Table 3.

Types of alloplastic (implant-based) reconstruction

TYPE	DEFINITION	TECHNICAL DETAILS	ADVANTAGES	DISADVANTAGES
Two stage	Performed in 2 stages: Stage 1—tissue expander inserted under pectoralis muscle Stage 2—expander exchanged for implant with or without fat grafting and with or without nipple reconstruction	Expander is filled (via transcutaneous injections) every 1–2 wk until appropriate volume is achieved (Figure 4) Fat grafting is used for lumpectomy defect reconstruction	Patient provides constant input on size desired Second stage allows for refinement and adjustment or adjunctive procedures (nipple areolar reconstruction, fat grafting, pocket adjustment for symmetry, etc)	Multiple surgeries
Direct to implant	Final implant inserted at time of mastectomy	Robust, healthy skin required at time of mastectomy Internal scaffold (acellular dermal matrix or synthetic mesh) is placed within mastectomy site to help support implant Appropriate for small or medium breasts with minimal ptosis only	No weekly saline injections	Technically challenging Might still require second operation (for contouring, symmetry, nipple-areolar reconstruction, etc)