HAS Validates DIEP Breast Reconstruction Technique

Following action by a patient advocacy group, the French National Authority for Health (Haute Autorité de Santé, HAS) convened a panel of experts in July 2011—at the request of the national health insurance system—to evaluate the DIEP (Deep Inferior Epigastric Perforator) free abdominal flap breast reconstruction technique. This evaluation is a critical step toward potentially assigning a specific procedural code for DIEP reconstruction within the French health insurance system’s medical procedure catalog (CCAM).

Currently, the DIEP technique is billed under a generic flap reconstruction code, which fails to reflect the procedure’s complexity. This has significant implications for private clinics, which are reimbursed just €950 for a surgery that actually costs between €1,200 and €1,500. The long-term viability of offering this advanced technique in private practice hinges on this assessment.

Key Findings from the HAS Report

The panel issued clear conclusions in favor of DIEP flap reconstruction:

• Proven Benefits: DIEP reconstruction significantly improves patients’ quality of life and provides lasting aesthetic satisfaction.
• Lower Risk of Abdominal Complications: Compared to the older TRAM flap technique, DIEP avoids many abdominal sequelae, preserving abdominal wall function.
• Complication Rates: The main surgical risk is total flap necrosis due to vascular thrombosis, estimated at around 5%—comparable to the TRAM flap.

Validated Indications for DIEP Breast Reconstruction

HAS has recommended the DIEP technique be approved for the following medical indications:

• Post-therapeutic mastectomy following breast cancer treatment
• Prophylactic mastectomy for women carrying BRCA1 or BRCA2 gene mutations
• Congenital hypoplasia or developmental breast asymmetry

Patient eligibility requirements include:

• No heavy smoking near the time of surgery (to reduce risks of vascular failure)
• Sufficient abdominal fat and skin to allow successful grafting

Required Surgical Team and Protocol

Due to the complexity of the procedure, the HAS outlines specific requirements for medical teams offering DIEP flap reconstruction:

• Two surgeons: one managing the abdominal donor site, the other reconstructing the breast (at least one must hold certification in microsurgery)
• Two operating room assistants
• A dedicated surgical instrument technician
• Post-operative monitoring for at least 24 hours with close surveillance of the flap for any signs of vascular compromise or necrosis

Implementation in Private Practice

We have assembled a dedicated DIEP surgical team at Hôpital Privé Armand Brillard, enabling this procedure to be performed in a private clinical setting. This team structure allows us to meet all safety and quality requirements outlined by the HAS.

We strongly support the formal integration of DIEP into the CCAM with a dedicated procedure code. This would not only acknowledge the technique’s medical and aesthetic benefits but also facilitate its broader adoption across both public and private healthcare institutions in France.