A right guaranteed for every woman after mastectomy. Immediate or delayed, implant or autologous tissue — every decision is made together.
Breast reconstruction is a personal decision. All modern techniques are available — chosen with you based on your anatomy, your history and your preferences.
Since the Act of 4 March 2002, breast reconstruction is an enforceable right for every woman who has undergone a mastectomy in the context of breast cancer. It must be systematically proposed — whether envisaged immediately, months later, or years afterwards. There is no right or wrong answer to this decision.
Some women wish to be reconstructed at the same time as the mastectomy so they never see themselves without a breast. Others need time — to get through their treatments, to regain their strength, to think it through calmly. Both paths are legitimate, and reconstruction remains possible at any time. Surgery is also not an obligation: some women choose not to reconstruct, and this choice deserves the same respect as any other.
If you have questions about your options, the reconstruction consultation is here to answer them with no obligation.
Three questions structure the surgical decision, but they don't all arise in every case. The context guides the pathway:
The mastectomy has not yet taken place, or is planned. Reconstruction will be immediate (same anaesthesia as the mastectomy). All 3 questions below arise: axillary procedure, choice to reconstruct, nipple and areola preservation.
The mastectomy has already taken place (sometimes years ago). Only the technique choice arises. The axillary procedure and nipple-areola preservation no longer apply — these decisions were already made at the initial mastectomy.
If the nipple and areola were removed, they can be reconstructed secondarily (3D medical tattoo, local flap).
The decision is made together, in consultation, after the assessment.
↓ The questions below present the broadest case (Context A) and concern the situation where you have a cancer currently being treated.
→ This question only arises in Context A (active cancer, planned mastectomy). In Context B (delayed reconstruction), the axillary procedure was already performed at the initial mastectomy.
For invasive cancer (one that can spread beyond the breast), we biopsy the sentinel lymph node at the same time as the mastectomy — it is the first lymph node (under the armpit) that "catches" what comes out of the breast. Analysing it tells us whether the disease has started to spread. If we already know before surgery that several lymph nodes are involved, we instead remove a larger group: this is called an axillary lymph node dissection (ALND).
→ Everything is explained here: sentinel lymph node biopsy & axillary dissection
A deeply personal choice. Reconstruction is always possible — either right away ("immediate reconstruction") or later ("delayed reconstruction"). And choosing not to reconstruct is also an entirely legitimate choice, and one that is increasingly recognised.
Reconstruction is performed under the same anaesthesia as the mastectomy: avoiding the period when the chest is "flat" between the two operations. Five technique families are possible depending on your anatomy:
→ Full details of techniques below
→ Also available as delayed reconstruction (6 to 9 months after radiotherapy)
→ This question only arises in Context A. In Context B, the nipple-areola complex was already preserved or removed at the initial mastectomy: if it was removed, it can be reconstructed secondarily (local flap + 3D tattoo).
In Context A, If you choose flat closure reconstruction, the nipple and areola cannot be preserved (there would be no breast volume to support them).
Preserving the nipple and areola (also called the nipple-areola complex, or nipple and areola) depends on several criteria assessed case by case: the tumour-to-nipple distance (ideally more than 1 cm), no nipple involvement on imaging, the shape and volume of the breast (the natural drop of the breast under gravity, called "ptosis"), the quality of the skin, and smoking (which significantly impairs healing).
The nipple and areola are preserved (nipple-sparing technique). The scar is hidden:
The skin of the breast is preserved, but the nipple and areola have to be removed (skin-sparing technique). The scar is central oblique.
Reconstruction of the nipple and areola in a second step remains possible: 3D tattooing in relief, skin grafting, or a small local flap.
Available only when the nipple and areola are preserved — minimally invasive approaches do not allow removal of the nipple-areola complex.
Inframammary or axillary approach with video optics. Short and discreet scars. Indication: nipple preservation with immediate implant reconstruction.
da Vinci system. Optimised precision and anatomical access. Longer operating time, but optimised aesthetic outcome. Available in equipped centres.
There is no universally superior technique. The choice depends on your anatomy, skin condition, treatments received or planned, and your preferences. These options can be combined — implant + lipofilling, flap + implant, etc. Click on a technique to expand the details. Each technique also has a dedicated page accessible from the title or the link at the bottom of each card.
Implant, expander, conventional · endoscopic · robot-assisted approaches
Heterologous reconstruction uses a foreign material — a breast implant or an expander — to restore volume. It is the most common technique for immediate reconstruction.
Direct implant: placement of a definitive implant in one stage. Possible if the remaining skin is sufficient and of good quality. Short hospitalisation, faster recovery.
Expander then implant: placement of an expander progressively inflated over several weeks, then exchanged for a definitive implant in a second stage. Indicated when the skin is taut or of poor quality — especially after radiotherapy.
Approaches: the classic approach is an inframammary incision (nipple and areola preserved) or central (nipple and areola removed). Less invasive alternatives are possible: endoscopic inframammary or axillary approach — discreet scar, video-assisted dissection — and robot-assisted approach, allowing increased precision and atraumatic dissection in narrow spaces. These techniques are reserved for specific indications.
When radiotherapy is planned, an implant is often preferred: irradiating an implant is less deleterious than irradiating a flap. The implant can later be replaced or supplemented by autologous tissue.
The latissimus dorsi flap involves transferring an island of skin and muscle from the back (latissimus dorsi muscle) to the breast pocket, preserving the vascular pedicle that nourishes the flap. This autologous tissue offers excellent tolerance to radiotherapy. The latissimus dorsi muscle is thin and broad; its function is not indispensable for everyday activities.
It can be combined with a breast implant when the volume of the flap alone is insufficient — but this combination then carries the complications associated with the implant. The donor site scar, located in the back, is covered by a bra.
The DIEP flap is the most advanced autologous reconstruction technique from both an oncological and cosmetic standpoint. It involves harvesting an island of skin and abdominal fat, irrigated by the perforating vessels of the deep inferior epigastric artery, without muscle sacrifice (unlike the TRAM). A CT angiogram of the abdominal vessels is indispensable before the procedure to map the perforators and plan the harvest.
The flap is then transferred to the chest and connected to the internal mammary or thoracodorsal vessels by microsurgery. This is a long procedure (3 to 5 hours) requiring an experienced microsurgical team. The result, when successful, is natural and long-lasting, without any implant. An abdominal scar equivalent to a wide caesarean section is the trade-off. Dr Zeitoun does not perform microsurgery himself: the procedure is carried out in collaboration with an experienced plastic microsurgeon.
→ Full page: DIEP flap — technique, indications, team collaboration
→ Detailed page: diep flap (deep inferior epigastric perforator) →
When the abdominal apron is insufficient for a DIEP, or after previous abdominal surgery contraindicating abdominal harvest, the inner thigh flap offers a reference microsurgical autologous alternative. Two main variants exist: the gracilis flap (TMG — Transverse Myocutaneous Gracilis — or TUG — Transverse Upper Gracilis), described in 2004, which harvests a small accessory muscle with the cutaneous-fat paddle; and the PAP flap (Profunda Artery Perforator), described in 2012, which harvests only skin and fat, without any muscle.
This technique is ideally suited to slim women with a moderate breast volume to rebuild, and is particularly well suited to bilateral prophylactic mastectomy. The scar is well concealed in the natural skin creases, from the groin crease to the infragluteal fold. Volume is moderate — a second-stage lipomodelling may be required. Dr Zeitoun does not perform microsurgery himself: the procedure is carried out in collaboration with an experienced plastic microsurgeon (see video at the top of the page ↑).
→ Full page: inner thigh flap — gracilis TMG/TUG and PAP, indications, team collaboration
→ Detailed page: inner thigh flap (gracilis tmg/tug or pap) →
Lipofilling involves harvesting autologous fat (abdomen, thighs, hips, love handles) by fine liposuction in the operating theatre, centrifuging it to separate intact fat cells, then reinjecting them in micro-boluses along multiple independent tracks creating a true three-dimensional network. The take-up of grafted cells is estimated at 60 to 70% — an over-correction is therefore performed when possible. The result is definitive: the remaining fat cells do not resorb.
Lipofilling is used as an adjunct technique — to refine a reconstruction result, correct an asymmetry or improve skin quality after radiotherapy. It can be repeated in several sessions.
→ Full page: breast fat grafting — procedure, indications, oncological safety
Flat closure is not the absence of reconstruction: it is a fully-fledged surgical reconstruction, designed to achieve a clean, flat and aesthetically careful chest result, without reconstituted breast volume. It involves resecting the excess skin, reshaping the edges and closing in a harmonious plane, without tension. The result is a well-positioned horizontal scar and a flat, symmetrical chest.
Some women complete this with a decorative tattoo over the scar, as a process of reclaiming their body. This choice is fully legitimate and deserves the same surgical quality as any other reconstruction. It is covered by the French National Health Insurance in exactly the same way. It is discussed without judgement in the consultation for any patient who wishes to explore this option.
The technique is chosen together, considering your anatomy (cup size, ptosis, BMI, smoking, diabetes), your medical history, treatments received or planned, and your wishes. Each technique has a dedicated page accessible from the menu.
Five clear stages, with no rush. Every consultation is an opportunity to revisit what is unclear. The final project does not exist before you have validated it.
Clinical examination, discussion of techniques (implant, latissimus dorsi flap, DIEP, lipofilling, flat closure), presentation of results photographs, answers to all your questions with no time limit. No commitment at the end of this consultation: time for reflection is respected.
Anaesthesia consultation at least 48 hours before the procedure. Blood tests. Abdominal CT angiogram if DIEP reconstruction is planned — it maps the perforators and plans the flap. For free flap reconstruction, meeting with the associated microsurgeon.
Standing surgical marking before theatre. Under general anaesthesia. Duration depends on technique: 1h for an implant, 3-5h for a latissimus dorsi flap, 6-8h for a DIEP. Hospitalisation 1 to 7 days. Suction drains in place for 5 to 10 days. Discharge authorised after drain removal.
Often performed in a second stage, 6-12 months after the main reconstruction, once the reconstructed breast has stabilised. Lift, reduction or augmentation of the opposite breast to harmonise the result. May require complementary lipofilling (1 to 3 sessions spaced 3 months apart).
Final stage of the pathway, 6-12 months after reconstruction. Nipple reconstruction by local flap under local anaesthesia at the practice, then medical 3D tattoo of the areola (2-3 sessions 6 weeks apart). The final result is appreciated 12 to 18 months after the initial reconstruction.
Flap reconstructions — such as the inner thigh (gracilis) flap — are performed in partnership with a plastic microsurgeon. I handle the oncological stage; the plastic surgeon performs the microsurgery. Video of a recent operation at Clinique Hartmann.
Surgical oncology — mastectomy, sentinel lymph node, margins, preparation of the recipient site. Oncological safety and follow-up.
Microsurgery — flap harvesting, vascular anastomoses under microscope, shaping of the reconstructed breast.
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Recovery varies depending on the technique used. A simple implant reconstruction is considerably shorter than a DIEP. In all cases, you are accompanied at every stage of post-operative follow-up.
Breast reconstruction is not just a surgical procedure — it is a pathway that unfolds over time. Here are the practical points patients most often ask us about.
For the first 6 weeks, a medical bra without underwire is recommended day and night, to support the area and limit oedema. After this period, you can gradually return to your usual underwear. Underwired bras are not recommended for 3 months after implant reconstruction.
From week 3 (closed scar), daily massages with a rich cream (sweet almond oil works well) help soften the scar and limit adhesions. About 5 minutes per scar, twice daily for 3 months. Protect scars from the sun (SPF50) for 12 months to prevent pigmentation.
Walking is encouraged from day 1. Gentle gymnastics from week 3. Swimming, jogging, cycling: 6 weeks after implant, 3 months after DIEP or latissimus dorsi. Weightlifting and heavy loads: not before 3 months. Post-operative physiotherapy (10 sessions on average, covered by ALD) significantly speeds up recovery.
Sick leave varies by technique: 2 to 3 weeks for implant, 4 to 6 weeks for latissimus dorsi, 6 to 8 weeks for DIEP. Physical jobs extend these durations. Driving: after 2 to 4 weeks, as soon as the seatbelt is no longer painful.
The reconstructed breast no longer has mammary gland tissue: it does not require mammography. Monitoring focuses on the contralateral breast (annual mammogram + ultrasound), on implants if present (annual ultrasound, MRI at 5 years then every 2 years), and on oncological follow-up (every 6 months for 5 years, then annually).
Every pathway is built case by case. The consultation is where everything is put on the table — your constraints, your wishes — to design a project that fits you.
Three elements to know. No surprises. Click each line to expand the details. A detailed transparent quote is systematically provided in consultation. Reflection time between the quote and the procedure is respected — you set the pace.
Breast reconstruction after mastectomy for cancer (or prophylactic mastectomy for BRCA1, BRCA2, PALB2 mutation) is covered by the French Health Insurance under ALD 30 (Affection Longue Durée — long-term illness scheme). This includes:
→ No time limit: reconstruction remains covered even 10 or 20 years after mastectomy.
Dr Zeitoun practises in sector 2 (non-OPTAM). This means the French Health Insurance reimburses on the basis of conventional tariffs, and additional fees may apply. These additional fees concern only surgical fees — hospitalisation, anaesthesia and facility fees remain covered by the Health Insurance.
A detailed transparent quote is provided in consultation, breaking down Health Insurance tariffs, potential additional fees, and total estimate. No hidden costs. You take the time you need to reflect and seek a second opinion if you wish before committing.
Additional fees are reimbursed in whole or in part by your complementary health insurance (mutuelle) depending on your coverage level. Most contracts cover between 200% and 400% of the conventional tariff for surgery.
Practical tip: with the quote provided in consultation, contact your insurer to obtain a reimbursement simulation before the procedure. The practice secretary can assist if needed. The medical claim form is then electronically transmitted to the Health Insurance, which automatically forwards to your complementary insurer.
For patients who choose not to reconstruct immediately, external prostheses (silicone, worn in a specific bra) are reimbursed by French Health Insurance under ALD 30. Renewal every 12 to 18 months.
Sick leave duration is set by the surgeon according to technique (2 to 8 weeks). Daily allowances are paid without a waiting period under ALD 30. An extension certificate may be issued at the post-operative consultation if needed.
Medical transport (approved taxi, ambulance if justified) for consultations and hospitalisation is covered by Health Insurance on prescription. Private room is at your charge (unless covered by your complementary insurance).
The reflection time between delivery of the detailed quote and signature of informed consent is respected — you set the pace. You can ask additional questions or request a second opinion at any time before committing.
The most frequent questions in consultation. Click to expand each answer.
No. Current implants have an estimated lifespan of 15 to 20 years. Replacement is not systematic without complications. Annual clinical follow-up is recommended.
The aesthetic result depends on the technique, anatomy, prior treatments, and time. Scars exist but fade. Final result at 12-18 months.
Touch sensitivity is diminished after mastectomy. Partial recovery is possible over 12-24 months but rarely reaches the original level.
Yes if natural tissue remains. After total mastectomy with implant or flap, monitoring is by clinical examination, ultrasound and MRI.
Breast reconstruction after mastectomy is covered by the French Health Insurance under ALD 30 (long-term illness) on the basis of conventional tariffs. Dr Zeitoun practises in sector 2 (non-OPTAM): additional fees may apply, partially reimbursed by your complementary health insurance.
Walking from day one. Gentle gymnastics from week 3. Swimming, jogging, cycling from week 6 (implant) to month 3 (DIEP). Weightlifting from month 3.
The choice between immediate reconstruction (same anaesthesia as the mastectomy) and delayed reconstruction (6 months to several years later) depends on several criteria: type of cancer (the only formal contraindication to immediate is inflammatory cancer), planned treatments (radiotherapy, chemotherapy), your general health, and above all your personal journey. Some women want to never see themselves without a breast and prefer immediate. Others need to go through treatments first, and prefer to reconstruct calmly once the active phase is over. Both paths are medically equivalent in terms of final result.
For patients carrying a genetic mutation (BRCA1, BRCA2, PALB2) who chose a prophylactic mastectomy, reconstruction is almost always performed immediately, bilaterally. The advantage is twofold: no breast-less period, and reconstruction is planned calmly with all anatomical elements preserved. Preferred techniques are often pre-pectoral implants with nipple-areola preservation (nipple-sparing), or DIEP for patients refusing implants. Coverage is full under ALD 30.
No, but it complicates things. Radiotherapy alters skin tissue quality: thinner, less extensible, more fragile around implants. Complications (capsular contracture, implant exposure, aesthetic failure) are significantly more frequent on an irradiated chest. Two strategies are possible: either prefer an autologous flap from the start (DIEP, latissimus dorsi, gracilis) which brings healthy well-vascularised tissue, or combine implant + flap (e.g. latissimus dorsi + implant) for tissue coverage. The decision is made case by case according to your preferences and the quality of the irradiated skin.
Post-operative pain varies by technique. For an implant alone, pain is moderate and well controlled by standard analgesics for 5 to 7 days. For a DIEP or latissimus dorsi, pain is more pronounced due to the dual surgical site (breast + donor area). Modern enhanced recovery protocols (multimodal analgesia, local anaesthetic blocks, scheduled analgesics) allow acceptable pain in the vast majority of cases, enabling walking from day 1 and discharge at day 2-5. Chronic post-reconstruction pain is rare (less than 10% of cases) and is referred to a specialist pain consultation if it persists beyond 3 months.
Flat closure is the option of aesthetically closing the skin without breast volume reconstruction. The surgeon removes excess skin, repositions tissues to obtain a flat, harmonious, symmetrical chest with a fine horizontal scar. This choice, long considered a "non-choice", is now fully recognised as an option in its own right. Advantages: a single shorter procedure, faster recovery, no implant monitoring, possibility to wear an external prosthesis (covered by Health Insurance) if desired. This option must be actively offered by the surgeon — it is not a reconstruction failure, it is a legitimate surgical strategy.
This question, rarely raised spontaneously, deserves to be asked. The loss of sensitivity in the reconstructed breast changes the associated erotic sensations: the reconstructed breast is no longer a functional erogenous zone in the classical sense. For many patients, this requires a period of adjustment and rediscovery of the body. The partner plays an important role in this process. Strictly mechanically, reconstruction prevents no activity — including penetration, intimate sport, pregnancy and breastfeeding (on the contralateral breast). The onco-sexology consultation, covered in the care pathway, can accompany this aspect of the return to normal.
Absolutely — it is even a recommended approach for such a defining intervention. A second opinion does not question the trust you have in your surgeon: on the contrary, it is proof of decisional maturity. Dr Zeitoun regularly receives patients for second opinions to discuss their project, validate a technique proposed by a colleague, or explore other options. The second opinion consultation is covered by Health Insurance under ALD. Bring your complete file: mastectomy report, imaging reports, MDT letters, pre and post-operative photos if available.
The complete pathway — from first consultation to definitive result — lasts on average 12 to 24 months. It breaks down as follows: initial consultation and workup (4 to 8 weeks), breast volume reconstruction (main procedure), healing and stabilisation (6 months), contralateral breast symmetrisation if needed (at 6-12 months), then nipple-areola reconstruction at an additional 6-12 months (local flap + 3D medical tattoo). Some patients choose to stop at volume reconstruction — this is entirely possible. The project is built step by step, with your pace and wishes as guides.
Come with your results, your questions, your concerns. A dedicated reconstruction consultation, without time pressure.
