Wednesday, July 11, 2012

One-Step Breast Reconstruction with Implants and Alloderm

Implant breast reconstruction is the most common method of breast reconstruction currently performed in the US. There are two main approaches: the "Alloderm one-step" (also referred to as "single stage" or "direct to implant" reconstruction), and the two-stage reconstruction with tissue expanders. To easier explain the ins-and-outs of the one-step procedure, I first need to summarize the more traditional two-stage approach...

Tissue expanders essentially act as "spacers". They can either be placed at the same time as the mastectomy or some time later. They are inflated with saline injections to recreate the desired breast size. This expansion process can take several weeks depending on the amount of expansion required to reach the optimal cup size. Once the expansion process is completed, the tissue expanders are removed and the final implants are placed. Reconstruction with breast implants is therefore usually performed as a multiple-step process and can take several months.

Alloderm One-Step / Single Stage / Direct to Implant Reconstruction

Some patients are candidates for a "One-Step" procedure whereby the permanent implant is inserted at the time of the mastectomy. A cadaveric implant known as Alloderm is also used to provide extra implant coverage and support. By going direct to the final implant in a single stage, the patient has only one procedure and avoids the use of a tissue expander (and the whole expansion process) altogether. The scar can also be placed in the inframammary fold (at the breast crease) which makes it much easier to hide. The One-Step procedure is also referred to as "direct to implant" or "single stage" reconstruction.

This procedure is obviously very appealing to many women, including those that may not be candidates for perforator flaps. The down time in terms of recovery is also much shorter than most of the alternatives (2-4 weeks).

There are some caveats though.... I used to offer this procedure to most patients. Some One-Step surgeons still do. Personally, I don't anymore - "the perfect candidate" for the procedure has evolved in my eyes. Experience (and grey hair) has a tendency of doing that.

So who is the "ideal candidate"?

1) Patients that do not have a current breast cancer diagnosis

2) Patients that are having prophylactic mastectomy only, e.g. for BRCA1 or BRCA2

3) Patients that are having nipple-sparing mastectomy

4) Patients that do not need a significant breast lift

5) Patients that have not had previous breast/chest radiation

By limiting the procedure to women who fulfill these strict criteria the surgical results are far more predictable and very cosmetic. The risk of further revision or "touch up" procedures is also very low.

PRMA patient Mrs Michelle Coben kindly shares her experience with the One-Step procedure in the video below. You can also see before and after pictures here.

I hope this info helps.

Dr C


Dr Chrysopoulo specializes in advanced breast reconstruction techniques including perforator flaps, Alloderm One-Step and fat grafting. He is In-Network for most US insurance plans. Patients are routinely welcomed from across the USA. Please call (800) 692-5565 or email to learn more about your breast reconstruction options. Connect with other breast cancer patients at



RayPublicHealth said...

Dr. C, could you post some information about recovery times for one-step BPM patients? I have had a hard time finding a range of posts about this topic, have only found a couple of personal testimonies. One woman had total recovery in about a month! Another, about 6 weeks. I am 17 days post surgery and feel like I have not really made any progress in the past 10 days or so. I feel "ok," and I look great, but there is no way I would drive, and still cannot reach over my head without pain. I am looking for some realistic info and also a little reassurance. Plus I am trying to give my boss a realistic idea of when I will return to work (desk/computer job).
Mahalo! --Rachel

Dr C said...

Hello Rachel,

Recovery is typically 2-4 weeks.

An important thing to consider though is that I only offer this procedure to patients undergoing prophylactic mastectomies. That makes a difference - recovery is easier since these patients do not undergo axillary surgery (sentinel lymph node biopsy or more formal axillary dissection).

You also have to remember that everyone is different when it comes to healing and recovery so coming across a range of experiences (as you're finding) is not unusual. As I mentioned above, the extent of the surgery can also vary.

Ask your surgeon if he's ok with you starting some physical therapy (like post-mastectomy exercises). That should help with your range of motion and discomfort.

I hope this info helps.

Dr C