In France, one in eight women is at risk of developing breast cancer. Today, this disease is increasingly well-managed. However, treatments remain intensive, involving procedures such as lumpectomy (removal of the part of the breast where the tumor was detected) or mastectomy (removal of the entire breast). In the case of a mastectomy, breast reconstruction with implants is the most commonly used technique.
Breast reconstruction with implants is the simplest technique. However, it requires maintaining good skin elasticity in the chest area to be effective. One advantage of this method is that it provides immediate results visible right after surgery and satisfactory results in the weeks following the procedure.
This technique avoids creating additional scars on the body, as the surgeon uses the existing mastectomy scar to place the breast implant.
In some cases, especially after radiation therapy, the skin on the chest may become fixed and unsuitable for implant placement. In such cases, a flap reconstruction may be performed. This plastic surgery technique provides excellent results but is more time-consuming and involves more discomfort.
Breast reconstruction with implants involves using prostheses available in various sizes and shapes. In some cases, if the skin is not sufficiently flexible, a tissue expander may be used before placing the final implant. Tissue expanders are temporary implants that are gradually filled with saline to stretch the skin, creating enough space for the permanent implant.
The surgeon uses the existing mastectomy scar, which is reopened to place the implant. This technique can also sometimes improve the appearance of the previous mastectomy scar.
In most cases, breast reconstruction with implants does not require additional scarring. The mastectomy scar is reused for the placement of the implant. The implant will recreate breast volume and is available in various sizes based on the desired final volume.
The procedure is performed under general anesthesia. The implant can be placed either in front of or behind the pectoral muscle, depending on your surgeon’s practice. If the implant is placed behind the muscle, recovery may be slightly more painful, but appropriate pain management will be provided.
For secondary breast reconstruction, the inframammary fold (under the breast) will also be reconstructed for a more natural appearance. A drain is typically used for a few days after the surgery.
The patient arrives at the clinic in the morning. The procedure is performed under general anesthesia and lasts between 1 and 1.5 hours. A compression bra is placed in the operating room at the end of the procedure.
Generally, the patient will go home the day after surgery with drains in place. If she feels weak or overly concerned about the postoperative recovery, she may choose to stay a few additional days at the clinic until the drains are removed. Approximately one month after breast reconstruction surgery, physical therapy sessions may be beneficial. A leave of absence from work of about 3 weeks is usually required.
It is important to inform the patient that she will need to wear a compression bra for about one month following the surgery. Immediately after the procedure, swelling is common but will decrease over time. The final result stabilizes approximately 3 to 6 months after the surgery. Sports activities can typically be resumed 6 weeks post-operation.
It is common to consider cosmetic enhancements after breast reconstruction with implants, such as fat injections to improve the appearance of the décolleté.
Bilateral breast reconstruction with anatomical implants
On the patient’s right: right mastectomy with a scar under the breast, preserving the areola and nipple, and immediate breast reconstruction (in the same operation as the mastectomy) with an anatomical implant.
On the patient’s left: secondary breast reconstruction with an anatomical implant placed under the muscle and areola reconstruction by skin graft.
Breast reconstruction with anatomical implant
Secondary breast reconstruction with anatomical implant placed under the muscle and areola reconstruction by skin graft (three-quarter view)
Immediate breast reconstruction with anatomical implant
On the patient’s left: mastectomy with preservation of the areola and nipple with a scar under the breast and immediate breast reconstruction (in the same operation as the mastectomy) with an anatomical implant.
Breast reconstruction with anatomical implant
Immediate left breast reconstruction with an implant performed at the same time as the mastectomy (removal of the breast) with right breast symmetry and left areola reconstruction
Breast reconstruction with anatomical implant
Immediate left breast reconstruction with an implant performed at the same time as the mastectomy (removal of the breast) with right breast symmetry and left areola reconstruction
Breast reconstruction with anatomical implant
Right mastectomy without preservation of the areola and nipple with immediate breast reconstruction by implant and right nipple reconstruction by graft. The areola will be reconstructed later by 3D tattoo.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle, with a slight increase in breast volume.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle, with a slight increase in breast volume.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle, with a slight increase in breast volume.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle, with a slight increase in breast volume.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle, with a slight increase in breast volume.
Bilateral mastectomy (removal of the breast) with preservation of the areola
Scar under the breast, and immediate breast reconstruction with implants placed in front of the pectoral muscle, with a slight increase in breast volume.
Prophylactic (preventive) bilateral mastectomy
Scar under the breast and immediate breast reconstruction with 260cc implants, moderate profile
Prophylactic (preventive) bilateral mastectomy
Scar under the breast and immediate breast reconstruction with 260cc implants, moderate profile
Left mastectomy (removal of the breast) via inframammary approach
Areola preservation and immediate breast reconstruction with an implant placed in front of the pectoral muscle and symmetry of the left breast
Left mastectomy (removal of the breast) via inframammary approach
Areola preservation and immediate breast reconstruction with an implant placed in front of the pectoral muscle and symmetry of the left breast
Left mastectomy (removal of the breast) via inframammary approach
Areola preservation and immediate breast reconstruction with an implant placed in front of the pectoral muscle and symmetry of the left breast
Secondary left breast reconstruction by implant with fat injection
Breast reconstruction in the décolletage area and reconstruction of the areola and nipple grafting
Secondary left breast reconstruction by implant
Change of left breast implant with fat injection (lipofilling) to treat capsule contracture
Breast reconstruction with implants
Left mastectomy without areola preservation and immediate breast reconstruction by implant, right breast symmetry by implant, and right nipple reconstruction by graft. Areola tattooing still pending
The cost of breast reconstruction with implants varies depending on the technique used. This type of breast reconstruction is covered by health insurance. It is necessary to submit a pre-authorization request to social security to obtain reimbursement.
DOCTOR BENJAMIN SARFATI
Specialist in breast surgery and intimate surgery
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