Breast reconstruction after mastectomy in Thessaloniki and Athens, Greece

Breast reconstruction is surgery that recreates the breast after a mastectomy, using either a silicone implant (often after a tissue expander) or your own body tissue. The aim is a breast that sits in balance with the other one. It can be done at the time of the mastectomy or months or years afterwards.

Immediate reconstruction takes place in the same operation as the mastectomy, so you wake up with a breast. Delayed reconstruction is done months or years later, usually once treatment is complete. I offer both, and the timing is agreed with your breast surgeon and oncologist.

The decision belongs to you, once we have gone through together every technique that suits your case.

You are likely to be a candidate if you have had, or are about to have, a mastectomy, or if you are choosing a prophylactic mastectomy because of high risk. The right method depends on your skin, any radiotherapy, the size of the other breast, the tissue available and your own preference.

At the consultation I review your history, the radiotherapy you have had or will have, the skin of your chest and the areas that could supply tissue. Before surgery you need routine tests for general anaesthesia and any imaging your oncology team requests, and you must stop smoking for 4 weeks before and after.

What happens at the consultation?

I review your medical history, any radiotherapy you have had or will need, the skin of your chest and the possible donor areas (abdomen and back). I explain the methods that suit you, with their advantages and drawbacks, and whether the other breast needs surgery for symmetry. You receive a written plan and quote.

What tests and instructions apply before surgery?

You need pre-operative tests for general anaesthesia and the imaging your oncology team asks for. For an abdominal flap, imaging of the blood vessels may be needed, usually a CT angiogram,. Stop smoking 4 weeks before and 4 weeks after surgery. If you take blood thinners (anticoagulants or antiplatelet medicines), they are stopped only with the agreement of the doctor who prescribes them.

Breast reconstruction is performed under general anaesthesia, at the time of the mastectomy or later. There are two main routes: silicone implants, often after a tissue expander, and your own tissue, using a flap from the abdomen or back or fat transfer. The two are often combined, over more than one stage.

The operation takes place at Interbalkan Medical Center in Thessaloniki. Reconstruction with an implant or expander usually takes 1 to 2 hours, a latissimus dorsi flap 3 to 4 hours and a microsurgical abdominal flap 5 to 8 hours. The choice depends on your skin, radiotherapy, the tissue available, the other breast and your preference.

Implants and tissue expanders

When the skin quality allows, the breast is reconstructed with silicone implants, with or without tissue expanders. An expander is a silicone device that is gradually filled with saline over 8 to 12 weeks, to create space for the final implant at a second operation. The implant usually sits under the pectoralis major muscle for better cover, and its volume is chosen to match the size and shape of the healthy breast.

Radiotherapy affects the skin, so an implant or expander carries a higher risk afterwards. In that case I reinforce the skin with a biocompatible mesh, which becomes incorporated into the tissues in about 3 months, to lower the risk of capsular contracture, wound breakdown or implant displacement.

Abdominal tissue: DIEP and TRAM flaps

Using microsurgery, we move skin and fat from the lower abdomen, together with their blood vessels, to rebuild the volume and skin of the breast. No implant is used, and the new breast follows changes in your weight. The lower abdomen is reshaped as in an abdominoplasty (tummy tuck).

In the DIEP flap only skin and fat are moved, without the abdominal muscle, and the vessels are joined microsurgically to vessels in the chest. No mesh is needed in the abdomen. The drawbacks are a longer operation and recovery, and a risk of problems with the flap’s blood supply.

In the TRAM flap the tissue is moved together with the rectus abdominis muscle, without cutting off its blood supply, so blood-supply complications are fewer. A biocompatible mesh is placed to support the abdominal wall.

Back muscle and skin: latissimus dorsi flap

We move the latissimus dorsi muscle, with its blood supply and an island of skin from the back, to the chest wall. It is useful when radiotherapy has damaged the skin and new skin is needed, not only volume. It has a low complication rate and a shorter operating time. For a larger breast, an implant is added under the muscle.

Fat transfer

Fat is taken with a modified liposuction from the abdomen, flanks or buttocks, processed and injected into the breast. Several sessions are needed, on average 3 to 4. There are no large incisions or foreign materials, but how much fat survives is not predictable. It suits relatively small breasts and often requires adjustment of the healthy breast. Fat is also used alongside other methods to refine the contour.

Nipple reconstruction

The nipple has to be removed in many mastectomies, especially when the tumour is close to it. My most common technique is to take part of the nipple and areola from the healthy breast as a free graft. When this is not possible, the areola is made with a skin graft from the labia majora, and the nipple’s projection with a cartilage or dermal graft or with small local flaps. Nipple reconstruction is usually done as a second stage, 3 to 6 months later.

Prophylactic mastectomy with immediate reconstruction

Prophylactic mastectomy removes the breast gland before cancer develops, in women at high risk, usually with immediate reconstruction. Mutations in BRCA1, BRCA2 and, more rarely, PALB2 raise the risk considerably. With a positive test, we decide together with a geneticist and an oncologist. With a strong family history but a negative test, it can be discussed.

Planning always follows oncological criteria and takes the aesthetic result into account. The incision is made under the breast or near the nipple. The breast gland is removed and sent for histology. Whether the nipple is kept is decided with you, based on your anatomy. The implant is placed under the pectoralis major muscle and, when needed, a biocompatible mesh or biological material is added to support the lower pole. The hospital stay is 1 to 2 nights.

Incisions and scars

On the breast, the incision is usually the mastectomy scar. An abdominal flap leaves a low horizontal scar on the abdomen, and the latissimus dorsi a scar on the back. Stitches: internal and absorbable with every method, so none need removing.

Combining procedures

To match the two breasts, I often suggest surgery on the healthy breast as well, in the same or a later operation: augmentation, a breast lift or a reduction. Fat transfer can be combined with any method to refine the contour.

Hospital stay

With implants or an expander, you stay 1 to 2 nights and the drains usually come out the next day. With an abdominal or back flap the stay is longer, usually 3 to 5 nights with an abdominal flap and 2 to 4 with the latissimus dorsi, because the operation is bigger and the flap is monitored closely.

Recovery depends on the method. With implants you go home after 1 to 2 nights, while an abdominal or back flap means a longer hospital stay and a longer recovery. The final shape develops over 2 to 3 months as the swelling settles, and nipple reconstruction follows 3 to 6 months later.

When	How you feel	What you can do
Days 1–2	Pain controlled with painkillers; drains	In hospital; with implants, home after 1 to 2 nights
First weeks	Swelling and discomfort, more at the donor site with a flap	Walking; no lifting and no sudden arm movements; back to work depending on the method
Weeks 6–10	Discomfort settles	Gradual return to exercise, depending on the method
Weeks 8–12 (expander)	With an expander: gradual filling at the practice	Second operation for the final implant once expansion is complete
Months 2–3	Swelling settles and the breast takes its final shape	Normal activity
Months 3–6	The shape has settled	Nipple reconstruction and, if needed, adjustment of the other breast

How long you stay depends on the method. After reconstruction with implants or an expander, you spend 1 to 2 nights in hospital at Interbalkan Medical Center in Thessaloniki. After an abdominal (DIEP or TRAM) or latissimus dorsi flap you stay in hospital longer, usually 3 to 5 nights with an abdominal flap and 2 to 4 with the latissimus dorsi, because the flap is monitored closely.

With implants, the drains usually come out the next day. After discharge, plan to stay in Greece for 5 to 10 days with implants, and after a flap, usually until about day 10. The stitches are internal and absorbable, so none need removing. Your follow-up after you return home is by video call at 10 days, 1 month, 6 months and 1 year.

Reconstruction often takes more than one trip. With a tissue expander, the expander is filled gradually at the practice over 8 to 12 weeks before a second operation for the final implant. Nipple reconstruction and any adjustment of the other breast usually follow 3 to 6 months later.

At home, arrange help for the first weeks, as you should avoid lifting and sudden arm movements. Your cancer follow-up continues with your own oncology team as usual.

When the nipple is preserved, the result is visible straight away, and the final shape develops over 2 to 3 months as the swelling settles. With expanders, the final result comes after the second operation. Nipple reconstruction, usually 3 to 6 months later, completes the reconstruction.

SliderSide by side

Before

After

Before

After

Before

After

Before

After

These photos include nudity.

View

Breast reconstruction

Woman, 45 · 6 months after

Results vary from patient to patient.

A breast made from your own tissue changes with your weight, as a natural breast does, and contains no foreign material. Implants are not lifelong and may need replacing over the years. The new breast does not have the sensation of a natural breast. In prophylactic mastectomy, because planning is based on the final result, the conditions for a good aesthetic result are at their best. Cancer follow-up continues as your oncology team advises.

Breast reconstruction is a bigger operation than cosmetic breast surgery, and the risks depend on the method, any radiotherapy and your general health. Most complications are uncommon and treatable, although some need further surgery. I go through the risks for your own case in detail at the consultation.

Complication	How common	Prevention and treatment
Haematoma or fluid collection	Uncommon, in the first days	Drains and review of medicines that affect clotting; if it occurs, it is drained
Infection	Rare	Antibiotics; rarely the implant has to be removed
Delayed healing or wound breakdown	More common after radiotherapy and in smokers	Stopping smoking; reinforcing the skin with collagen or your own tissue
Capsular contracture or implant displacement	More common after radiotherapy	Placement under the muscle, biological matrix; correction with further surgery
Problems with the flap’s blood supply	Rarely leads to partial or total loss of the flap	Close monitoring in the first days; immediate return to theatre if needed
Discomfort at the donor site	Varies with the method	On the abdomen, mesh with TRAM; on the back, physiotherapy
Fat necrosis or fat resorption	Some loss of transferred fat is expected	Injection in thin layers; repeat session
Asymmetry	A small correction is often needed	Fat transfer or adjustment of the other breast

Smoking. Stop at least 4 weeks before and 4 weeks after surgery. Smoking greatly increases healing complications, especially with flaps, and reduces the success of fat transfer.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

We do not publish prices. The cost of breast reconstruction differs from one woman to another, depending on the method, the number of stages, nipple reconstruction and any surgery on the other breast. You receive a quote after the consultation, once you have been examined.

• The method: implant, expander then implant, abdominal or back flap, fat transfer.
• The number of stages and operations.
• The length of the hospital stay.
• Materials, such as the implant, expander or biological matrix.
• Nipple reconstruction.
• Surgery on the other breast for symmetry.

If you hope to claim part of the cost from your own health insurer, check your policy before booking; the practice provides a medical letter for your insurer.

+ ADD TO MY PLAN