Immediate breast reconstruction: advantages and psychological impact

Facing a mastectomy does not only mean undergoing surgery, but also living with its physical and emotional consequences. Today, reconstructive surgery offers patients the chance to regain a breast immediately, during the same operation, with significant effects on quality of life. Dr. Mattia Brogi, specialist in plastic, reconstructive, and aesthetic surgery at the Careggi University Hospital, explains that breast reconstruction can be immediate, performed at the same time as the mastectomy, or delayed, when the reconstructive part is carried out in a separate surgery. The choice depends on several factors, but in recent years, surgical techniques have greatly expanded the possibilities for immediate reconstruction.

Immediate and delayed breast reconstruction: the differences

«Breast reconstruction can be divided into immediate and delayed. Immediate means it is carried out at the same time as the mastectomy. Delayed means the removal is performed first and the reconstruction follows later, in a second procedure», explains the surgeon.

Immediate reconstruction may be heterologous, using prosthetic devices or expanders, or autologous, meaning tissues from the patient’s own body are used. «The DIEP flap, which uses tissue from the abdominal area, is now the reference technique».

The benefits are clear, both physically and psychologically. «First of all, there are advantages for the skin envelope: it is preserved right away, avoiding scarring retractions. The other major advantage is psychological: the patient leaves the operating room already with her own shape, with a reconstructed breast».

However, this approach is not always possible. «There may be oncological factors, such as locally advanced disease, or patient-related ones, like health conditions that do not allow for prolonged surgery. Heavy smokers or patients with severe obesity may also be unsuitable».
When clinical conditions allow, the reconstructive options vary and are chosen based on the condition of the tissues. «If the tissue allows, if it is well perfused and vascularized, I immediately place a breast implant, which can be positioned in the pre-pectoral or retro-pectoral plane, using different techniques».

Radiotherapy and possible complications

An important variable is radiotherapy, which can compromise the outcome. «It causes tissue fibrosis and increases the incidence of capsular contracture in prosthetic reconstruction. Recent studies show that, if postoperative radiotherapy is already planned, implants seem to suffer less damage compared to expanders». To improve the quality of irradiated tissues, the doctor adds, lipofilling can be helpful: «The transfer of adipose tissue has regenerative effects thanks to the growth factors and stem cells contained in fat».

As with any surgery, reconstruction can present complications. «Immediate complications include bleeding, infections, or wound dehiscence. In the long term, the main complications are related to the implant: risk of rupture, though very low, and above all capsular contracture». The latter, Brogi explains, can lead to hardening and displacement of the implant and, in the most severe cases, pain.

Psychological impact and return to daily life

The true strength of immediate reconstruction, however, remains its impact on daily life. «Immediate breast reconstruction allows the patient to leave the operating room already reconstructed. Within about a month, she can wear a bikini again and go to the beach. This helps her forget more quickly that she has undergone oncological surgery and ensures a better quality of life».