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DIRECT TO IMPLANT BREAST RECONSTRUCTION

Whilst not exactly new overseas, it is a relatively recent phenomenon which is gaining traction in Australia and it has been made more possible by the recent advent of tissue matrices.

The increasing availability of these matrices or acellular dermal matrix (ADM) is making it easier to do DTI reconstruction. These were previously difficult to get in the Australian market. The advantage of DTI reconstruction is that the result is immediate and it avoids the painstaking process of tissue expansion.

However all is not as it seems. Many of the overseas experts which have had a much greater experience with DTI and were advocates for the procedure are now going back to 2 stage. Call me old fashioned but it is a safer and more predictable approach that has withstood the test of time and it is my preferred option in most cases. Whilst seemingly DTI will avoid another operation it is not uncommon for DTI’s to need revisionary surgery anyway as it is very difficult to get an excellent result in one stage. Breast reconstruction is not a perfect science and there are many factors which can influence the result. These include the type and quality of the mastectomy, anatomical factors, blood supply to the skin and many more.

Why do I say tissue expansion is safer? Well for a number of reasons – Firstly it allows a variable amount of fill which can be changed at any time. This means that if the skin viability looks to be struggling then some fluid can be removed to take tension off the skin. Secondly there is not as much volume in the pocket to start with so the tension on the skin is less and skin survival will be higher. Thirdly a planned second operation allows for fine tuning of the shape and final result of the implant reconstruction. We hope you enjoy this article which was brought to you by Dr Damien Grinsell.