Implant-Based Breast Reconstruction — Expanders, ADM, Revision Surgery, and Nipple Reconstruction

This episode reviews the core principles of implant-based breast reconstruction, focusing on patient selection, mastectomy flap viability, pocket control, and revision surgery.Topics include direct-to-implant vs two-stage reconstruction, the “small, healthy, tight” candidate for DTI, the importance of a well-performed mastectomy, and how to evaluate skin flap perfusion using clinical judgment and ICG angiography. The episode also reviews key risk factors including smoking, obesity, infection, inflammatory breast cancer, and radiation.Surgical strategies include subpectoral reconstruction, prepectoral reconstruction, tissue expanders, ADM, Vicryl mesh, IMF incision planning, skin-reducing mastectomy, Wise-pattern reconstruction, and preservation of medial perforators to protect the T-junction.Secondary reconstruction is discussed through revision problems such as capsular contracture, malposition, ptosis, visibility, rippling, symmastia, and bottoming out. Additional topics include fat grafting, site-change maneuvers, capsulotomy, capsulectomy, implant infection salvage, seroma management, and staged nipple reconstruction using skate, star, CV flaps, nipple sharing, tattooing, and the 50% shrinkage rule.Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.Disclaimer:This podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsimplant-based breast reconstruction, tissue expander breast reconstruction, direct-to-implant reconstruction, prepectoral breast reconstruction, subpectoral reconstruction, ADM breast reconstruction, acellular dermal matrix, ICG angiography mastectomy flap, nipple-sparing mastectomy, skin-sparing mastectomy, Wise-pattern mastectomy reconstruction, capsular contracture, breast implant malposition, symmastia, bottoming out, fat grafting breast reconstruction, implant infection salvage, red breast syndrome, nipple reconstruction, skate flap, CV flap, nipple tattooing, 50% shrinkage rule