Breast Reconstruction after Mastectomy, Implant-Based

Nearly 80% of women in the United States who undergo mastectomy and desire a reconstruction make use of implants. While most surgeons use a two stage approach where a temporary implant is first placed followed by definitive implant placement 3-6 months later, Dr. Schwartz almost exclusively goes “direct-to-implant” placing the definitive implant at the time of the mastectomy. In addition, unlike most surgeons, Dr. Schwartz places his implants above the muscle which minimizes pain and breast deformity, facilitating a quicker recovery with a more aesthetic final result. This approach combined with an expertly performed nipple-sparing mastectomy leaves many patients with results that appear as if they have had a cosmetic breast augmentation. The majority of Dr. Schwartz’s patients are good candidates for nipple-sparing procedures.

Dr. Schwartz was one of the first surgeons to document the safety of the outpatient mastectomy and immediate implant-based reconstruction in an Ambulatory Surgery Center, without the need for hospital admission. He further documented increased patient satisfaction and a lower infection rate as well compared to patients undergoing surgery in the hospital. Most patients undergoing implant-based breast reconstruction above the muscle have their implants covered in an acellular dermal matrix (donor skin) or reinforced tissue matrix (donor tissue) which is also secured to the chest wall to prevent migration of the implant and avoid other complications. Dr. Schwartz typically completes a unilateral mastectomy and immediate implant reconstruction in about an hour and bilateral cases in close to two hours. Drains are left in place for 10-14 days and patients are recovered by 2 weeks and without any physical restrictions by 4 weeks. Most patients never need additional surgery, but some choose to improve their aesthetic result with fat transfer and or changing out their implants (usually upsizing) 3-6 months after their initial surgery. 

For those patients who are not good candidates for a nipple-sparing approach secondary to oncological concerns or because the nipple is located very far from its ideal location, Dr. Schwartz can immediately reconstruct you a nipple or transplant your own nipples as skin grafts into a more ideal position at the time of mastectomy. Dr. Schwartz has significant experience performing just one-sided mastectomy surgery and reconstructions and getting good symmetry with the contralateral healthy breast without operating on it. Some patients who prefer to have just a mastectomy on one side require a breast reduction on the other side to get good symmetry with their reconstructed breast that has undergone mastectomy. Dr. Schwartz performs all of this surgery in one operation and uses his expertise to get the best result possible with just one surgical procedure.