Dr. de Clermont-TonnerrePlastic Surgeon

Paris 16th & Pontoise (95)

Breast Reconstruction

After mastectomy — 100% covered by Social Security

Breast reconstruction is a right guaranteed by law since 1994. It can be performed immediately at the time of mastectomy, or delayed after completion of all treatments. Several techniques are available depending on the patient's body shape, treatments received, and personal wishes. Coverage is fully assured by Social Security, with no out-of-pocket cost.

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Timing

Immediate or Delayed Reconstruction?

1

Immediate Reconstruction

Performed during the same operation as the mastectomy. The patient wakes up with a reconstructed breast or an expander already in place. This timing offers an important psychological benefit and reduces the number of general anaesthetics required.

Indications

  • No post-operative radiotherapy planned
  • Expander placement if radiotherapy is possible (replaced later)
  • Sufficient skin tissue available
  • Patient's wish and oncology team agreement

Psychological benefit ✓

One anaesthetic — no period without a breast

2

Delayed Reconstruction

Performed after mastectomy, generally 6 to 12 months after the completion of all treatments (chemotherapy, radiotherapy). Tissues are healed, the field is clear, and the patient can plan her reconstruction project more calmly.

Indications

  • Post-mastectomy radiotherapy planned or completed
  • Wish to take time to decide
  • Allows for better planning of the result
  • No maximum legal time limit for reconstruction

Full flexibility ✓

Even years after mastectomy

Surgical techniques

Reconstruction Techniques

Breast Implant

The simplest technique. A tissue expander is first placed beneath the pectoral muscle and progressively inflated during outpatient sessions to create the necessary space. It is then replaced by the definitive implant in a second procedure.

  • Least complex surgical technique
  • Scars limited to the chest
  • Two surgical stages generally required
  • Indicated when chest skin and muscle are in good condition
  • Contraindicated after extensive radiotherapy

Latissimus Dorsi Flap (LD)

A musculocutaneous flap harvested from the back (latissimus dorsi muscle + skin) is rotated onto the chest to reconstruct the breast. It can be used alone or combined with an implant to increase volume. A robust technique particularly indicated after radiotherapy.

  • Healthy, well-vascularised tissue brought to the irradiated chest
  • Natural feel
  • Scar on the back (often concealable)
  • Can be combined with an implant for volume
  • Preferred choice after chest radiotherapy

DIEP Flap (Microsurgery)

A microsurgical technique involving the harvest of abdominal skin and fat (without the muscle) and their transfer to the chest via microscopic vascular anastomosis. A very natural result without an implant. The most complex technique, requiring a specialised team.

  • Most natural feel (autologous tissue)
  • No implant — no foreign body
  • Low abdominal scar (bikini line)
  • Long procedure (4 to 8 hours) — 4–5 day hospital stay
  • Provides an abdominoplasty-like effect on the donor site

Contralateral Breast Symmetry

To achieve harmonious symmetry between both breasts, surgery on the healthy breast may be proposed: breast reduction, lift (mastopexy), or augmentation. This procedure is fully reimbursed by Social Security as part of the reconstruction pathway.

  • Reduction of the healthy breast if too large
  • Lift (mastopexy) if the contralateral breast has ptosis
  • Augmentation if the healthy breast is insufficient
  • 100% covered by Social Security
  • Can be performed at the same time as reconstruction

100% reimbursed ✓

As part of the breast reconstruction pathway

Reimbursement

100% Covered by Social Security

Breast reconstruction after breast cancer has benefited from a full exemption from the co-payment since the law of 21 December 1994. This is an absolute right, with no income condition and no maximum time limit.

What is covered at 100%

  • ✓Breast reconstruction after mastectomy (all techniques)
  • ✓Nipple reconstruction (local flap)
  • ✓Areola reconstruction (medical tattooing or graft)
  • ✓Symmetry surgery on the contralateral breast (reduction, lift, augmentation)
  • ✓All touch-ups and secondary procedures related to reconstruction

Important

The 100% coverage refers to Social Security reimbursement (no co-payment). Any additional fees charged by the surgeon remain your responsibility, partially covered depending on your complementary health insurance. Please check with your insurer.

Complementary steps

Nipple and Areola Reconstruction

Breast reconstruction can be completed by nipple and areola reconstruction, performed in a second or third surgical stage. This optional step is psychologically important for many patients as it finalises the natural appearance of the reconstructed breast.

Nipple Reconstruction

Performed using a local flap (a small fold of skin taken from the reconstructed breast), shaped to create a projection resembling the nipple. A brief procedure, often performed under local anaesthesia.

100% covered by Social Security

Areola Reconstruction

Performed by medical tattooing (dermopigmentation) to restore the natural colour and appearance of the areola, or by skin graft. Medical tattooing can be carried out by a specialist professional.

100% covered by Social Security

Frequently asked questions

FAQ — Breast Reconstruction

Is breast reconstruction mandatory after a mastectomy?+
No. Breast reconstruction is a personal choice and no woman is obligated to undergo it. Some patients choose not to reconstruct, to use an external prosthesis, or to live with the mastectomy. This decision is fully respected. Reconstruction is a right, not an obligation.
Is breast reconstruction covered at 100%?+
Yes. Breast reconstruction after breast cancer has been exempt from the co-payment since the law of 21 December 1994. The entire pathway — breast reconstruction, nipple reconstruction, areola reconstruction, and contralateral breast symmetry — is covered at 100% by the French Health Insurance (Social Security), with no out-of-pocket cost for Social Security fees (surgeon's supplementary fees may apply depending on your complementary insurance).
What is the best breast reconstruction technique?+
There is no universally superior technique. The choice depends on many factors: the patient's body shape, the quality of the chest skin, history of radiotherapy, the patient's preference (implant or autologous tissue), and general health. Dr. de Clermont-Tonnerre offers a personalised assessment during the consultation to determine the most suitable technique for your situation.
Can a breast be reconstructed after radiotherapy?+
Yes, but radiotherapy alters chest tissue and influences the choice of technique. After irradiation, the chest skin may be less vascularised and more fragile, which sometimes contraindicates the use of an implant alone. In this case, an autologous tissue flap (latissimus dorsi or DIEP) is often preferred to bring in healthy, well-vascularised tissue.
When can reconstruction begin after breast cancer?+
Reconstruction can be immediate (performed at the time of mastectomy, in a single surgical procedure) or delayed (after completion of all treatments, generally 6 to 12 months after the end of radiotherapy or chemotherapy). The timing is defined in consultation with the oncology team.
Does breast reconstruction give a natural result?+
Modern techniques make it possible to achieve very good aesthetic results. The outcome depends on the technique, the desired volume, and the treatments received. Several surgical steps may be needed to refine the result: nipple reconstruction, touch-ups. Reconstruction using autologous tissue (DIEP) often offers the most natural feel.
Is the reconstructed breast sensitive?+
Sensation in the reconstructed breast is generally reduced, as the cutaneous nerves are severed during mastectomy. However, sensation can partially recover over time through nerve regeneration, particularly with autologous tissue transfer techniques. Recovery varies from patient to patient.
Does breast reconstruction delay oncological follow-up?+
No. Oncological surveillance (consultations, imaging, laboratory tests) is maintained independently of reconstruction. The two pathways are complementary. Reconstruction does not interfere with cancer follow-up.
Does reconstruction involve both breasts?+
No, reconstruction generally concerns the operated breast(s). However, to achieve harmonious symmetry, surgery on the healthy contralateral breast may be proposed — reduction, lift, or augmentation. This symmetry procedure is covered at 100% by Social Security in this context.
Can I choose my own surgeon for breast reconstruction?+
Yes, you have the free choice of your plastic surgeon for breast reconstruction. It is not necessary to use the surgeon who performed the mastectomy. Dr. de Clermont-Tonnerre can intervene in this context, in coordination with your oncology team.
Can reconstruction be performed long after mastectomy?+
Yes, there is no maximum legal time limit for breast reconstruction. Patients who underwent mastectomy 10, 15, or 20 years ago can consult and benefit from reconstruction. Full coverage by Social Security applies regardless of how much time has passed.
What is a breast tissue expander?+
A tissue expander is a temporary inflatable prosthesis placed at the time of mastectomy (immediate reconstruction) or in a second stage. It is progressively filled with saline solution during outpatient sessions to stretch the skin and create the necessary space. It is then replaced by the definitive implant in a second procedure.

Patient reviews

Testimonials

★★★★★

“After my mastectomy, I was unsure whether I wanted reconstruction. Dr. de Clermont-Tonnerre took the time to explain everything without pressure. I chose DIEP flap reconstruction. The result is remarkable and feels natural. I feel whole again.”

Anne-Sophie

Paris 16th

★★★★★

“I had my mastectomy 8 years ago. I hesitated for a long time about reconstruction. Dr. de Clermont-Tonnerre welcomed me with great kindness and explained that it was not too late. The implant reconstruction went very smoothly, covered 100% with no surprises.”

Brigitte

Cergy (95)

★★★★★

“Immediate reconstruction performed at the time of mastectomy. One anaesthetic, one surgical procedure. The symmetry of the opposite breast was also covered. I am very grateful to have been cared for with such professionalism and compassion.”

Laurence

Pontoise (95)

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See also

Breast Augmentation→Breast Lift→Breast Asymmetry→Breast Fat Transfer→Breast Surgery — Overview→Dermatology — Melanoma→

Consultation

Your reconstruction, your choice

Dr. de Clermont-Tonnerre sees patients in Paris 16th and Pontoise (95) to listen to your project, analyse your situation, and propose the reconstruction options best suited to your body shape and care pathway. You are free in your decision — we are here to support you at your own pace.

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