Conservative mastectomy: preserving to rebuild

Breast surgery is increasingly synonymous with rebuilding confidence and harmony. Conservative mastectomies and personalized reconstruction techniques make it possible to preserve the shape, natural appearance, and confidence of those undergoing treatment.

«The term conservative mastectomy might almost seem contradictory because it combines two seemingly opposite concepts – says Dante Palli, Director of the Complex Operational Unit of Breast Surgery and the Breast Unit of the Piacenza Health Authority – On one hand, conservation, and on the other, the radical removal of an entire organ, the breast. In reality, this is not the case because with modern breast surgery supported by oncoplastic techniques, we can now apply reconstructive approaches not only to conservative surgery but also to radical and demolitive procedures, including mastectomies».

Conservative mastectomy: modern techniques for more natural results

Conservative mastectomy represents a major step forward. «It consists of removing the gland while preserving the skin envelope and, when possible, the nipple-areola complex. This is not always possible because oncologic radicality remains the priority – explains Palli – However, when the clinical conditions allow it, based on tumor characteristics, we can reconstruct the breast during the same operation, replacing the gland with a silicone implant or with a tissue expander if a definitive implant cannot be placed immediately».

Breast reconstruction techniques have significantly evolved in recent years, making it possible to combine oncological safety with increasingly natural aesthetic outcomes. Today, breast surgery is based on a tailored approach, customized to each patient’s characteristics and needs.

The primary goal is to preserve the skin envelope and, when possible, the nipple-areola complex. «During surgery, we perform a biopsy of the tissue remaining behind the areola to ensure no residual disease. If the pathologist confirms the absence of cancer cells, we can proceed with immediate reconstruction after the breast gland removal».

One of the currently preferred techniques is prepectoral reconstruction, in which the implant is placed in front of the pectoral muscle rather than behind it, as was common until the early 2000s. Placing the implant behind the muscle was previously done to create a protective layer between the implant and the skin.

«Today, placing the implant above the muscle is preferable because it allows the muscle to retain its function, which is essential for shoulder support and movement». To wrap and support the implant in the prepectoral space, surgeons now use biological membranes derived from animal dermis, such as acellular porcine dermis, fully compatible with the human body.

Early diagnosis and healthy lifestyle habits

Early diagnosis plays a crucial role in breast cancer treatment. Detecting increasingly smaller and early-stage lesions makes it possible to perform conservative treatments with significantly improved aesthetic and functional outcomes. These procedures also offer a faster recovery compared to traditional mastectomies.

«We almost always use local anesthesia with sedation, avoiding general anesthesia and orotracheal intubation. Procedures are performed as day surgery, and patients can return home the same evening».

Conservation also applies to the sentinel lymph node and axillary lymph nodes. «We are not always required to remove all axillary lymph nodes, even if the sentinel node tests positive».

Breast screening remains the most effective tool available to women to protect their health, but prevention goes beyond diagnostic tests.

«Healthy lifestyle habits, proper nutrition, avoiding smoking, and regular physical activity are concrete tools patients can use to reduce cancer risk. This does not mean becoming Olympic athletes, simply walking briskly for around 30 minutes every day is enough». Preventing obesity through a balanced diet and complete smoking cessation remains essential, as smoking is a major risk factor not only for lung cancer but for most malignancies.

Dedicated teams and continuous collaboration

Facing breast cancer does not mean facing the journey alone. Today, care is a team effort, with surgeons, oncologists, radiologists, and psychologists working side by side to support patients.

«A woman treated in a Breast Unit has approximately a 20% higher chance of recovery compared to one treated by isolated professionals working independently. Collaboration and daily teamwork lead to better surgical and oncological outcomes. Dedicated professionals mean experience, and experience leads to better care».

The multidisciplinary approach is not just an organizational choice: it leads to better clinical, aesthetic, and psychological outcomes.These topics will be the focus of the conference “Multidisciplinary Management in the Care of High-Risk Breast Cancer Patients.” The event will be held in Piacenza on December 5, 2025, at the Best Western Park Hotel. The meeting will bring together Breast Units from across the Emilia-Romagna region to share best practices and ensure equal access to high-quality care for all patients.