Breast reconstruction

by DIEP / PAP flap

This procedure allows to restore in a way that natural and without implant the breast after a breast cancer. The technique was described by Dr. Allen's team since 1989 in the United States. It is now one of the techniques of breast reconstruction by autologous tissue (its own tissue) the most most popular.

Surgical indications

This procedure is for women who have one breast cancer or a mastectomy.

In fact, breast reconstruction can be done in a way immediate (during the mastectomy) which is called a RMI (immediate breast reconstruction). Or remotely, this is called a RMS (Secondary breast reconstruction). The choice of one or the other technique is based on a multidisciplinary decision between the patient's choice and the doctors involved (oncologists, radiotherapists, gynecologist, plastic surgeons).

Before / After

If you would like to see more before and after results, Dr. Alexandre G. LELLOUCH will share them with you during your consultation

Course of the intervention

The preoperative consultation

It takes place at medical practice. You will discuss with Dr. Alexandre G. LELLOUCH in order to specify your expectations and he will determine with you the best possible option

A additional examinations will be prescribed (adapted according to each patient) as well as preoperative photos will be performed.

At the end of the consultation, the plastic surgeon will give you a estimate and a operative consent.

Course of the intervention

of the intervention

This is a surgery that takes place in double team with the gynecologist and the plastic surgeon in charge. The 11st time operation is to perform the mastectomy (within the framework of the RMI), then to prepare the mammary vessels. At the same time Dr. Alexandre G. LELLOUCH lifts the DIEP flap then places it in the breast thanks to two microsurgical anastomoses (artery and vein) using a latest generation microscope. Dr Alexandre G. LELLOUCH selects with great care his operating aids who must have a very high surgical level (being part of his team trained at Harvard University in microsurgery).


LEGEND: 1: Mastectomy / 2: DIEP flap lift / 3: Flap placement and breast design

Location of scars: several possibilities depending on whether it is an IMR, an SMR, with or without preservation of the areola (depending on the case and to be discussed with Dr Alexandre G. LELLOUCH). If the patient does not have enough abdominal skin laxity, other anatomical sites are possible such as the thigh (PAP). Dr Alexandre G. LELLOUCH has a extensive experience in this surgery with the realization of more than 400 breast reconstructions during his career at the Georges Pompidou European Hospital (7 years).

There is always a 2ndth time of symmetrization :

  • Reconstruction of the areolar mammolar plate (AMP)
  • Contralateral breast lift or mastopexy
  • Lipoaspiration

Type of anesthesia

General anesthesia performed by an anesthesiologist

Duration of the intervention

between 3 and 5 hours (for a unilateral DIEP)

Type of hospitalization



After the intervention


Varies according to the procedure. Well controlled with prescribed analgesics. 

Control visit

Daily visit with your surgeon during your hospitalization Post-operative consultation with the surgeon at 1 month. Dr. Alexandre G. LELLOUCH remains available in case of additional needs

Duration of convalescence and care

6 days of hospitalization.

Nursing care

Daily shower and dressing until complete healing + Nurse at home if needed (dressing and stitching at D-10 if the sutures are not already resorbed)

Resumption of sports activities

3 months.


Work stoppage for 1 month.

Wear abdominal belt day and night for 6 weeks.

The results are immediateHowever, it is necessary to wait a few months for the final results

The scars have their final appearance around 12-18 months

Practical Information
(for everyone

  • Do a blood test prescribed by the surgeon
  • Have an Ultrasound/Mammography and or angioscan prescribed by the surgeon
  • Well Fill out your clinic file before your consultation with the anesthesiologist
  • Take appointment with an anesthesiologist at the clinic and schedule a consultation between 1 month and 1 week before your surgery date
  • Smoking cessation 3 weeks before and 3 weeks after for optimal results
  • No exposure to the sun on scars for 1 year
  • Buy postoperative medication/medical equipment before the procedure so that you have as little stress as possible after the procedure

Surgical references of the surgeon

For more information on the intervention


DIEP reconstruction is a complex technique that must be performed by experienced microsurgeons. Dr. LELLOUCH published a study in 2021 showing that there is no greater risk of having surgery after the age of 65.

Reference: Dejean MF, Dabi Y, Goutard M, Taveau CB, Lantieri LA, Lellouch AG. Deep inferior epigastric perforator free flap in elderly women for breast reconstruction: The experience of a tertiary referral center and a literature review. Breast J. 2021 Sep;27(9):700-705. doi: 10.1111/tbj.14273. Epub 2021 Jul 13. PMID: 34258820.

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For any specific or additional questions, please contact us directly by mail...or on the contact form here.

Doctor Alexandre G. LELLOUCH

The Dr. Alexandre G. LELLOUCH is a surgeon specialized in Plastic Reconstructive Aesthetic Surgery, registered with the Order of Physicians of the city of Paris 16 under the number 75/89697.

The Dr. Alexandre G. LELLOUCH is a specialist in cosmetic surgery, reconstructive surgery, and aesthetic medicine injections, which he practices at the MAISON ABEILLE in Paris 16.