Breast reconstruction using a long dorsal flap

La mastectomie ou mammectomie (les termes sont synonymes) correspond à l’ablation de la glande mammaire, d’un fuseau de peau et de l’aréole.
Elle reste malheureusement nécessaire dans certaines formes de cancer du sein.
La reconstruction par lambeau MSLD ou Muscle Sparring Latissimus Dorsi utilise de la peau et la graisse prélevée au niveau du dos,  dont l’irrigation sanguine passe par des vaisseaux traversant le muscle grand dorsal. Selon l’anatomie, on va devoir prendre une fine bandelette antérieure de muscle (technique MSLD) ou dans de rares cas pas de muscle du tout (technique TDAP. Selon l’épaisseur de la graisse du dos on va associer une prothèse ou une injection de graisse <afin de recréer le volume mammaire. Cette reconstruction est prise en charge par l’Assurance-maladie.

The principles of MSLD reconstruction

The Latissimus dorsi muscle is a thin, extensive muscle in the back region, whose function is not essential for everyday movements.

However, its total removal leads to chronic pain in over 20% of cases. That's why we pioneered muscle-sparing techniques in France, which make it possible to use the skin and fat of the back, leaving a fully functional latissimus dorsi muscle.

The mastectomy scar is used as an approach for reconstruction; although it can sometimes be improved, it is impossible to make it disappear.
The procedure consists of inserting a spindle of skin and muscle from the back into the thoracic region.

Smoking cessation is strongly recommended at least one month before and one month after the operation (smoking can delay healing).

This procedure takes place in the operating room under general anaesthetic.
The anesthetist will be consulted at least 48 hours before the procedure.
The procedure can last from 2 to 3 hours.

A hospital stay of 3 to 5 days is required.
The placement of an internal prosthesis under the skin spindle can be used at the same time, or at a later stage, to restore sufficient volume.
In some cases, the use of a prosthesis can be replaced by one or more injections of fat taken from the abdomen. This is called breast lipofilling (also known as natural breast augmentation) , but it should be performed at least 2 months after the flap has been made.
Symmetrization of the other breast and reconstruction of the nipple-areolar plate (areola + nipple) are usually performed at a later stage, once the volume of the reconstructed breast has stabilized.
In the area where the skin was removed, the residual scar is usually horizontal and concealed by the bra strap.

Pain varies in intensity. It is systematically managed in a preventive manner and adapted to your case. The vitality of the flap (its color, its warmth, its capillary pulse) is monitored regularly.
Upon discharge, physical therapy sessions are systematically prescribed in order to quickly recover the function of your shoulder. A 15-day work stoppage is usually necessary.

Reconstruction using the long dorsal flap is reimbursed by the French health insurance system. We charge additional fees ranging from €3,500 to €4,500, which may be covered by your supplementary health insurance.