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This takes place during the same operation as the Mastectomy, and is not usually suggested unless there is no radiotherapy planned for after the operation, because this treatment increases the risk of complications and alters the outcome of the reconstruction. Most immediate reconstructions are done using prostheses.
In practice, immediate reconstruction is mainly considered :
- when removal of the breast is carried out as a preventive measure (prophylactic mastectomy)
- in the case of intraductal cancer (carcinoma in situ, DICS or non-invasive cancer);
- in women who have a local recurrence of breast cancer after a Axillary dissection Conserving treatment (as they have already had radiotherapy during the conservative treatment).
- In the case of prophylactic Mastectomy, the areola and nipple can be retained (nipple sparing mastectomy). If the breast is not too large, the incision is made in the under-breast crease.
- In the case of carcinoma in situ, if the breasts are not too large then the surgeon can carry out a Mastectomy while retaining the breast skin (skin sparing mastectomy) to minimise scarring (scar around the areola with a small extension at the side).
- If an immediate reconstruction seems to be essential but radiotherapy is indicated, it is sometimes possible to reverse the order of the treatments: radiotherapy first, then the mastectomy with immediate reconstruction. In this case, the surgeon must reconstruct using the flap technique because radiation weakens the skin.
- Acellular dermal matrices: these are derived from human or animal skin which have been stripped of their cells to only leave the tissue framework, or 'lattice'. In immediate reconstruction using prostheses, they are interposed between the skin and the prostheses to help obtain results that are much more supple and natural. The after-effects of surgery last longer as the drain is kept in for longer. These matrices are not covered by social security for French residents and cost between €1,000 and €3,500 depending on the tissues used.