Mastectomy and breast reconstruction

When is mastectomy indicated?

Although breast-conserving surgery is the first choice in most early stages, mastectomy remains the necessary or recommended option in well-defined situations:

• Unfavourable tumour-to-breast volume ratio: When a resection with clear margins would leave a severe defect that cannot be corrected oncoplastically.
• Multicentric tumours: Several malignant foci in different quadrants of the same breast.
• Diffuse or extensive microcalcifications: Which cannot be excised completely in a single block.
• Contraindications to radiotherapy: Situations in which the patient cannot receive adjuvant radiotherapy (which is mandatory after breast-conserving surgery).
• Persistent positive resection margins: After repeated attempts at conservative re-excision.
• Prophylactic (risk-reducing) mastectomy: Recommended for carriers of high-risk genetic mutations.
• The patient’s informed choice: Some patients prefer mastectomy to avoid radiotherapy or for greater psychological comfort.

Axillary staging is performed together with the mastectomy, most often with the sentinel lymph node biopsy technique.

Surgical types of mastectomy

Thanks to advances in reconstructive techniques, modern mastectomy comes in several variants:

Breast reconstruction options: when and how?

Reconstruction can be done immediately (in the same operation) or secondarily (a few months or even years later, after chemotherapy and radiotherapy are completed).

Prosthetic reconstruction (implant-based)

• Direct to implant: The final silicone implant is inserted in the same operation (often placed prepectorally).
• In two stages (tissue expander → final implant): If the skin envelope is insufficient or under tension, a tissue expander is placed temporarily. It is gradually inflated over 6–8 weeks in the clinic with saline, and in a second operation it is replaced with the final silicone implant.
• Advantages: Shorter operating time, no secondary scars in other areas of the body.
• Worth remembering: Breast implants are not lifelong devices; in the long term they may need adjustment or replacement.

Autologous reconstruction (with your own tissue)

It uses skin, fat and sometimes muscle taken from other parts of the patient’s body:

• DIEP flap (abdominal): Uses the excess skin-and-fat tissue of the lower abdomen (similar to an abdominoplasty).
• Latissimus dorsi (LD) flap: Uses a portion of the muscle and skin from the back of the chest.
• Advantages: The reconstructed breast has a soft, natural consistency, ages and changes in weight along with the body, and tolerates postoperative radiotherapy much better.
• Worth remembering: Longer microsurgical operations, involving a longer recovery period and an additional scar at the donor site.

Aesthetic flat closure

Many patients knowingly choose not to go through the stages of a reconstruction. The surgeon carries out a meticulous excision and smoothing of the skin folds so that the chest wall remains smooth, symmetrical and free of unsightly irregularities. The patient can easily wear an external silicone prosthesis in her bra or choose the comfort of wearing none.

Stages of surgical treatment

1. Initial surgical consultation

   We determine the optimal type of mastectomy and discuss the reconstructive options suited to your anatomy, your wishes and the oncological plan.

2. Assessment in the Multidisciplinary Board (Tumor Board)

   The sequence of treatments is set rigorously (for example, if postoperative radiotherapy is anticipated, the reconstruction strategy is chosen to prevent damage to the aesthetic result).

3. The operation

   It is performed under general anaesthesia. Removal of the breast, sentinel lymph node biopsy and the first reconstructive stage (implant, expander or flap) take place at the same time.

4. Staging and refinement (if needed)

   A few months later, small symmetrisation procedures on the opposite breast, lipofilling (transfer of the patient’s own fat for fine contouring) or reconstruction of the nipple-areola complex (using local flaps and 3D medical micropigmentation) can be carried out.

Possible risks and complications

• General: Bleeding, haematoma, seroma (a fluid collection that may need drainage punctures in the clinic), infections or partial dehiscence of the wound edges.
• Specific to implant reconstruction: Partial necrosis of the remaining skin flap, capsular contracture (thickening and stiffening of the capsule around the implant over time), displacement of the implant or, in case of severe infection, the need to remove it temporarily.
• Specific to autologous reconstruction: Complications at the donor site (abdomen, back) or vascular compromise of the transferred tissue flap.

Post-operative recovery

Hospital stay

2–4 days, depending on the complexity of the reconstructive operation.

Drains

They are usually kept for 5 to 14 days to drain lymphatic secretions and are safely removed at the post-operative check-up.

Compression garment

Continuous wearing of a special post-mastectomy/post-reconstruction bra for at least 6 weeks is mandatory.

Mobility

Lifting more than 2–3 kg is forbidden for at least a month.

Skin sensation

The skin of the operated chest wall will have an area of hypoaesthesia (numbness), which may partly resolve over time.

Warning signs: when to contact your surgeon

Tell the medical team immediately if you notice any of the following:

• Persistent fever above 38°C or chills
• Sudden pain and asymmetric swelling of the operated breast
• A change in the colour of the skin of the reconstructed breast (extreme pallor, cyanosis/bluish-purple tint or darkening)
• Purulent or bloody discharge from the wound or around the drain tube
• Opening of the sutures

For major medical emergencies, call 112.

Frequently asked questions