Immediate reconstruction

Rebuilding without living through the absence

When immediate breast reconstruction is possible and indicated, the most widely used technique is implant reconstruction. Autologous flap techniques also have their place, case by case.

Three situations lead to it. Patients with a non-invasive in situ or intraductal lesion requiring a mastectomy, but no complementary treatment expected. Those who have previously had breast-conserving treatment and who, for a new lesion, require a mastectomy: there will be no radiotherapy, since it has already been given. And prophylactic mastectomies.

The technique is chosen according to the size of the opposite breast, the patient’s build, and the anatomy of the donor sites such as the back and the abdomen.

Two surgeons, one operation

The cancer surgeon performs the mastectomy jointly with the plastic surgeon, who rebuilds the breast in the same operation.

The case is validated beforehand by a multidisciplinary board. That validation is not a formality: it commits the whole team to the principle of immediate reconstruction, and to its timing.

Implant reconstruction

Immediate breast reconstruction with a definitive implant is most often possible for small and medium volumes.

The implant is placed under the muscle and the central scar is closed. The procedure is therefore done in one go, with no intermediate stage, which is why it is reserved for situations where skin and muscle can accommodate the final volume straight away.

The tissue expander, when the skin needs time

Where volumes are large or anatomical conditions difficult, the surgeon may place a temporary tissue expander filled with saline.

It is filled to one third of its volume during the operation. This allows the scar and the underlying muscle to heal cautiously, without any tension on the skin, thereby avoiding necrosis and healing defects.

In those cases, the expander is gradually filled at the office from day 21, over 3 to 5 painless sessions a fortnight apart.

Acellular dermal matrix

A more recent material, particularly useful in immediate breast reconstruction: a treated and purified dermal matrix, placed between the lower edge of the pectoral muscle and the inframammary fold.

The reconstruction implant is then fully covered and never lies directly beneath the mastectomy scar. This gives better healing, and natural support for the implant.