[Indications for total mastectomy with immediate breast reconstruction in oncology: Surgical strategies tailored to breast morphology and adjuvant treatments].

Immediate breast reconstruction (IBR) following total mastectomy is now an established surgical approach that combines oncological safety with aesthetic benefits. This review discusses indications, techniques, and surgical adaptations of IBR based on breast morphology and adjuvant therapy planning. At Institut Curie, experience with over 600 reconstructions has led to refined patient selection, with an overall implant removal rate of 5.8%, dropping to 4% in "low risk" patients. Prepectoral implant placement, with or without acellular dermal matrices (ADM), has emerged as a reliable alternative to subpectoral techniques. It offers less postoperative pain, eliminates animation deformity, and significantly reduces capsular contracture. For large or ptotic breasts, skin-reducing mastectomy or two-stage reconstruction enhances outcomes.