BREAST RECONSTRUCTION WITH DIEP IN PARIS
DIEP reconstruction is a reconstructive surgery technique. It makes it possible to restore breast volume using the patient's own tissues (without a prosthesis).
The flap, the living tissue used for reconstruction, is taken from the abdomen.
- The breast reconstruction with DIEP uses the own belly fat and skin to reshape the breast, without the need for a prosthesis.
- It is intended for patients after mastectomy, surgery immediate or prophylactic (BRCA1/2).
- The intervention combines abdominal lift and breast reconstruction at general anesthesia (duration: 4 to 5 h).
- The abdominal flap is grafted onto the thoracic vessels, then shaped to create a natural volume.
- Hospitalization lasts 5 to 6 days, followed by a 3 week convalescence.
- A breast symmetrization is performed after 3 months to harmonize both breasts.
WHO SHOULD UNDERGO DIEP RECONSTRUCTION?
The breast reconstruction with DIEP is a technique for plastic surgery. It is preferable when the patient has a slight excess of skin and fat (commonly referred to as «beading») below the navel. This can be used to reconstruct the entire breast.
This technique does not use a breast prosthesis.
DIEP is suitable for several types of patients:
- Secondary breast reconstruction: patient with undergone ablation complete breast (total mastectomy). The entire breast is reconstructed remotely.
- Immediate breast reconstruction: reconstruction at the same time as breast cancer surgery. The breast skin is preserved.
- Prophylactic breast reconstruction patient with a genetic mutation (BRCA1 BRCA2).
Thesurgical operation from flap reconstruction can be coverage by Social Security.
PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY
DIEP reconstruction
DIEP reconstruction is possible when the patient has a small bulge or abdominal apron. The surgeon samples to reconstruct the breast.
This is a combined surgery. The surgeon performs a tummy tuck (tummy tuck) and breast reconstruction.
The procedure, performed under general anaesthetic, takes between 4 and 5 hours.
The surgeon begins by removing the abdominal flap which will be used breast reconstruction.
It then prepares the recipient vessels for the thorax level to which the dorsalis major flap, which remains a living tissue, will be connected. In fact, it will be connected to the blood vessels of the dorsalis major muscle. Le plastic surgeon connects the vessels (artery and vein) at breast level, like a graft.
Finally, the flap is «molded» into the shape of a breast and the belly is closed (tummy tuck).
After DIEP surgery
The flap (DIEP) is monitored regularly by a team of nurses specializing in follow-up care post-operative tatters.
Regular Doppler examination ensures that the flap is in good condition.
A probe for monitoring tissue oxygen pressure (Licox probe) is also used in specialized centers (such as at the Hôpital Européen George Pompidou where the Dr Djian).
A hospital stay of around 5 to 6 days is required, with convalescence at home lasting around 3 weeks.
An appointment with plastic surgeon is scheduled two weeks after the operation.
Breast symmetrization
From 3 months after DIEP, a second DIEP procedure is recommended. breast symmetrization completes the rebuild.
This plastic surgery restores symmetry between the two breasts.
The most common symmetrization gestures are :
- Lift and/or reduce the contralateral breast; ;
- Fat grafting (lipofilling) of the reconstructed breast to increase its volume;
- Retouching a scar;
- Creation of the nipple and areola.
The areola (pigmented part) can be reconstructed either by skin grafting or tattooing (see 3D tattooing).
EXPLANATORY VIDEOS of the technique on Dr Jérémy DJIAN's Instagram.
Your Questions
Frequently Asked Questions in Consultation
WHAT IS SYMMETRIZATION OR SECOND STAGE?
Symmetrization is the second procedure, which aims to operate on the other breast in order to lift +/- reduce breast size.
This second operation is not compulsory if symmetry is achieved during the first operation.
In most cases, this second stage is still necessary (3 to 6 months after the first surgery).
The reconstructed breast (DIEP) can be enlarged by fat injections (breast lipofilling).
The contralateral breast (non-DIEP) is usually raised and the size of the areola is reduced.
HOW IS THE AREOLA RECONSTRUCTED?
Several areola reconstruction techniques are available.
The technique used is chosen in consultation with the patient.
- The nipple (the projected part) :
- Small local flap: like a small fold to reconstruct the nipple;
- Tattoo.
- The areola (the circle around the nipple):
- Skin grafting;
- Tattoo.
HOW DOES THE DIEP FLAP EVOLVE OVER TIME?
The flap is part of the patient's own tissue. These are living tissues, which evolve naturally.
Being made up of fat, it increases in volume with weight gain and decreases in volume with weight loss. This is its major advantage over a breast implant.
It's important to know that reconstruction breast with DIEP ensures better long-term quality of life for patients.
IS DIEP OR IMPLANT RECONSTRUCTION PREFERABLE?
If the conditions are right for DIEP reconstruction, there will be no need for further surgery.
On the other hand, the breast implant reconstruction is less durable in the long term. It may be necessary to replace the implant, or even to perform a new one. autologous reconstruction at a distance, if the implant is poorly tolerated.
If radiotherapy was performed prior to tumor removal as part of the cancer treatment, the preferred treatment will be flap breast reconstruction (DIEP or other).
Your surgeon will help you choose between these two breast reconstruction techniques.
WHAT IS THE FAILURE RATE FOR THIS PROCEDURE?
The DIEP failure rate is approximately 2 %or even less with some teams trained (HEGP). In fact, this technique does not involve foreign body.
It occurs when micro-vessel connections become blocked (thrombosis).
This is generally linked to poor vessel quality. Before we can talk of failure, in most cases we can save the flap by unblocking the affected vessels.
Dr Jérémy Djian is a plastic surgeon based at 5 square Thiers, near the Victor Hugo roundabout, in the 16th arrondissement of Paris.
He trained in Paris and remains attached to the hospital in the prestigious department of Pr Laurent Lantieri.
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TO DR. DJIAN
Binjourj had a mastectomy in 2018. I would like to have a reconstruction, and I am thinking of the diep method but I live in Corsica. Is this possible or is it inconvenient because there are a lot of appointments with the surgeon postoperatively?
Thank you in advance for your reply.
Dear Madam,
Yes, it's possible. A videoconsultation is possible,
Kind regards,
Dr Djian