A team from the Clinique de l'Alma performs the first implant-free breast reconstruction in Europe using a DIEP flap harvested by surgical robot

The first implant-free breast reconstruction using an abdominal flap (DIEP) harvested with the help of a surgical robot was performed on 27 November 2017 at the Clinique de l'Alma in Paris. The procedure, which is a European first, was led by Dr Marc-David Benjoar, plastic surgeon in charge of breast reconstruction at the Institut Français du Sein.
The 45-year-old patient was discharged five days after the operation, with minimal post-operative pain.

Dr Benjoar was assisted by Dr Francis Dubosq, a surgeon specialising in robotics, and Dr Yaël Berdah, a plastic surgeon, for this complex operation, which lasted a total of seven hours and went perfectly.

"The robot made it possible to carry out this phase of the operation with unrivalled surgical precision, thereby limiting the total operating time for an already complex operation. The scar on the abdominal wall was limited to four centimetres. Post-operative pain was minimal, and the patient was discharged five days after her operation," says Dr Benjoar.

Natural breast reconstruction using the patient's own tissue, without silicone implants, has become the gold standard. This technique, known as the DIEP(Deep Inferior Epigastric Perforator) flap, involves harvesting a flap of abdominal skin and fat to reconstruct breast volume after a mastectomy. To ensure that this flap is well vascularised, the surgeon must also remove an artery and a vein located deep in the patient's pelvis and reconnect them to the breast under a microscope.

The conventional technique requires a 20 cm opening in the abdominal wall, which can cause post-operative pain and abdominal curvature.

• "The Da Vinci robot offers a real advantage in that it greatly reduces pain and after-effects in the abdomen," explains Dr Benjoar. " We were surprised by the patient's extremely rapid recovery after the operation.

Up until then, only one American team had reported carrying out such an operation, but it was performed intraperitoneally, which meant that the patient ran the risk of suffering an intestinal flange. The French team chose to harvest the abdominal flap by passing between the peritoneum and the muscle, exactly as in the open approach.

In collaboration with Dr Mickael Hivelin and Dr Stéphane Hans, surgeons at the Université Paris-Descartes, trials on anatomical subjects concluded that the technique was feasible.

This operation has been detailed in a draft publication submitted to the journal Plastic and Reconstructive Surgery.