A right guaranteed for every woman after mastectomy. Immediate or delayed, implant or autologous tissue — every decision is made together.
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.
The timing question is often the first to arise. There is no universal rule — but there are objective factors that guide the decision, and your personal feelings have their full place in this balance.
There is no universally superior technique. The choice depends on your body shape, the condition of remaining skin, treatments received and your preferences. We build this choice together in the consultation, showing you examples of results.
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.
Reconstruction with an implant alone involves placing a silicone gel breast implant under the pectoral muscle or under the skin (prepectoral), using the natural envelopes — or even a biological mesh (acellular dermal matrix) to optimise support. It carries a non-negligible rate of specific complications: capsular contracture, peri-prosthetic infection, implant displacement, skin necrosis or secondary asymmetry, the risk of which must be clearly discussed in the pre-operative consultation.
After radiotherapy, an implant alone is poorly tolerated: the irradiated skin is fragile, poorly vascularised and predisposed to complications. An autologous flap is then preferred to protect the implant with well-vascularised tissue.
When the quality or quantity of remaining skin is insufficient to accommodate a definitive implant directly, a tissue expander is first placed. This temporary implant is progressively inflated in the consultation by injection of saline solution — generally once a week for 4 to 12 weeks — to recreate sufficient skin envelope. It is recommended to wait at least 3 to 6 months after the end of inflation to allow stabilised retraction before replacing the expander with the definitive implant.
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 (4 to 8 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.
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
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 after breast cancer is fully covered by the French National Health Insurance, with no time conditions. Here is what this concretely covers.
Additional fees apply in sector 2. A complete and detailed quote is systematically provided at the consultation — surgical fees, anaesthesia and facility fees included. No hidden costs. The mandatory legal 15-day reflection period before signing is observed.
Come with your results, your questions, your concerns. A dedicated reconstruction consultation, without time pressure.