Traditionally, implant-based breast reconstruction has been performed using a two-stage approach. The first stage involves placing a tissue expander under the skin and chest muscle, either at the same time of the mastectomy or in a delayed fashion. A tissue expander is a temporary implant-like device that is filled with saline at the time of placement as well as during subsequent postoperative visits. The goal of the tissue expander is to stretch the patient’s chest skin so that several months later it can be replaced with a permanent breast implant (a procedure referred to as the “second stage”).

The biggest advantage of this two-stage approach is that small-breasted women who wish to have reconstructed breasts larger than their natural size are able to. Additionally, this technique allows the patient to choose the final size during the expansion period by living with the expanders at different sizes, as they are filled over time.

Direct-to-implant reconstruction is a new alternative to the two-stage approach, and involves a single surgery. The technique involves reconstructing the breast immediately with a permanent implant, eliminating the need for a tissue expander or second surgery. The obvious advantage is that, in most cases, it allows for the patient to have their mastectomy and final reconstruction in only one procedure. The direct-to implant approach continues to increase in popularity among patients due to its efficiency and excellent esthetic outcomes.