Breast reconstruction at a glance
- Surgical stages3 on average
- Interval between stagesAt least 6 months
- Total duration18 to 24 months
- AnaesthesiaGeneral
- TimingImmediate or delayed
- CoverAssurance Maladie
- PriceCovered
After a mastectomy for breast cancer, breast reconstruction recreates a breast close in shape and size to the other breast, so that you no longer need to wear an external prosthesis. It can be carried out at the same time as the mastectomy (immediate reconstruction) or later (delayed reconstruction). It uses an implant, the patient’s own tissue (latissimus dorsi flap, DIEP flap, fat transfer/lipofilling) or both. It takes place in three stages on average — reconstruction of the breast, matching (symmetrisation) of the other breast, then areola and nipple — at least 6 months apart, i.e. 18 to 24 months in total.
Price and cover: covered by French national health insurance (Assurance Maladie) and by your mutuelle (top-up health insurance); additional fees may remain payable (Sector 2), on a written quote.
What is a mastectomy?
A total mastectomy removes the whole breast: the mammary gland, the skin and the areola with the nipple. It is necessary in certain forms of breast cancer. Sometimes the mastectomy preserves the breast skin (skin-sparing mastectomy) or the areola and nipple (nipple-sparing mastectomy), which makes reconstruction easier.
Immediate or delayed reconstruction?
- Immediate: carried out during the mastectomy, in agreement with the surgeon treating the cancer.
- Delayed: carried out later, in a patient who has already had surgery, most often after the end of treatment (chemotherapy, radiotherapy).
The choice depends on the cancer treatment, radiotherapy and the patient’s wishes; it is discussed with the team treating the cancer.
What are the reconstruction techniques?
Reconstruction provides the breast with an envelope (the skin) and a content (the volume).
| Technique | Principle | Skin | Volume |
|---|---|---|---|
| Implant + abdominal advancement flap | The abdominal skin is advanced up towards the breast; the implant provides the volume | Advanced abdominal skin | Implant |
| Implant + latissimus dorsi flap | The back muscle and its skin rebuild the breast envelope | Back skin | Implant |
| Autologous latissimus dorsi (no implant) | The latissimus dorsi muscle and the fat of the back provide the volume | Back skin or advanced abdominal skin | Back muscle and fat |
| DIEP (or SIEP) perforator flap | Abdominal skin and fat transferred by microsurgery, without taking the abdominal muscles | Abdominal skin | Abdominal fat |
| sGAP or iGAP perforator flap | Buttock skin and fat transferred by microsurgery | Buttock skin | Buttock fat |
| Fat transfer (lipofilling, lipomodelling) | Injection of the patient’s own fat, in addition to the other techniques | — | Fat, over several sessions |
Implant or your own tissue?
Autologous reconstruction (without an implant) usually gives a breast that feels more natural and changes over time in the same way as the other breast; it leaves a scar at the donor site (back, abdomen or buttock). Implant reconstruction is a shorter operation, with no donor site for the volume; the implant will need monitoring and sometimes replacing. After radiotherapy, the patient’s own tissue is often preferred.
Breast reconstruction in diagrams
Recreating the volume of the breast
Before: side cross-section of the breast.
Dotted line: the contour at the previous step. The volume is provided by an implant or by the patient’s own tissue (here, fat).
Where does the tissue come from?
The tissue taken (skin, fat, muscle) rebuilds the breast; the donor site keeps a scar. Tap a technique to show it on its own.
1st stage: reconstruction of the breast
The breast is reconstructed using one of the techniques above.
Each stage is at least 6 months apart.
What are the stages of reconstruction?
At least three operations are needed before the final result, at least 6 months apart: 18 to 24 months pass between the start and the end of the reconstruction.
1st stage: reconstruction of the breast
The breast is reconstructed using one of the techniques above, chosen according to the skin available, radiotherapy, body shape and the patient’s wishes.
2nd stage: matching the other breast
At least 6 months later, the other breast is adjusted to match the reconstructed breast using the usual cosmetic surgery techniques:
- small other breast: augmentation with implants;
- sagging other breast: breast lift (mastopexy);
- large other breast: breast reduction.
At this stage, fat transfer (lipofilling) often completes the volume or shape of the reconstructed breast.
3rd stage: areola and nipple
This is usually the last step. It recreates the projection of the nipple, the texture of the areola and their colour:
- nipple: if the other nipple is large, half of it is taken and grafted onto the reconstructed breast; otherwise, the nipple is reconstructed with a local flap (local plasty);
- areola: a skin graft taken from the groin crease recreates its texture and may take on pigment;
- colour: the shade of the two areolas is matched by dermopigmentation (medical tattooing carried out by a dermographer).
Where will you be?
3 months after the procedure
Dr Médard de Chardon’s experience
- Qualified plastic surgeon in plastic, reconstructive and aesthetic surgery, former Chef de Clinique (university hospital senior registrar), Nice Faculty of Medicine; in practice in Cannes since 2011.
- Breast surgery: more than 1,500 breast lifts (mastopexies) and breast reductions, more than 3,000 breast implants placed; MD thesis on breast augmentation.
- Member of SOFCEP (French Society of Aesthetic Plastic Surgery), SOFCPRE (French Society of Plastic, Reconstructive and Aesthetic Surgery) and ISAPS (International Society of Aesthetic Plastic Surgery).
Reconstruction after breast-conserving treatment
After a lumpectomy followed by radiotherapy, the breast may be left with a deformity, a hollow or asymmetry. These after-effects are most often corrected by fat transfer (lipofilling), sometimes combined with matching of the other breast.
How does reconstruction with Dr Médard de Chardon work?
- ConsultationAt the practice, 101 rue d’Antibes, Cannes: your treatment pathway, your wishes, examination of the chest, the other breast and possible donor sites; choice of technique.
- CoordinationWith the team treating the cancer, particularly for immediate reconstruction.
- ProcedureAt the Clinique Oxford in Cannes, under general anaesthesia.
- Following stagesMatching, then areola and nipple, at least 6 months after each stage.
- Follow-upBy Dr Médard de Chardon’s team throughout the pathway.
What are the risks?
Complications depend on the technique:
- haematoma, infection, delayed healing, more frequent after radiotherapy and in smokers;
- with an implant: capsular contracture (hardening), displacement, exposure or removal of the implant;
- with a flap: partial or total flap compromise (failure) (rarer after a latissimus dorsi flap), seroma in the back after a latissimus dorsi flap;
- scars at the donor site;
- residual asymmetry, corrected during the following stages.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and can even eliminate some of them.
Is reconstruction covered?
Covered
Breast reconstruction after cancer is covered by Assurance Maladie, including matching of the other breast and reconstruction of the areola and nipple. As Dr Médard de Chardon practises in Sector 2 (fees above the national health insurance rate), additional fees may remain payable by you or by your mutuelle, depending on your policy; a detailed written quote is given to you before each operation.
Book an appointment: +33 (0)4 93 68 86 68 or Doctolib.
Frequently asked questions about breast reconstruction
Should breast reconstruction be done at the same time as the mastectomy?
It is not compulsory. Reconstruction can be immediate, during the mastectomy, or delayed, later on; the choice depends on the cancer treatment, radiotherapy and your wishes.
How many operations should I expect for breast reconstruction?
At least three on average: reconstruction of the breast, matching of the other breast, then areola and nipple. They are at least 6 months apart, i.e. 18 to 24 months in total.
Breast reconstruction with an implant or with my own tissue: which should I choose?
Your own tissue usually gives a breast that feels more natural and ages like the other breast, at the cost of a donor-site scar. An implant avoids this donor site but needs monitoring. The choice is made at the consultation, according to your situation.
Can the breast be reconstructed after radiotherapy?
Yes. After radiotherapy, reconstruction with your own tissue (latissimus dorsi, DIEP) or fat transfer (lipofilling) is often preferred.
Can the nipple be reconstructed after a mastectomy?
Yes, this is generally the last step: a graft of part of the other nipple or a local flap, a skin graft for the areola, then dermopigmentation for the colour.
Does breast reconstruction interfere with cancer monitoring?
No: monitoring continues according to your oncology team’s protocol; tell the radiologist about your reconstruction.
Is it too late for reconstruction several years after the mastectomy?
No, delayed reconstruction is possible several years after the mastectomy.
Is breast reconstruction reimbursed?
Breast reconstruction after cancer is covered by Assurance Maladie, including matching of the other breast and reconstruction of the areola and nipple. As Dr Médard de Chardon practises in Sector 2 (fees above the national health insurance rate), additional fees may remain payable by you or by your mutuelle, depending on your policy; a detailed written quote is given to you before each operation.