ID Sein

After mastectomy

The treatment of breast cancer is primarily surgical: it involves removing the tumour.
Thanks to oncoplastic techniques, in which the cancerous lesion is removed while retaining the normal appearance of the breast, and neoadjuvant chemotherapies administered to shrink the tumour before surgery, breast conservation is now possible in around 70% of cases. Mastectomy (the removal of the breast) is still necessary in other cases.

Although each woman experiences it differently, the loss of a breast always has an effect in terms of her femininity and sensuality. Breast reconstruction can be offered to all patients and provides satisfactory results, but it does not alter the prognosis of the disease. However, in France, less than 40% of women who have undergone a Mastectomy go through with a breast reconstruction. Sometime this is because the woman does not want to, but often they refuse it because they are discouraged by their family or by their doctor who may mistakenly believe that reconstruction holds a risk of cancer.
It is entirely up to the patient in question whether or not they have a breast reconstruction…

It has been proven that reconstruction :

  • does not increase the risk of recurrence
  • does not delay the diagnosis of a recurrence
  • does not change the prognosis

When is reconstruction appropriate ?

The ideal scenario is to carry out a reconstruction at the same time as the Mastectomy (Immediate Breast Reconstruction, IBR) but this is not always possible; in particular when radiotherapy is scheduled afterwards. In this case, the procedure is planned for after the end of treatment (Delayed Breast Reconstruction, DBR). Some women even decide to do it several years later...

Immediate reconstruction may be offered if there is no radiotherapy planned after the mastectomy. Otherwise, it is preferable to postpone the reconstruction until about a year after radiotherapy.


How is reconstruction carried out?

The breast can be reconstructed using a prosthetic implant or from a flap (tissue taken from the patient's back or stomach). The choice of technique largely depends on the flexibility and quality of the abdominal skin, but also on the patient's anatomy and their objectives).
Not all women have the same requirements after a mastectomy.

  • Some are willing to undergo several procedures to obtain optimal results, while others expect a simple reconstruction of the shape and size, to avoid wearing an external prosthesis.
  • Some women prefer the flap technique for a supple and natural look, while others want a reconstruction using a prosthetic implant so as to minimise scarring, even if the local conditions are not that suitable (skin quality), and might opt for a flap reconstruction even if the results are not optimal.

It is therefore very important to define, using case-by-case consultation, the objectives of the reconstruction and to establish a 'treatment plan'.


There are several stages to reconstruction

  • 1st stage: reconstruction of the shape and size of the breast, symmetry with the other breast
    Reconstructed breast are always of a reasonable size and fairly 'pert'. Therefore, it is sometimes helpful to operate on the other breast in order to obtain a similar appearance to the reconstructed breast. The surgeon reduces or increases the size depending on the case, and corrects the ptosis (sagging of the breast). Both breasts are operated on during the same procedure.
  • 2nd stage: evaluation of the result, retouches and finishing
    After surgery, tissues do not all react in the same way, particularly after radiotherapy sessions are completed. We can judge the result approximately 2 weeks after reconstruction and then consider any possible improvements. The proposed actions are generally not very invasive and can be performed on an outpatient basis.
    Sometimes, the technique that was initially chosen does not offer a satisfactory outcome, and it may be wise to change it. This is the case for some reconstructions using prostheses, when there is a lack of skin laxity (suppleness). The surgeon may then suggest opting for a flap reconstruction.
  • 3rd stage: reconstruction of the nipple and areola (Nipple-Areolar Complex, NAC)
    This is the final stage of the reconstruction. It can only be carried out once the symmetry of the breasts is good enough.

Secretary of Dr I. Sarfati

Phone : 01 45 63 01 02

If your inquiry is urgent, we recommend that you send sms to 06 52 63 06 32 or mail to secret.is@idsein.fr