What is breast reconstruction?
Breast reconstruction is a set of surgical procedures aimed at restoring the shape, volume and symmetry of the breast in women who have undergone a mastectomy — total or partial — as treatment for breast carcinoma or for high-risk conditions. It is a procedure with a profound impact that is not only aesthetic but also psychological and emotional, contributing to the full recovery of the patient's wellbeing and self-esteem along the post-oncological pathway.
In Italy, breast reconstruction is recognised as an integral part of oncological treatment and, in the majority of cases, is guaranteed by the National Health Service (SSN). Dr. Marco Galati, a specialist in plastic, aesthetic and reconstructive surgery with over 20 years of experience and 5,000 certified procedures, approaches each case with a multidisciplinary method, working alongside the oncology team to plan the most appropriate reconstructive pathway.
Reconstruction can rely on different techniques, chosen according to the patient's physical characteristics, the extent of the resection, the adjuvant treatments received (chemotherapy, radiotherapy) and personal expectations:
- Reconstruction with breast implants: indicated when the remaining skin is of good quality and the volume removed allows it. In some variants a definitive implant is placed immediately, possibly supported by a biological support mesh (acellular dermal matrix).
- Reconstruction with tissue expanders: a two-stage solution in which a temporary expander is first inserted and progressively inflated to stretch the skin, then replaced with the definitive implant in a second operation.
- Reconstruction with autologous tissue (flaps): uses tissue harvested from other areas of the body (abdomen, back, thigh) to recreate a breast of natural volume and consistency, without the use of prosthetic material.
- Breast lipofilling: a complementary or stand-alone technique using the patient's own fat, harvested by liposuction and reinjected into the reconstructed breast to improve the volume, shape and softness of the final result.
How the operation is performed
The breast reconstruction pathway always begins with a detailed consultation in which Dr. Galati reviews the patient's clinical history, examines the skin and remaining tissues, discusses the available options and explains the pros and cons of each technique. In this phase it is essential to establish an open, informed dialogue in order to identify the solution most in line with the patient's expectations and state of health.
- 1. Consultation and planning — specialist visit with physical examination, review of the oncological documentation and planning of the most suitable surgical technique. Timing, risks and realistic expectations are discussed. In the case of immediate reconstruction, planning takes place in close collaboration with the oncology team.
- 2. Preparation for surgery — before the operation, blood tests, an anaesthesiology assessment and, where necessary, imaging studies (ultrasound, mammography, MRI) are carried out. Smoking and anticoagulant medication must be suspended in the preceding weeks. Fasting begins the night before admission.
- 3. The surgical procedure — the operation is performed under general anaesthesia and lasts 2 to 5 hours depending on the technique. In expander-based reconstruction, the device is inserted through the same incision as the mastectomy. With autologous flaps, tissue is harvested from the donor area (abdomen or back) and shaped to recreate the breast.
- 4. Progressive expansion (where indicated) — when a tissue expander is used, outpatient sessions of gradual inflation are performed in the weeks after surgery (about every 1–2 weeks) through a subcutaneous valve. Once the desired volume is reached, a wait of 1–3 months precedes replacement with the definitive implant.
- 5. Refinement and symmetrisation — after the main reconstruction, one or more secondary procedures may be needed to perfect the result: reconstruction of the nipple-areola complex (with a skin graft or medical tattooing), corrective lipofilling and symmetrisation of the contralateral breast to ensure a balanced appearance.
- 6. Long-term follow-up — the final result matures over 6–12 months. During follow-up, Dr. Galati monitors scarring, symmetry and tissue integration. Patients with implants undergo periodic checks over time to verify the integrity of the device.
Recovery and results
The post-operative course of breast reconstruction varies according to the technique used and the patient's general condition. As a rule, the hospital stay lasts 2 to 4 days. During this phase, wound healing, tissue vascularisation and the patient's comfort are monitored, with adequate pain-relief therapy provided.
In the first two weeks it is important to limit movements of the arm on the operated side, avoid exertion and keep the wound clean and dry. A soft, wire-free post-operative bra must be worn for at least 4–6 weeks. Drains, if present, are removed within 3–7 days.
The return to light daily activities generally takes place between the third and fourth week. Driving, sedentary work and outings without physical exertion are gradually permitted after 2–3 weeks. Intense sport and heavy lifting require a wait of at least 6–8 weeks.
Natural appearance
Modern techniques make it possible to recreate a breast with a very natural appearance and consistency. Lipofilling, in particular, adds softness and continuity to the contour, reducing surface irregularities and improving symmetry with the contralateral breast.
Stability over time
Latest-generation cohesive silicone gel implants offer high stability over time. Periodic checks (ultrasound every 2–3 years) allow the integrity of the implants to be monitored and any issue to be addressed promptly.
Psychological wellbeing
Numerous clinical studies show that breast reconstruction contributes significantly to the recovery of body image, self-esteem and overall quality of life in women who have undergone mastectomy, supporting a more serene return to social and emotional life.
Scars kept to a minimum
Dr. Galati plans the incisions to follow the margins of the mastectomy scar as far as possible, keeping new suture areas to a minimum. With time, and with the use of specific topical treatments, the scars tend to lighten and flatten considerably.
Results – example case
Case treated by Dr. Marco Galati. Post-mastectomy breast reconstruction aims to restore a harmonious breast profile and a renewed sense of body identity.
Frequently asked questions
Reconstruction can be immediate, performed during the same operation as the mastectomy, or delayed, i.e. carried out weeks or months later, once oncological treatments such as chemotherapy or radiotherapy have been completed. The choice depends on the patient's clinical condition, the possible need for post-operative radiotherapy and personal preferences. Many oncology centres today favour immediate reconstruction when technically possible, as it reduces the total number of operations and limits the psychological impact of the absence of the breast.
The choice of technique depends on several factors: the extent of the mastectomy, the quality and quantity of the remaining skin, the size of the contralateral breast, the type of oncological treatments received and the patient's expectations. Dr. Galati assesses each case individually: in general, implants and tissue expanders are preferred when the skin is sufficient, while lipofilling with autologous fat is indicated for partial reconstructions, as a complement to the final result or when prosthetic materials are best avoided. Autologous flaps are the optimal choice when maximum naturalness is sought or in cases where previous radiotherapy has compromised the tissues.
Yes. In Italy, breast reconstruction after mastectomy for carcinoma is recognised by the SSN as an oncological-reconstructive procedure and, in most cases, can be provided as an inpatient procedure with exemption. The patient has the right to freely choose the professional and the facility, subject to the availability of accredited services. It is advisable to verify the specific arrangements with the referring oncologist and the chosen facility. Subsequent refinement procedures (such as nipple reconstruction) also generally fall within the pathway guaranteed by the SSN.
The hospital stay generally lasts 2–4 days. In the first weeks it is necessary to limit arm movements and wear a post-operative bra. The return to light daily activities takes about 3–4 weeks, while intense physical activity can resume after 6–8 weeks. With expanders, periodic sessions of progressive inflation are scheduled (every 1–2 weeks) until the desired volume is reached, followed by a second operation to place the definitive implant. The final result, with full tissue maturation and scar settling, stabilises over 6–12 months.
Modern reconstructive techniques allow a very natural appearance and consistency to be achieved, especially when lipofilling or autologous flaps are used. Sensation in the reconstructed breast is usually reduced compared with a natural breast, although partial recovery may occur over time. During the consultation, Dr. Galati explains in detail what results can realistically be expected in each individual case.