Authors
O Mathieu, J-F Honart, N Leymarie
Published in
Annales de chirurgie plastique et esthetique. Volume 71. Issue 6. Pages 629-643.
Abstract
Immediate implant-based breast reconstruction (IBBR) has become a key component of surgical breast cancer management. Available evidence supports its oncologic safety, with no detrimental effect on overall survival, disease-free survival, or local recurrence, while improving quality of life and reducing the psychological burden of mastectomy. Its main advantage lies in preservation of the native skin envelope, allowing maintenance of skin quality, pigmentation, and, to some extent, sensitivity, even within an evolving reconstructive pathway that may later include autologous conversion. Patient selection relies on the combined assessment of oncologic criteria, breast morphology, and anticipated adjuvant treatments. Ideal candidates are patients with small- to medium-volume breasts, minimal or no ptosis, and well-vascularized mastectomy flaps. Nipple-sparing mastectomy is the preferred option when oncologic safety criteria are met, whereas large and/or ptotic breasts require tailored strategies, including skin-reducing mastectomy or staged sequential approaches. In our practice, direct-to-implant prepectoral reconstruction is used almost systematically, combined with matrix support, most often with resorbable synthetic meshes. Tissue expanders are rarely used, includingin patients expected to receive postmastectomy radiotherapy, as our preferred strategy is to irradiate the definitive implant when needed. In the event of unfavorable evolution, implant revision or secondary conversion to autologous reconstruction may be proposed. Recent technical innovations, including minimally invasive endoscopic and robot-assisted approaches, may further improve aesthetic outcomes while reducing surgical morbidity.
PMID:
43014846
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.
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