Breast cancer: breast reconstruction without prosthesis (DIEP)

By Dr Marc-David Benjoar, plastic surgeon at the Institut Français du Sein (Clinique de l'Alma)

Breast reconstruction after mastectomy remains an important issue for women. Techniques have evolved considerably over the last ten years. Reliable techniques have been developed that have few after-effects, enabling a breast to be reconstructed naturally using its own tissues.

This is known as autologous breast reconstruction. This is an alternative to the traditional technique of breast reconstruction using silicone implants. Although this technique is simple and quick, it does not give stable results over time, especially if the patient has undergone radiotherapy during her treatment.

There are two main autologous techniques: the dorsalis major flap followed by fat injection and the DIEP abdominal flap.

The DIEP flap is preferable. It provides a more natural reconstruction because it uses the skin and fat of the abdomen without taking any muscle, unlike the large dorsal flap.

A natural technique that is now well mastered

The DIEP technique is now highly standardised, with a low complication rate. However, the operation is long and complex. It requires the simultaneous intervention of two experienced senior surgeons specialising in microsurgery. While a first surgeon removes the scar from the removed breast and prepares an artery and vein on the patient's chest, a second surgeon removes skin and fat from the stomach without muscle but including an artery and vein. These are then sutured under a microscope. The breast is reconstructed naturally and the tummy is slimmer.

The major advantage of DIEP is that it allows natural reconstruction without foreign bodies, without muscle and stable over time.

The operation takes an average of five hours, compared with one hour for a prosthesis.

While half of all breast reconstructions in the UK are autologous, this rate is less than one in five in France. This technique should therefore gradually become more widespread in France, but it is still poorly reimbursed by the social security system, and patients are often asked to pay additional fees, and an estimate is systematically provided before the operation.

Some rare private centres have nevertheless decided to promote the DIEP technique, despite this financial problem. The Clinique de l'Alma, for example, has worked closely with the French Breast Institute (IFS) to offer state-of-the-art, accessible treatment to breast cancer patients, enabling them to undergo reconstruction using the most modern techniques.

Breast cancer is a malignant tumour of the mammary gland. It affects 10% of the female population. Around 1.4 million women are diagnosed with the disease every year worldwide, and 460,000 die from it. In France, it accounts for almost one cancer in three.

Every year, more than 11,000 women die from it, i.e. around one woman every hour.