title: Embrace the Change: Incorporating Single-Stage Implant Breast Reconstruction into Your Practice.
abstract: BACKGROUND
  Multiple studies have reported on the safety of nipple-sparing mastectomy and low complication rates associated with single-stage implant breast reconstruction. Yet many plastic surgeons continue to be resistant to change. This article presents the senior author's (M.A.C.) experience during his transition period from the latissimus dorsi flap with adjustable implants to a "one-and-done" approach using shaped implants and fetal bovine acellular dermal matrix.
  
  
  METHODS
  A literature review was performed selecting articles discussing single-stage implant reconstruction, indications, outcomes, technique, and complications. Additional articles were selected after review of the references of identified articles. Clinical pearls discussed include patient selection, implant selection, and mastectomy incision choices, with a detailed description of the senior author's operative technique.
  
  
  RESULTS
  Twenty-seven single-stage implant reconstructions were performed. Average mastectomy weight was 343.82 g. The average implant volume was 367 cc. Shaped implants were most commonly used. Acellular dermal matrix was used in all breasts. Complications included erythema requiring intravenous antibiotics (three patients), skin ischemia caused by methylene blue (one patient), seroma (one patient), unilateral partial nipple necrosis (one patient), mastectomy skin necrosis (one patient), and exposed/infected implants that were salvaged using a sequential irrigation protocol described by Sforza et al. in 2014 (two patients).
  
  
  CONCLUSIONS
  Breast reconstruction after mastectomy has evolved toward less invasive, single-stage procedures. Aesthetic refinements include nipple-sparing mastectomy, use of acellular dermal matrix, shaped implants, and fat grafting. Selected patients will benefit from a one-and-done breast implant reconstruction with no additional oncologic risk. Surgeons must embrace the change and provide their patients with a procedure that will offer the best aesthetic outcomes.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Atlanta, Ga. From Emory University and Mark Codner MD Plastic Surgery.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodriguez-Feliz
authors.forename: Mark A
authors.initials: MA
authors.lastname: Codner
mesh_terms: D062088:Acellular Dermis; D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015414:Mastectomy, Subcutaneous / Q000379:methods; D008875:Middle Aged; D009558:Nipples; D059351:Organ Sparing Treatments; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000639:trends; D019651:Plastic Surgery Procedures / Q000592:standards / Q000639:trends; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology