Breast reconstruction using a dorsalis major flap

Mastectomy or mammectomy (the terms are synonymous) is the removal of the mammary gland, a spindle of skin and the areola.
Unfortunately, it is still necessary in some forms of breast cancer.
Reconstruction with a dorsalis major flap uses skin taken from the back, the dorsalis major muscle (a thin and extensive muscle of the back) and often a prosthesis or a lipomodelling to recreate the breast volume.
This reconstruction is covered by Medicare.
The principles of reconstruction by dorsalis major muscle flap
The latissimus dorsi muscle is a thin and extensive muscle of the back region, the function of which is not essential for the gestures of everyday life. The mastectomy scar is reused as an approach in case of reconstruction; if it can sometimes be improved, it is impossible to make it disappear.
The procedure consists of placing a spindle of skin and muscle from the back in the thoracic area.

It is strongly recommended to stop smoking at least one month before and one month after the operation (smoking can cause a delay in healing).
No medication containing Aspirin should be taken in the 10 days preceding the operation.
This procedure takes place in the operating room under general anesthesia.
The anesthesiologist will be seen in consultation at the latest 48 hours before the operation.
The procedure can last from 2 to 3 hours. At the end of the procedure, a bra-shaped dressing is applied.

A hospital stay of 3 to 5 days is necessary.
The placement of an internal prosthesis under the skin and muscle spindle is usually used to obtain the restoration of a 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 lipofilling.
The symmetrization of the other breast and the reconstruction of the areola-nipple plate (areola + nipple) are most often performed later, when the volume of the reconstructed breast has stabilized.
In the area where the skin was removed, the residual scar is usually horizontal and can be hidden 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.

This is a procedure that is reimbursed by the health insurance. We charge additional fees ranging from 2500 to 3500 € which may be covered by your health insurance.