Reconstruction mammaire autologue microchirurgicale par lambeau libre perforant aux dépens de l'artère epigastrique inférieure profonde (DIEP) : techniques classique et mini-invasive extra-péritonéale par laparoscopie

Perforator free flaps allow breast reconstructions « like with like » with skin and fat, excluding mammary gland, with a low morbidity. Those autologous reconstructions prevent material associated infections, capsular contracture and implant replacements, associated to breast reconstructions including implants. DIEP flap was described in 1994 to reduce the morbidity faced with TRAM flaps harvest. It only includes sub-umbilical skin and deep epigastric vessels. Deep inferior epigastric vessels harvest requires rectus abdominis muscle sheet opening and traction on rectus muscles, both associated with increased risks of abdominal bulges. Since 2014, we developed a minimally invasive DIEP harvest by totally extra-peritoneal laparoscopic dissection of epigastric vessels with a 70% reduction of aponeurosis opening and avoiding traction on rectus' motor nerves. We report both classic and minimally invasive DIEP harvest techniques. Bresat reconstructions by DIEP require that the ombilicus can be transposed and are indicated for all patients with need for skin inset, particularly secondary breast reconstructions. The reconstructed breast as a volume that follows patients weight variations and allows for improved quality of life on a long term. Its minimally invasive totally extra peritoneal harvest by laparoscopy, with or without robotic assistance, offers a reduced morbidity and might allows for reduced risks of abdominal wall weakness on a long-term.