IMMEDIATE BREAST RECONSTRUCTION WITH IMPLANTS
Advancements and refinements in breast cancer surgery techniques have made it possible to choose increasingly sophisticated and less invasive reconstruction options. It has long been recognized that breast reconstruction significantly improves quality of life, helping patients reconnect with a body image that feels authentically their own.
As a plastic surgeon, I firmly believe in a personalized approach to reconstruction, which allows me to offer a surgical plan tailored to your anatomy and medical history. To achieve this, I rely on a series of anthropometric measurements developed through my international scientific research. Combined with my surgical artistry, these allow me to deliver elegant, natural results in the least invasive way possible. I believe that creating a personalized reconstruction plan means tailoring every decision to your unique body structure. I take into account the type of mastectomy performed, any pre- or postoperative therapies, your professional and social life, existing medical conditions, lifestyle factors such as smoking and diet, and, last but not least, your mindset.
“Immediate reconstruction, which is performed at the same time as breast tumor removal, is one of the cornerstones of the plastic surgeon’s role in the modern approach to breast cancer surgery. It helps prevent the inevitable sense of loss and psychological impact, allowing you to open your eyes and see yourself once again whole in your femininity”.
Immediate breast reconstruction can be performed using breast implants placed either under the muscle, with the implant in a pocket under the chest and abdominal muscles (pectoralis major, pectoralis minor, serratus anterior, and rectus abdominis), or over the muscle, specifically above the pectoral muscle, directly beneath the skin. After a thorough multidisciplinary evaluation, when immediate reconstruction is the best option, I prefer to place the implant in a prepectoral position whenever possible. This approach provides the key advantage of preserving the natural movement and function of the pectoral muscle while preventing implant animation, which is the unwanted shifting of the implant during muscle contraction. To achieve the best aesthetic and functional results, the patient should have sufficient soft and fatty tissue to ensure proper coverage of the implant.
UNDERSTANDING THE PROCEDURE
After the complete removal of the breast gland through mastectomy, I carefully evaluate the quality and blood supply of the remaining skin to determine if immediate breast reconstruction with an implant is feasible. It is important to remember that smoking, very thin skin, extensive previous scars, or limited tissue elasticity are all factors that can prevent immediate implant-based reconstruction. Very large breasts are not necessarily a barrier to immediate reconstruction in my practice.
The choice of mastectomy incision, whether radial, periareolar, vertical, or inverted-T, is determined mainly by any skin affected by the disease, as well as the size and degree of sagging (ptosis) of your breast. A mastectomy removes the glandular tissue and a portion of the fatty tissue beneath the skin. In my reconstruction technique, I select the most suitable implant based on anthropometric measurements and careful preoperative planning, adjusting it during surgery according to the volume of breast tissue removed, the size of your chest, and the other breast.
Whenever possible, I place the implant directly under the skin. Depending on the specific case, I may use textured implants wrapped in a biological membrane (ADM). This membrane, thanks to its natural structure, promotes the growth of your own cells and reduces the body’s recognition of the implant, allowing it to integrate fully into the pocket. Alternatively, I may use implants coated with a specialized layer of polyurethane, which adheres well to surrounding tissues and carries a very low risk of capsular contracture. When appropriate, I offer simultaneous symmetry correction of your other breast during the same procedure. My scientific research allows me to apply highly accurate assessment algorithms to predict the healing process and aesthetic outcome of the breast being symmetrized, using techniques such as breast reduction, breast lift, breast lift with implants, or breast augmentation.
“Implant placement just beneath the breast tissue represents a significant advancement in minimally invasive surgery, offering less pain, faster functional recovery, the possibility of one-stage reconstruction, and a reduced risk of capsular contracture. From an aesthetic perspective, it allows for a highly natural reconstructive result.”
FOR A MORE CONSCIOUS CHOICE
Immediate prepectoral breast reconstruction can be performed in patients who do not have tumor involvement near or on the skin, are non-smokers, have not undergone prior breast surgery followed by radiotherapy with extensive scarring, are not too thin, and have sufficient skin and tissue thickness. Other cases may also be considered on an individual basis. If the patient is to undergo postoperative radiotherapy, which remains the main challenge for implant-based reconstruction, current scientific evidence suggests that complications with prepectoral reconstruction are generally more manageable compared to retropectoral implant reconstruction or two-stage reconstruction (tissue expander followed by implant). Over time, radiotherapy can sometimes cause the skin to thicken and become less flexible, which leads to discomfort that may turn into chronic pain, or cause firmness around the implant, which can create tension or slight shifting, and potentially result in capsular contracture. When these issues arise, they can often be improved with fat grafting. The stem cells naturally present in the grafted fat (ADSC) support the scarring process internally, restoring comfort.
In this unexpected journey, having a trusted professional by your side who can guide you through the options that best suit your medical history and personal goals is more important than ever. Often, there is not just one path for breast reconstruction, but several, each with its own benefits and considerations. Our mission is to support you safely, ensuring your health is protected while also focusing on achieving the best possible aesthetic result, which is often overlooked. Whenever possible and with your consent, we typically recommend immediate implant-based reconstruction as a first option, ideally placed above the muscle in a prepectoral position. However, this may not always be feasible. In some cases, prior radiotherapy or other factors may have affected your tissues, leaving them less elastic or resilient and less able to accommodate an implant. In these situations, we may recommend using your own tissue for reconstruction, taking a flap from a suitable area of your body and transferring it to the breast. While using your own tissue offers significant benefits, this method is surgically more complex and requires a longer recovery period, which is why we feel it is important that you are fully motivated and actively engaged in the process.
You may not be able to choose the “right time” in advance, but you can choose to make the best decision for yourself in the situation you are facing. Sometimes, after a breast cancer diagnosis, patients eagerly await a consultation with Dr. Elisa Bolletta, looking for a glimmer of hope and reassurance amidst everything they have just learned. When discussing immediate breast reconstruction, we often see eyes filled with fear, uncertainty, or detachment, searching for comfort and guidance, yet at the same time skeptical about the possibility of reconstruction, as if aesthetic considerations were something distant or too complex to consider at that moment. Other times, especially with younger patients, the consultation with Dr. Bolletta becomes the only source of relief and even a reason to smile in an otherwise frightening and overwhelming situation. In these moments, we help piece together your personal puzzle, showing you that it is essential to focus not only on your illness but also on the opportunities you have to regain confidence and feel even more beautiful and attractive than before. When it comes to immediate reconstruction, making an informed decision quickly is crucial. With prepectoral reconstruction in particular, your recovery is generally smooth and quick. Most patients can resume daily activities within about 15 days, and return to more vigorous activities, including sports, around 40 days after surgery.
During the first 48 to 72 hours after surgery, you may experience noticeable swelling, which will gradually ease over the following weeks. In the immediate postoperative period, it is important to monitor blood flow to the skin to ensure the implant is securely surrounded by healthy tissue and is fully protected. You may also feel the implant as a foreign body for several months, along with tightness or discomfort during movement, especially in the underarm and back areas. To support your recovery, we follow structured rehabilitation protocols in collaboration with physiatrists, physical therapists, and osteopaths. These programs help promote a faster recovery, restore balance in the body, and support your muscles and connective tissue. They also prevent both short and long-term complications, including localized pain, reduced mobility or sensation in the underarm and upper limb, seromas, lymphangitis or lymphedema, scar tightening and contractures, and posture problems.
You will be warmly welcomed to the clinic. After completing preoperative checks and having an additional consultation with Dr. Elisa Bolletta, you will be escorted to the operating room, where our team will support you throughout the process. You will always be informed about what is happening in a safe and comfortable environment. Once you are ready, the surgery will be performed according to your personalized surgical plan.
The length of the procedure depends on the complexity of the reconstruction and whether any symmetry adjustments are needed for the other breast. On average, surgery takes between two and four hours, including the preparation of the implant pocket and placement of the selected implant.
At Elisà Plastic Surgery, your comfort and peace of mind are our top priorities. One of our main goals is to provide an almost entirely pain-free experience from start to finish, which is why we place great emphasis on anesthesia. Our team of anesthesiologists uses state-of-the-art techniques, including targeted local blocks, to ensure maximum comfort, reduce post-operative pain, and minimize the risks associated with general anesthesia. The main sensation you may notice is a mild pressure in the chest, especially when lying down, due to increased volume. At the end of the procedure, a long-acting local anesthetic will be administered directly to the surgical area to provide lasting comfort during awakening. You will also be fitted with a soft, supportive bra, designed to relieve pressure and help you maintain a comfortable posture from the start. In the days following surgery, you may experience mild discomfort or tenderness in the treated area, especially with movement. This is completely normal and can be easily managed with topical therapies and pain medication.
Recovery varies from person to person. In most cases, you can resume light activities after about a week, while avoiding heavy lifting and strenuous effort. More intense or athletic activities are usually reintroduced gradually, typically after 4–6 weeks, depending on your personal progress. Dr. Elisa Bolletta will strongly recommend using a supportive bra for 4–6 weeks to properly support your breasts and promote healing. A gradual, targeted approach is key to returning to your routine safely, comfortably, and smoothly.
After the procedure, a regenerative dressing will be applied to support tissue recovery. During the first few days, it is important to avoid strenuous activity, excessive sweating, and sudden movements of the chest and arms. For about a month, avoid lifting heavy objects. Once the wounds are dry, fully healed, and well-closed, the scars can be treated with specialized products containing silicone or exosomes, following the protocol prescribed by Dr. Elisa Bolletta. Keep in mind that the results evolve over time. Initially, the breasts may appear fuller and more lifted, gradually softening and taking on a natural shape over approximately four months.
As with any surgery, there are potential risks, though they are generally limited. These can include bleeding, infection, changes in tissue sensitivity or blood flow, changes in the health or appearance of the nipple and areola, minor asymmetries, capsular contracture, or challenges with implant integration. Using advanced surgical techniques and a personalized approach helps minimize these risks.
Immediate reconstruction is fully customized to you, considering your anatomy, the type of mastectomy, and your overall well-being. The quality of the tissue under the skin is crucial, as factors like smoking, previous scars, or reduced elasticity can impact the results. Placing the implant above the muscle helps achieve a natural, comfortable, and elegant appearance while preserving muscle function.
We will follow your progress through scheduled follow-up visits: during the first few days to assess initial healing and tissue health; at around 1 week to remove any sutures or drains; and at 1, 3, and 6 months to monitor implant integration, symmetry, and the overall aesthetic result. The final visit, 1 year after surgery, allows us to assess the fully matured scar and the settled results, showing their natural, final appearance. Your care will continue beyond this stage, with ongoing support to ensure balanced, long-lasting, and dependable results. Each check-up is designed not only for your safety but also for your peace of mind, providing consistent, personalized, and thoughtful support that is part of the Elisà Plastic Surgery experience.
The team includes Dr. Elisa Bolletta, who specializes in breast reconstruction, the anesthesiologist, operating room nurses, and clinical support staff. For complex procedures or symmetry corrections, we also collaborate with other specialists to ensure a safe, multidisciplinary approach.
