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Reconstructive surgery

Founded by Professor Claude Dufourmentel in 1961, the Saint-Louis Hospital plastic surgery department was the first in France to offer plastic surgery services.
Professors Pierre Banzet (1980-1995), Jean-Marie Servant (1995-2010), and Marc Revol (as of 2010) have succeeded one another as heads of the department.
Doctor Vincent Masson had the honour to work in this prestigious department as an intern at the Public Hospitals of Paris, and later as Chief Physician. He still practises there as a permanent surgeon and is actively involved in the teaching of plastic surgery.

What Is Reconstructive Surgery?

Reconstructive surgery is at the very root of cosmetic surgery and covers a widely diverse field. It addresses most of the body’s anatomical structure from head to toe, except the inside of the skull, of the thorax, and of the abdomen. From post-cancer breast reconstruction to excision surgery for skin cancer (basal cell carcinoma, squamous cell carcinoma, melanoma, and sarcoma), all the way to the after-effects of weight loss, hand surgery, dentofacial surgery, the after-effects of accidents, burns, moles, and lipoma, there are many reconstruction techniques. The excision of lesions, skin grafts, and skin flaps (local, latissimus dorsi, DIEP, etc.), as well as chest and calf prostheses are among the most common restorative surgery procedures.
The main goal of reconstructive surgery is to restore the physical and psychological well-being of a person. It can be relevant following an accident, after losing weight, or following cancer treatment, for instance. The role of the surgeon is to reconstruct and to improve the appearance of the face or body. This may include:

  • Reconstructing an area of the body such as the breasts, the calves, the arms, or the abdomen.
  • Restoring function to an area of the face or body.
  • Treating the after-effects of a condition, such as breast fibroadenoma and breast cancer.
  • Preparing for a surgical procedure to address a birth defect, such as cleft lip and palate in children, or a breast reduction.

Far from subordinate, this type of surgery differs from cosmetic surgery. Reconstructive surgery procedures are covered by the French health insurance.
Doctor Vincent Masson practises cosmetic surgery and reconstructive surgery in Paris as both specialisations are difficult to separate.

What Are the Most Common Reconstructive Surgery Procedures?

An individual may undergo restorative procedures for their face or for various parts of their body. It can be shoulder reconstruction surgery, chest reconstruction surgery, or arm reconstruction surgery. For the face, a procedure may be necessary to address a scar, a burn or skin lesion, or a birth defect, for instance.

Reconstructive Surgery After Weight Loss

Reconstruction surgery may be performed after any major weight loss, be it spontaneous or the result of bariatric surgery or obesity surgery involving a gastric sleeve, a by-pass, or a band.
Following obesity surgery, most patients lose a very significant amount of weight. This weight loss is not without consequences for the skin, which can be severely overstretched. Excess skin can be located on various areas of the body:

  • The breasts: Breast ptosis is a common consequence of obesity surgery. Breast ptosis describes a distension of the skin around the breasts. Breast reconstruction surgery counts as one possible procedure to lift the breasts back up. When necessary, it can be performed in addition to breast implants.
  • The abdominal area: Excess skin around the abdomen may be treated surgically through abdominoplasty or a body lift.
  • The buttocks: Losing weight often leads to a significant loss of body fat in the buttocks area. Several solutions can address this issue, including a body lift which, together with lipofilling (fat grafting), will restore those beautiful curves.
  • The arms and thighs: Treatment may rely on liposuction and a thigh lift to correct any stubborn residual excess fat and address any potential skin ptosis.
    In some rare cases, the face is another area where reconstructive surgery may be required after installing a gastric sleeve.

Breast Reconstruction Surgery

Breast reconstruction surgery mainly involves two types of procedures. The first one consists in reducing the size of the breasts when they are deemed too substantial. Breast hypertrophy can cause back pain and hinder physical activity or prevent the patient from carrying out certain tasks at work.
The surgical treatment in question is called reduction mammoplasty. It takes about 2 hours to perform and requires a complete cessation of work for 2 to 3 weeks depending on the patient. The procedure is covered by the French national health services if the breast reduction exceeds 300 grams in each breast.
The second type of procedure is breast reconstruction. This can be done following the surgical removal of a breast due to cancer or a severe breast deformity such as Poland syndrome. Several techniques are available to offer a tailored approach for every patient. A preliminary consultation with the surgeon will allow them to select the most suitable technique to give the missing breast the right shape and size and to reconstruct the nipple, should the patient wish to do so. Breast reconstruction surgery in Paris can also correct any contralateral breast asymmetry.

Scar Reconstructive Surgery

Scar reconstructive surgery consists in making the presence of unsightly scars on parts of the face or body more discreet. The techniques used are many and treatment varies depending on the initial aspect of the scar. It may include exeresis, skin grafting, local plasty, or skin expansion.
Several types of scars can be treated through reconstruction surgery in Paris, including:

  • Contracture scars: This type of scar happens when the scar tissue shrinks, causing the skin to tighten. Contracture scars form hard, fibrous, bumpy cords and, if they are located near joints, can often impair movement.
  • Keloid scars: Particularly fragile, these scars are usually caused by a superficial abrasion on the surface of the skin which hollows itself out and worsens until it becomes permanent.
    Hypertrophic scars: Usually painful, these red scars can sometimes rise significantly above the level of the skin.
  • Typically, the procedure is performed under local anaesthesia in ambulatory surgery. Depending on the type of scars that need correcting, the operation may also take place at the surgeon’s office. The post-operational effects are usually straightforward and involve little pain. In most cases, a noticeable improvement can be observed immediately after the surgical treatment.

Reconstructive Abdominoplasty

Reconstructive surgery of the belly can correct any damage done to the abdominal area following an accident or significant weight loss, for instance. The goal is to achieve a more harmonious-looking belly by getting rid of excess skin and fat. Abdominoplasty – also called tummy tuck, is a reconstructive surgery procedure that can also minimise the stretch marks which can be quite numerous on this area of the body.
Several techniques may be used to treat the area (liposuction, mini abdominoplasty or abdominoplasty). The surgeon selects the most suitable reconstruction technique for each patient based on their medical history, on the condition of their venous system, weight, skin quality, excess fat, and possible scars.
Choosing to undergo reconstructive surgery in Paris to address this particular area may be covered by the French national health services in cases where the abdominal area folds over the pubis or if there is a severe diastasis. An agreement from the Sécurité Sociale should be obtained beforehand.

Is Reconstructive Surgery in Paris Covered by My Health Insurance?

When a surgical operation is carried out as part of a reconstructive surgery procedure, the Assurance Maladie (the French national health services) covers 100% of the cost. Both the price of the operation itself and that of the anaesthesia are taken into account. However, it is worth noting that, regarding any reconstructive surgery in Paris, only registered healthcare institutions are eligible. In addition, the Sécurité Sociale does not cover cost overrun. Some private health insurances reimburse these extra fees after reviewing the estimate drafted by the surgeon in charge of the intervention.

About

Dr Vincent Masson is a plastic surgeon with a post-graduate diploma in plastic, reconstructive and aesthetic surgery and a gold medal in surgery from the Paris Hospitals. He is a former senior registrar and attaché at the Hôpital Saint Louis.

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