Breast reconstruction using a long dorsal flap

A mastectomy or mammectomy (the terms are synonymous) involves removal of the mammary gland, a spindle of skin and the areola.
Unfortunately, it remains necessary in certain forms of breast cancer.
Reconstruction with a dorsalis major flap uses skin taken from the back, the dorsalis major muscle (a thin, extended muscle of the back) and often a prosthesis or lipomodelling to recreate breast volume. This type of reconstruction is covered by French health insurance.

Principles of dorsalis major flap reconstruction

The latissimus dorsi muscle is a thin, extensive muscle of the back region, whose function is not essential for everyday movements. The mastectomy scar is reused as an approach for reconstruction; although it can sometimes be improved, it is impossible to make it disappear.
The procedure consists in inserting a spindle of skin and muscle from the back into the thoracic region.

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 required.
The placement of an internal prosthesis under the skin and muscle spindle is usually used 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 known as breast lipofilling.
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 €2,500 to €3,500, which may be covered by your supplementary health insurance.