Following action by a patient association, in July 2011 the French National Authority for Health (HALDE), acting on a referral from the French health insurance system, convened a panel of experts to assess the DIEP free abdominal flap breast reconstruction technique.This assessment is the prerequisite for the possible creation of a specific code for this technique in the French health insurance system's nomenclature of medical acts (CCAM).Indeed, this technique is currently coded as a non-specific flap for breast reconstruction, which does not take into account the technical difficulties of this procedure. This is critical for a private clinic, which currently receives only €950 for a procedure costing between €1,200 and €1,500, and the future of this technique in France depends on this opinion.

The conclusions of this report are very clear:

  • the DIEP technique has proven benefits in terms of quality of life and aesthetic satisfaction - its benefits are stable over time(Reconstruction mammaire DIEP - Stabilité)

  • unlike the TRAM technique, it causes few abdominal sequelae
  • its main complication is total necrosis due to vascular thrombosis, estimated at 5% of cases (equivalent to the TRAM technique)

TheHAS recommends that this technique be validated for the following indications:

  • after therapeutic mastectomy (removal) for breast cancer
  • after prophylactic mastectomy (in women with BRCA 1 OR 2 genetic mutation)
  • for hypoplastic congenital breast defects.

Women eligible for this technique must not smoke heavily around the time of the procedure, and must have excess abdominal skin and fat.

The surgical team must be composed of :

  • two surgeons: one working on the donor site, the other on the recipient site. At least one of the two surgeons must be trained in microsurgery (DU de microchirurgie).
  • at least two operating aids
  • an instrumentalist

Post-operative monitoring is based on surveillance of the flap for the first 24 hours after surgery, in search of any risk of necrosis.we have set up such a team at Hôpital Privé Armand Brillard to be able to perform this procedure in private clinics.we hope that the CCAM will rapidly validate a specific code so that this technique can finally be developed in France, particularly in the private sector.

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