Dr. de Clermont-TonnerrePlastic Surgeon

Prevention & Reconstruction — Medical Information

Breast Cancer

Screening, mammography and risk factors

Breast cancer is the most common cancer in women in France (approximately 60,000 new cases per year). When detected early, it is cured in the vast majority of cases. Understanding screening, risk factors and reconstruction options is essential for every woman.

Note: This article is for informational purposes only. It does not replace a medical consultation. If you notice any suspicious symptom, consult your doctor or gynaecologist promptly.

Risk factors

Non-modifiable factors

  • Female sex (99% of cases)
  • Age (rising risk after 50)
  • Personal history of breast cancer
  • BRCA1 or BRCA2 mutation
  • First-degree family history
  • High-dose chest irradiation before age 30

Modifiable factors

  • Overweight and obesity after menopause
  • Alcohol consumption
  • Physical inactivity
  • Prolonged menopausal hormone therapy
  • Late first pregnancy or nulliparity
  • Not breastfeeding

Screening modalities

Mammography — organised screening

Every 2 years, ages 50–74

Mammography remains the reference examination for breast cancer screening. In France, the national programme invites all women aged 50 to 74. Coverage is 100% with no upfront cost. Two views per breast are taken. If an anomaly is found, a second reading by a different radiologist is systematic. Women living outside France should check their own country's national screening guidelines.

Breast self-examination

Monthly, all ages

Self-examination of the breasts allows a woman to detect a lump, a lymph node, nipple discharge or a change in skin appearance. While not a substitute for mammography, it enables a rapid medical consultation when an abnormality is found. It is recommended to perform self-examination after your period, once a month.

Breast MRI

On prescription, high-risk women

MRI is more sensitive than mammography for detecting cancers in dense breast tissue or in high-risk women (BRCA mutation, strong family history). It is prescribed as part of a personalised surveillance programme, on medical advice.

Breast ultrasound

Diagnostic complement

Ultrasound is used alongside mammography to characterise an abnormality, evaluate dense breast tissue or when mammography is contraindicated. It is not recommended as a stand-alone routine screening examination.

Warning signs: seek medical advice without delay

These signs do not necessarily indicate cancer, but they require prompt medical consultation (within days):

A palpable lump or nodule in the breast

A change in shape or volume of one breast

Nipple retraction or deviation

Nipple discharge (especially unilateral or blood-stained)

Redness, swelling or "orange-peel" skin appearance

Persistent, unusual pain in one breast

Persistent axillary (underarm) lymph node

Ulceration or a wound that does not heal

The plastic surgeon's role in breast cancer care

The plastic surgeon does not treat the cancer itself — which is the remit of the breast surgeon (senologist) and the oncologist — but plays an essential role in breast reconstruction after mastectomy.

Reconstruction may be immediate (at the same time as the mastectomy) or delayed (several months after the end of oncological treatment). It aims to restore the volume, shape and symmetry of the breast.

Dr. de Clermont-Tonnerre performs breast reconstruction after mastectomy, working in close coordination with the oncology team.

Reconstruction techniques

  • Implant-based reconstruction

    Breast implant with or without a tissue expander. The least invasive technique.

  • Latissimus dorsi flap

    Using muscle and skin from the back to reconstruct volume.

  • DIEP flap

    Using skin and fat from the abdomen. Very natural-looking result.

  • Symmetrisation

    Surgery on the opposite breast to harmonise symmetry.

Frequently asked questions

From what age should I have a mammogram?+
In France, the national organised screening programme invites all women aged 50 to 74 to have a mammogram every 2 years, fully covered (100%) by the French national health insurance (Assurance Maladie / Sécurité Sociale) with no upfront payment. For women at elevated risk (family history, BRCA mutation, personal history of breast cancer), personalised screening often begins from age 30 to 40, on medical prescription. Women living outside France should consult their national screening guidelines, as recommendations vary by country.
Do breast implants interfere with breast cancer screening?+
Implants can reduce the visibility of part of the breast tissue on standard mammography views. However, additional displacement views (known as Eklund views) allow examination of almost all breast tissue. Breast MRI is also more sensitive than mammography in the presence of implants. Screening remains possible and effective with implants.
What is a BRCA mutation and what should I do if I carry one?+
BRCA1 and BRCA2 (BReast CAncer genes) are tumour-suppressor genes. A pathogenic mutation in either gene significantly increases the lifetime risk of breast cancer (up to 70% for BRCA1) and ovarian cancer. If a mutation is identified, enhanced surveillance and options including prophylactic surgery (preventive mastectomy) can be discussed with a multidisciplinary specialist team.
What is the role of the plastic surgeon in breast cancer care?+
The plastic surgeon does not treat the cancer itself — that is the remit of the breast surgeon (senologist) and the oncologist — but plays a key role in breast reconstruction after mastectomy (surgical removal of the breast). Reconstruction may be immediate (at the same time as the mastectomy) or delayed (months after completing oncological treatment). It aims to restore the volume, shape and symmetry of the breast. Dr. de Clermont-Tonnerre performs breast reconstruction after mastectomy, working in coordination with the oncology team.
Is breast reconstruction covered by insurance?+
In France, breast reconstruction after mastectomy for breast cancer is fully covered by the national health insurance (Assurance Maladie / Sécurité Sociale), regardless of the technique used (implant, flap, lipofilling). Symmetrisation of the opposite breast is also covered. International patients should check with their own insurer.
Is immediate reconstruction possible after mastectomy?+
Yes, in many cases. Immediate reconstruction (during the same operative procedure as the mastectomy) is possible when post-operative radiotherapy is not definitively planned. It spares the patient from waking without a breast. The decision is made by a multidisciplinary team.
What is a prophylactic mastectomy?+
A prophylactic mastectomy is the preventive removal of breast tissue in a woman at very high risk of breast cancer (confirmed BRCA mutation, very strong family history). It reduces the risk of breast cancer by 90 to 95%. It is always accompanied by immediate reconstruction and decided in consultation with a specialist multidisciplinary team.