Implant-based breast reconstruction is the most common technique after mastectomy. It immediately restores breast volume in one or two surgical stages depending on skin quality and oncological context.
Implant-based (heterologous) reconstruction uses a breast prosthesis to restore breast volume after mastectomy. It is the most widely used reconstruction technique, particularly for immediate reconstruction.
Mastectomy always removes the entire mammary gland. The question is not how much is removed, but how to reconstruct — and when.
The procedure involves placing a breast implant, most often beneath the skin and pectoral muscle. In straightforward cases, a permanent implant is placed in a single stage. In others, a temporary tissue expander is first inserted, gradually inflated, then exchanged for the definitive implant.
Breast reconstruction does not affect cancer surveillance — oncological follow-up is maintained with the same rigour after the procedure.
Breast reconstruction is never compulsory. It remains a personal choice. An external prosthesis may be sufficient for some women. Flat closure is also an option. Prophylactic mastectomy (e.g. for BRCA mutation) follows the same reconstruction principles.
The NAC — nipple and areola — is the visible, central part of the breast. At the time of mastectomy, the question of whether it can be preserved or must be sacrificed is always addressed.
The NAC can be preserved when the tumour is at a distance, the tissue is histologically healthy, and vascular and anatomical conditions allow it. When preserved, sensitivity is usually maintained.
The NAC is sacrificed when the tumour is close to the nipple, when breast ptosis is significant, or when vascular status raises concern about necrosis. This is not an arbitrary decision — it is a considered surgical decision, discussed with you before the operation.
If the NAC is sacrificed, nipple reconstruction and medical areola tattooing can be performed at a later stage, covered by French Health Insurance.
Performed under the same anaesthetic as the mastectomy. Advantage: no waking without a breast, fewer total procedures. Possible in the vast majority of cases. The only formal contraindication is inflammatory breast cancer.
Absolute rule: immediate reconstruction must never delay cancer treatment. If any doubt exists, reconstruction is deferred. Life comes before aesthetics.
Performed once all treatments are complete and tissues have stabilised. It allows time to process the decision and assess skin condition. After radiotherapy, it can begin 6 to 9 months after the end of irradiation. It is never too late.
If radiotherapy is planned, an implant is generally preferred first: irradiating a prosthesis is better tolerated than irradiating a flap. If no radiotherapy is planned, a flap may be discussed straight away. With rare exceptions, radiotherapy is given only once — all secondary modifications (flap, fat grafting, implant exchange) remain possible afterwards.
The choice between a direct implant and a tissue expander depends primarily on the quality and quantity of skin available after mastectomy, and on the oncological context.
The definitive implant is placed immediately at the time of mastectomy (immediate reconstruction) or at a later stage (delayed). Possible when remaining skin is of good quality and sufficient quantity.
Advantages: single procedure, faster recovery, immediate result. The implant is placed subpectorally or prepectorally depending on the indication.
When radiotherapy is anticipated, an implant is often preferred over a flap during the irradiation period — it can subsequently be exchanged or supplemented with autologous tissue if needed.
A temporary tissue expander is placed at the first stage. It is gradually inflated with saline injections (usually weekly) over 4 to 12 weeks, stretching the skin to create the necessary space.
After a stabilisation period of 3 to 6 months, the expander is exchanged for the definitive implant. This second stage may be combined with symmetrisation of the opposite breast.
Typical indications: tight or poor-quality skin, reconstruction after radiotherapy, insufficient skin after extensive mastectomy.
All breast implants available in France carry the CE mark and ANSM approval. They consist of a silicone elastomer shell, smooth or textured.
Cohesive silicone gel (most common, consistency close to natural breast tissue) or saline. Modern cohesive gels limit the risk of spread in the event of rupture.
Round or anatomical (more projected inferiorly, simulating the natural breast profile). Choice depends on body type, desired volume and skin quality.
Smooth or textured. Textured surfaces reduce the risk of capsular contracture but are associated in rare cases with BIA-ALCL. Macro-textured implants are now very rarely used.
Implant reconstruction is performed under general anaesthesia at Hartmann Clinic (Neuilly-sur-Seine). It may be performed at the same time as mastectomy or as a separate stage.
A standard pre-operative assessment is performed (blood tests, ECG, anaesthesia consultation at least 48h before). In all cases, imaging of the opposite breast is verified — if the last examination is more than a year old, a new assessment is arranged.
Complete smoking cessation at least 1 month before surgery — smoking significantly increases the risk of wound complications, implant infections and surgical failure. E-cigarettes are treated the same way.
No aspirin or anti-inflammatory drugs in the 10 days before surgery. Anti-thrombosis stockings may be prescribed to wear until discharge.
General anaesthesia.
The procedure takes 1 to 2 hours. A hospital stay of several days is usual, until drainage is removed.
Covered by French Health Insurance (ALD) for breast cancer. Additional fees apply (secteur 2) — quote provided in consultation.
Since November 2016, all breast implants placed in France are recorded in an anonymous national registry — guaranteeing traceability and follow-up.
Implant reconstruction immediately restores volume, allowing normal dressing with a neckline. However, the final result is not immediate — 2 to 3 months are needed.
Some asymmetry will always remain between the two breasts: in volume (the base can never be perfectly identical), in shape (when lying down, the implant does not spread like natural tissue), and in height (the unoperated breast will gradually descend over time).
Scars initially appear pink and raised, then gradually fade. They never disappear entirely.
The aim is to bring a clear improvement without aiming for perfection. With realistic expectations, the result should bring great satisfaction.
Implant breast reconstruction is a genuine surgical procedure carrying risks inherent to any medical act. Serious complications are fortunately rare when performed by an experienced surgeon.
A fibrous capsule around the implant always forms — it is the body's normal response to a foreign material. In some cases this capsule contracts abnormally, causing hardness, pain and visible breast deformity.
This risk is significantly higher after radiotherapy to the implant. It has decreased with newer implant designs but remains unpredictable. Surgical revision may be required.
Higher risk after radiotherapy Surgical revision may be neededRupture may occur from trauma, excessive compression (e.g. mammography), or spontaneously through shell ageing. No implant can be considered permanent for life.
With cohesive silicone gel implants, clinical diagnosis is less obvious. Digital mammography confirms the diagnosis. Implant replacement is necessary. MRI monitoring every 2 years is recommended in France.
MRI monitoring every 2 years Replacement if rupture confirmedInfection requires antibiotic treatment and sometimes reoperation, including temporary implant removal. The risk is higher after radiotherapy and in smokers, who are more prone to implant infections.
Systematic intraoperative antibiotic prophylaxisBreast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a very rare entity, observed mainly with macro-textured implants. In the event of recurring late peri-implant effusion, specialist breast imaging assessment is required.
If in doubt, surgical exploration with removal of the periprosthetic fibrous capsule (capsulectomy) may be proposed. Macro-textured implants are now very rarely used.
Mainly linked to macro-textured implants Report any late peri-implant effusionImmediate reconstruction is performed at the same time as mastectomy — the patient wakes up with a reconstructed breast. It is an onco-surgical option discussed in multidisciplinary team meetings, proposed when disease status and tissue quality allow.
Delayed reconstruction is performed after all treatments are complete — months or years after mastectomy. It allows time for adjuvant treatments (chemotherapy, radiotherapy) and tissue stabilisation. It is never too late to undertake reconstruction.
Decision made in multidisciplinary team Never too late to reconstructBreast reconstruction after breast cancer is covered at 100% on the French Health Insurance standard rate under the long-term illness scheme (ALD). This covers all surgical stages: volume reconstruction, symmetrisation of the opposite breast, and nipple-areola complex reconstruction.
Dr Zeitoun practises in secteur 2 — additional fees apply, including for ALD patients. A detailed, transparent quote is provided in consultation before any procedure. Your complementary health insurance may cover part or all of the additional fees.
100% French Health Insurance standard rate (ALD) Additional fees — secteur 2 Systematic quote in consultationRadiotherapy does not prevent implant reconstruction, but it significantly increases the risk of capsular contracture and skin complications. If radiotherapy is planned, an implant is often preferred over a flap during the irradiation period — it can subsequently be exchanged or supplemented.
After irradiation, autologous tissue reconstruction (DIEP, latissimus dorsi flap) is often preferable as one's own tissue tolerates radiation sequelae better. Each situation is assessed individually.
Higher capsular contracture risk after irradiation Autologous tissue often preferred post-radiotherapyYes. An implant can make mammography images more difficult to interpret — it must be reported to the radiologist so they can adapt the technique (Eklund views). Centres experienced in this follow-up handle it well.
After total mastectomy, there is no glandular tissue left to monitor on the operated side — mammography is reserved for the opposite breast. MRI monitoring every 2 years is recommended to detect rupture.
Inform the radiologist of the implant MRI monitoring every 2 years Contralateral breast mammography maintainedNo implant can be considered permanent for life — it ages progressively. Contrary to common belief, there is no obligation to replace an implant every 10 years if it is causing no problems.
Replacement is necessary in cases of: confirmed rupture, significant capsular contracture, major displacement, or patient preference. MRI monitoring every 2 years is recommended to detect rupture early, even when asymptomatic.
No obligation to change every 10 years MRI monitoring every 2 yearsTwo possible situations, two adapted approaches. Choose the one that best matches your journey.
A second opinion at the practice to discuss implant choice, incision, subpectoral vs prepectoral placement, immediate vs delayed reconstruction.
Request a second opinion →Video teleconsultation from home: assessment of the current implant, ongoing surveillance, feasibility of implant replacement or complementary lipofilling.
Video teleconsultation →Unsure or prefer talking? Request a callback from the secretary — Coralie will guide you to the right slot.
Dr Zeitoun practises in the French private sector (sector 2, non-OPTAM agreement) with fees above the standard rate set by French statutory health insurance (Assurance Maladie). The standard rate is reimbursed — with enhanced coverage for cancer (ALD long-term illness scheme) — but does not cover additional fees. Your private complementary health insurance may cover part or all of these additional fees.
