruction is one of the most popular techniques available, with a high rate of patient satisfaction. In this procedure, the breast(s) are recreated using saline (salt water) or silicone gel-filled implants.

At most medical centers, implant breast reconstruction is accomplished by placing the implant under your pectoral chest muscle, resulting in a flat, unnatural look. This can be especially noticeable when you use your chest muscles, as this movement can create a visible distortion. In order to give you a better outcome, board-certified plastic surgeon Troy Pittman, MD, of MedStar Georgetown University Hospital has created and developed a new pre-pectoral breast reconstruction technique known as the P1 method.

With the P1 method, the implant is placed over your muscle. This results in little to no muscle deformity or pain since the muscle doesn’t need to be cut. Instead, the implant is placed directly under the skin, providing a more natural-looking result when you move.

Planning and Recovery

If you’re planning on breast reconstruction after your mastectomy, you should discuss this with your doctor prior to your initial surgery. This gives your breast removal surgeon and reconstructive surgeon an opportunity to work together to create a surgical strategy that meets your needs.

When planning your breast reconstruction, a board-certified plastic surgeon who specializes in breast surgery will present you with your options and determine if the P1 method is right for you. You will be given a recommendation based on your body type and health status.

Many patients who undergo implant breast reconstruction at MedStar do so at the time of their mastectomy, resulting in only one surgery with a shorter combined recovery time. Women who undergo reconstruction alone are typically able to return home the day after their procedure. The recovery process with the P1 method results in less pain and no chronic pain, unlike the traditional method.

When you are discharged, you may have one or more drains, which are small tubes that remove extra fluid from your surgery site while it heals. The fluid typically collects in a hollow ball that’s connected to the other end of your drain. Your reconstructive team will explain how to care and maintain your drains and explain when they can be safely removed.

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Frequently Asked Questions

The ideal candidate to benefit from this advanced breast reconstruction technique is:

  • Newly diagnosed or a former reconstruction patient
  • A smaller-breasted woman seeking a moderate-sized implant (B- or C-cup)
  • Physically fit with a moderate (18.5–24.9) body mass index (BMI)
  • Talk with our board-certified surgeons to discuss the best options for your circumstances and priorities.

    Since the passing of the Women’s Health and Cancer Rights Act (WHCRA) of 1998, all group health plans that offer coverage for mastectomies must also cover breast reconstruction. In addition, breast reconstruction is covered under Medicare and in some states may also be covered by Medicaid. However, not all of your procedure cost may be covered by insurance. Contact your insurance carrier to verify coverage.

    If you’re exploring options for insurance coverage, you may need to request a referral from your primary care doctor, depending on your health insurance plan. Check with your carrier to see if medical coverage is an option for you and, if so, whether a referral is required.

    There are risks associated with direct-to-implant breast reconstruction.
    Early complications may include:

  • Bleeding
  • Infection
  • Pain
  • Seroma (fluid collection around the implant)
  • After healing, there is a small chance your implants will rotate so they look upside down, and they may rupture. Additionally, implants typically last 10 to 15 years, so you may need another procedure for new implants in the future.

    Before surgery, you may be asked to get blood tests and take or adjust medications. If you smoke, quitting will help you heal faster and better avoid complications.

    For more information visit Patient Resources or Preparing for Surgery

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