Who is a candidate for direct implant reconstruction? This really depends upon the type of breast cancer they have, the location of the tumor and the size of the tumor. What happens for direct implant reconstruction is usually in patients who have enough soft tissue coverage, enough skin to perform the direct implant reconstruction. As for nipple sparing reconstructions, this also depends upon the location of the tumor and the size of the tumor and sampling underneath the nipple as well. Direct implant reconstuction mean exactly what it says instead of putting tissue expander and the implant is placed right into the pocket without having to go through the expansion process and this can happen of course to a number of individuals but it depends on many different conditions to be met.