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Breast reconstruction

Breast reconstruction is an integral part of the options available after a mastectomy. It is not simply a matter of restoring the appearance of the breast, but is part of an overall approach to care, in which the body and self-image are taken into account as part of the continuum of treatment for breast cancer.
Breast reconstruction can be carried out in one or more stages, immediately or at a later date, using proven surgical techniques tailored to each individual profile. Today, these solutions offer reliable, long-lasting aesthetic results and improved body integration for patients who wish it.
Definition and stakes of breast reconstruction

What is breast reconstruction?

Breast reconstruction is a surgical procedure designed to recreate the shape of the breast after a mastectomy or, in some cases, a lumpectomy. It can be performed immediately after removal or at a later date, depending on the patient's condition, additional treatments and personal preferences.
This surgery can be performed either with implants (silicone or saline), or with tissue taken from elsewhere in the body (so-called autologous tissue), or with a combination of the two approaches. Beyond its aesthetic purpose, this surgery is part of an approach to restoring identity and personal well-being. It helps to improve self-perception, promotes psychological balance and enables some people to reclaim their bodies after illness.

Who is it suitable for?

Breast reconstruction is suitable for people who have had a mastectomy (complete removal of the breast), often as part of the treatment or prevention of breast cancer. It can also be offered after breast-conserving surgery when there is a significant deformity. The operation can be considered at any age, subject to the patient's general state of health, ongoing treatment (particularly radiotherapy) and the quality of the tissue available.

Some people with high-risk genetic mutations opt for a preventive mastectomy. Here too, reconstruction may be proposed to minimise the psychological and physical impact of this decision.

The timing of reconstruction (immediate or deferred) will depend on the characteristics of the cancer, the additional treatments envisaged, the state of the skin and muscles, and the patient's life plan and aesthetic expectations.

Types of breast reconstruction
Reconstruction with breast implants

Breast reconstruction using implants is based on the use of implants, usually made of silicone, to restore volume to the breasts. This method can be performed in one or two stages. In some cases, the implant is placed directly after the mastectomy. More commonly, the process begins with the placement of a tissue expander, a temporary device that is gradually inflated to stretch the skin. A second operation is then carried out to implant the definitive prosthesis. The implants can be positioned under the pectoral muscle (subpectoral technique) or above it (prepectoral). The choice depends on a number of factors, including tissue quality, previous radiotherapy and the patient's morphology.

This technique has the advantage of being less invasive than flap reconstruction, with shorter operating times and often faster recovery. On the other hand, implants have a limited lifespan and may need to be replaced over time. There are also specific risks: shell formation around the implant (capsulitis), rupture or displacement, and in rare cases, anaplastic large-cell lymphoma associated with textured implants.

Flap reconstruction (autologous tissue)

Flap reconstruction uses the patient's own tissue to reconstruct the breast. This tissue transfer can come from different areas: abdomen (DIEP, TRAM), back (latissimus dorsi), buttocks (SGAP, IGAP), thigh (PAP, TUG). The flap may contain skin, fat, blood vessels and sometimes muscle. It is moved to the thoracic area, either retaining its vascularisation (pedicled flap), or being completely detached and revascularised in the thorax (free flap, by microsurgery).

These reconstructions often give a more natural result, both to the touch and to the eye. However, they involve a more complex operation, a longer hospital stay and specific risks (loss of sensitivity, abdominal hernia, necrosis of the flap in the event of poor vascularisation).

Combined approaches: implants and flaps

In certain situations, breast reconstruction combines an implant and an autologous flap. This is particularly important when the volume of tissue removed is insufficient, as with a flap from the back or thigh. In this case, the implant completes the breast volume, while the flap improves skin coverage, especially after radiotherapy.

This hybrid procedure makes it possible to optimise aesthetic results and achieve greater symmetry, but it may involve a slightly higher complication rate, particularly when performed simultaneously.

Other techniques: lipofilling and reconstruction using autologous fat

Breast lipofilling involves reinjecting fat taken from other parts of the body to correct defects or improve the shape of a reconstructed breast. It is often used in addition to an implant or flap.
Some patients can benefit from complete breast reconstruction using fat grafting, without the need for an implant or flap. This gentle but long and gradual method is spread over several sessions and is particularly suitable for small volumes. It has the advantage of being natural and free of foreign bodies, although partial resorption of the fat is common.

Breast reconstruction and surgical sequence

Immediate reconstruction

Breast reconstruction can be carried out as soon as the mastectomy is performed, during the same operation. This approach, known as immediate reconstruction, avoids the need for a second general anaesthetic, preserves more of the skin tissue and, in some cases, produces a more natural aesthetic result, particularly when a maximum amount of skin or the nipple can be preserved. However, this option is not suitable for all situations. In the presence of locally advanced cancer, or if post-mastectomy radiotherapy is planned, immediate reconstruction may be contraindicated.
In these cases, surgical teams can sometimes insert a temporary expander, designed to maintain a volume or space, with a view to delayed reconstruction after treatment.

 

Delayed reconstruction: after treatment

When reconstruction cannot be carried out immediately, it may be envisaged several months or even several years after the mastectomy. This delayed reconstruction has the advantage of giving the body time to heal and to complete the oncological treatments, particularly radiotherapy or chemotherapy. This delay also gives some patients time to reflect on whether or not they want to reconstruct their breasts. It is also sometimes medically necessary, in the case of scarred or damaged tissue.

In this configuration, reconstruction can be carried out using an implant, a flap or a combined approach, depending on the quality of the tissue, the patient's morphology and her aesthetic goals. Delayed surgery does, however, involve a second operation under anaesthetic, which can be a barrier for some patients.

Choosing the right moment: a multi-dimensional decision

The choice of when to undergo reconstruction depends on a number of factors: type of mastectomy, need for additional treatments, skin condition, age, co-morbidities, smoking, but also life plans and aesthetic expectations.

Consultation between the oncology surgeon, the plastic surgeon and the patient is essential to assess the advantages and disadvantages of each approach. It is also important to anticipate the following stages: reconstruction of the nipple, possible touch-ups, or operations on the contralateral breast to achieve harmonious symmetry.

In all cases, breast reconstruction is part of a multidisciplinary care programme. It must be considered in the context of overall support, combining oncological safety, surgical precision and attention to quality of life.

Nipple and areola reconstruction

Reconstruction of the nipple and areola is the final stage in the reconstructive process. Carried out several months after the main surgery, it visually completes the reconstructed breast and reinforces body acceptance. This operation is optional.
Several surgical methods are available. The nipple can be recreated from local skin, reshaped to form a protuberance. The areola can be obtained by a pigmented skin graft or by medical tattooing. Non-invasive 3D tattooing allows the appearance of a nipple to be imitated very realistically, with or without relief, and is an alternative of choice.
Some patients opt for an external, removable solution, such as the adhesive nipple. This silicone device, positioned directly on the reconstructed breast, offers an immediate aesthetic illusion without surgery. It can be worn daily or occasionally, depending on individual preference.

In some cases, the nipple can be preserved during the mastectomy (‘nipple-sparing’ technique), offering an optimal aesthetic result. This choice depends on the type of cancer, its location and the quality of the skin.

Risks, complications and post-operative follow-up

Like all surgical procedures, breast reconstruction involves risks. Some are general: haematoma, infection, delayed healing, post-operative pain, effects of anaesthesia. Others are specific to the technique chosen: fibrous shell, anaplastic lymphoma, necrosis of the transferred tissue, etc.
Regular surgical follow-up is essential after breast reconstruction. Post-operative consultations are used to assess healing, aesthetic appearance and symmetry. In some cases, secondary touch-ups may be necessary and, in the long term, implants may need to be replaced or removed

Coverage, insurance and access to care

In Switzerland, breast reconstruction is covered by basic insurance, whether immediate or delayed. This also includes corrective surgery on the opposite breast to restore symmetry. Implant replacements or complications are also covered.

Patients with a high-risk genetic mutation may benefit from reconstruction after prophylactic mastectomy, if a genetic consultation has been carried out.

Conclusion : une décision éclairée, soutenue par une équipe spécialisée

Breast reconstruction is a personal, medical and emotional process. It is neither an obligation nor a standard to be followed, but a legitimate therapeutic option, offered to women who wish to restore their bodily integrity after a mastectomy or conservative surgery.
The choice of whether or not to reconstruct a breast, as well as the timing and technique of the operation, depends on a number of medical factors: type of cancer, treatments received (particularly radiotherapy), morphology, general state of health and personal preferences. This process can be immediate or delayed, and carried out in one or more stages, according to multidisciplinary planning.

The techniques currently available - implants, autologous flaps, lipofilling, tattooing or nipple reconstruction - offer solutions tailored to each clinical situation. Although the results are generally satisfactory, anatomical, functional and aesthetic limitations must be taken into account when considering the treatment.

Breast reconstruction remains a supervised, individualised and evolving procedure, based on consultation between the patient and healthcare professionals. Regular post-operative follow-up, comprehensive support and full information are essential to a successful outcome.

Breast reconstruction can have a profound impact on a patient's physical and emotional healing process. My aim is to provide each patient with comprehensive medical and emotional support throughout the healing journey. »
Teresa Rotunno
Nos patients témoignent
Julie R.
,
Julie R.,

La reconstruction mammaire est-elle obligatoire après une mastectomie ?

Non. Il s’agit d’un choix personnel. La décision dépend des souhaits, du contexte médical et du vécu de chacune.

Quelles sont les différences entre implant et lambeau ?

L’implant est une prothèse en silicone. Le lambeau utilise les propres tissus de la patiente (abdomen, dos, cuisse). Les lambeaux offrent souvent un rendu plus naturel, mais impliquent une chirurgie plus complexe.

Peut-on reconstruire le mamelon après une mastectomie ?

Oui. Il est possible de le recréer chirurgicalement, par tatouage médical 3D ou avec un mamelon adhésif. Ces solutions sont proposées plusieurs mois après la reconstruction du sein.

La reconstruction mammaire est-elle douloureuse ?

Comme toute chirurgie, elle entraîne des douleurs postopératoires temporaires, bien prises en charge. Les reconstructions par lambeaux impliquent une convalescence plus longue que celles par implants.

Quels sont les risques d’une reconstruction mammaire ?

Ils varient selon la technique : coque ou rupture d’implant, nécrose du lambeau, infection, ou asymétrie. Un suivi médical régulier permet de surveiller et traiter ces éventuelles complications.

Peut-on allaiter après une reconstruction mammaire ?

Non. Après une mastectomie totale, la glande mammaire est retirée, ce qui rend l’allaitement impossible, quelle que soit la méthode de reconstruction.

La reconstruction mammaire est-elle remboursée par l’assurance maladie ?

En Suisse, oui. L’assurance de base prend en charge l’ensemble du processus : reconstruction, retouches, chirurgie de symétrie, et remplacement d’implants en cas de complications.

Peut-on faire une reconstruction mammaire plusieurs années après une mastectomie ?

Oui. La reconstruction différée peut être réalisée des mois, voire des années après. Elle laisse le temps au corps de guérir et à la patiente de réfléchir à son projet.

Who should I see about these symptoms?

We recommend that you see the following health professional(s) :
Dr.
Teresa Rotunno
Chirurgien plastique, esthétique et reconstructif
Hôpital de La Tour

Specialties involved

Aesthetic medicine, plastic & reconstructive surgery