Time is reconstruction: why immediacy makes the difference

For a woman affected by breast cancer, the possibility of reconstructing her body image is not merely an aesthetic detail, it is a fundamental part of the healing journey.
Today, breast reconstruction is increasingly an integral part of oncological treatment, and thanks to advances in surgery and the spread of Breast Units, it has become an accessible reality.

This is explained by Professor Marzia Salgarello, Associate Professor at the Catholic University of the Sacred Heart in Rome and plastic surgeon at the Fondazione Policlinico Gemelli IRCCS, where she mainly focuses on plastic, post-oncological, and aesthetic breast reconstruction surgery.

Reconstructing to restore one’s image

Professor Salgarello, a member of the Breast Unit directed by Professor Gianluca Franceschini, emphasizes that time is one of the most crucial factors in reconstruction.

«Time is very important because we must tell patients to take advantage of the mastectomy opportunity to have a simultaneous, or immediate, reconstruction – explains Salgarello – Today, mastectomies are almost always conservative: in most cases, both the areola and nipple can be preserved. In more than half of the cases, it’s possible to perform a nipple-sparing mastectomy, which maintains the outer skin envelope of the breast. In other cases, a skin-sparing mastectomy is performed, preserving all the skin except the areola and nipple. By doing so, we preserve the maximum skin coverage. Not filling that space immediately, with a flap, a prosthesis, or another reconstructive method, but instead waiting for it to shrink and retract means losing a major opportunity».

From a psychological point of view, waking up after surgery without any reconstruction can be very distressing, while the chance to immediately see one’s own image again offers real support during recovery.

«Let’s also remember that reconstruction is covered by the national health system. Of course, it can be done at any time, but this is the best time».

Toward more personalised reconstruction

Each reconstruction is highly personalized: the patient’s body, breast morphology, and clinical conditions determine the technique. Options have expanded significantly over the years.

«We must be as skilled with our reconstruction palette as a painter with his colors, able to use all available techniques. The more we have, the better we can meet patients’ reconstructive needs, depending on their body type and breast shape».

Beyond traditional reconstruction with implants under the muscle or using autologous tissue, the prepectoral reconstruction, where implants are placed in front of the muscle—is now common.

Mastectomy techniques have evolved greatly, becoming increasingly conservative. Around 10–15 years ago, it became clear that after a mastectomy, the implant did not necessarily have to be placed behind the muscle, it could instead be inserted directly into the space left by the removed gland.

«Placing the implant in front of the muscle makes the reconstruction more natural because it fills the space emptied by the breast surgeon», explains Salgarello.

This evolution has significantly expanded reconstructive options, even for patients who were previously not ideal candidates for prosthetic reconstruction and were directed toward autologous options.

«Autologous reconstruction is a wonderful option – says Salgarello – but it’s far more demanding technically, physically, and financially for the National Health System».

Doubts, fears, and hopes

The most frequent questions concern the impact of reconstruction on the cancer treatment process. While patients are generally satisfied and pleased with the results, many still worry about possible negative effects on oncological outcomes.

«We want to give patients back their sense of normality – says Salgarello – We discuss their intentions first. Some are concerned that reconstruction might negatively affect their cancer treatment, and I want to reassure them: there are no negative effects. Reconstruction must not interfere with healing or delay subsequent therapies. If done properly, recovery happens on schedule, and treatment proceeds as planned. My advice is, have the reconstruction, because there’s no oncological reason not to».

The multidisciplinary role of breast units

The biggest change in perception and practice of breast reconstruction in Italy is linked to the spread of Breast Units: multidisciplinary centers that bring together all specialists involved in breast cancer care, including plastic surgeons.

«The importance of Breast Units is proven: scientific studies show that patients treated in these centers recover better and more often. That’s thanks to the dedication of multiple specialists working toward one goal, the cure of breast cancer. This is also an invitation for patients to seek care in such centers, which are found throughout Italy. Everything there is designed for the woman’s well-being, from diagnosis to recovery».

Cutting-edge technologies for less invasive surgery

New technologies, from microsurgery to robotics, are making procedures safer, more precise, and less invasive. From ultralight implants to autologous tissue reconstruction, the future of breast reconstruction looks both technologically advanced and patient-centered.

«We can now achieve aesthetic closures similar to a tummy tuck when tissue is taken from the abdomen, or a thigh lift when taken from the thighs, producing pleasing results. With autologous transplants, instead of implants, we use the patient’s own tissue. These reconstructions age naturally with the patient, they gain or lose weight with her, because they are truly part of her body», explains Salgarello.

BRA Day: a day for awareness and information

On October 15, 2025, the BRA Day (Breast Reconstruction Awareness Day) will be celebrated worldwide, a day dedicated to raising awareness about breast reconstruction.

«Fifteen years ago, in the United States, Canadian surgeon Mitchell Brown created this initiative to promote awareness among surgeons and women about the importance of reconstruction. In Italy, we proudly embraced this mission through the Beautiful after Breast Cancer Italia Onlus, the Italian branch of an international foundation from Belgium, founded by Professor Philippe Blondel of Ghent University. The initiative was later continued by SICPRE, the Italian Society of Plastic Surgeons. Today, we celebrate BRA Day SICPRE, and this year it will be hosted in Rome. It will be a wonderful opportunity to connect all Italian centers involved in breast reconstructive surgery, and, above all, to inform patients», concludes Salgarello.