Les complications de la reconstruction mammaire immédiate (à propos d'une étude rétrospective de 174 cas)

La reconstruction mammaire immédiate est un apport psychologique majeur dans le traitement du cancer du sein. Ses indications carcinologiques sont maintenant bien validées et devant une demande croissante, il convient de préciser au mieux la technique opératoire. Pour cela, la prise en compte du terrain de la patiente ainsi que ses différents facteurs de risque à travers une meilleure connaissance des complications peuvent aider à poser la bonne indication. Notre étude rétrospective sur 5 ans présente une série de 174 cas de reconstructions mammaires immédiates consécutives réparties de la sorte : prothèses seules (n=104), expandeurs (n=21), lambeaux de grands dorsaux avec et sans prothèses (n=42) et TRAM (n=7). Les complications les plus fréquemment retrouvées ont été les souffrances et nécroses cutanées de la peau thoracique, les hématomes et les infections sur implants. Nous n avons eu qu un échec total de la reconstruction. Les séromes dorsaux ont été les principaux inconvénients des reconstructions par lambeau de grand dorsal. Enfin nous avons pu dégager des facteurs de risque comme l obésité, la morphologie du sein, l hypertension artérielle, le tabagisme et le type de prothèse. L étude a permis de mettre en avant, que l élargissement des indications chez des patientes qui présentaient plus de facteurs de risque était possible entraînant certes plus de complications mais, ceci sans remettre en cause la reconstruction, ni engager le pronostic vital. Exploiter le maximum du raisonnable pour donner le maximum de chances à la patiente de se reconstruire moralement par la reconstruction physique.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Comparison of the Explantation Rate of Poly Implant Prothèse, Allergan, and Pérouse Silicone Breast Implants within the First Four Years after Reconstructive Surgery before the Poly Implant Prothèse Alert by the French Regulatory Authority

Background. In March 2010, ANSM (Agence Nationale de Sécurité du Medicament), the French Medical Regulatory Authority, withdrew Poly Implant Prothèse (PIP) breast implants from the market due to the use of non-medical-grade silicone gel. The aim of this study was to compare the removal rate (and reasons thereof) of breast implants produced by different manufacturers before the ANSM alert. Materials and Methods. From October 2006 to January 2010, 652 women received 944 implants after breast cancer surgery at the Gustave Roussy Comprehensive Cancer Center, Paris (France). The complications and removal rates of the different implant brands used (PIP, Allergan, and Pérouse) were evaluated and compared. Results. PIP implants represented 50.6% of the used implants, Allergan 33.4%, and Pérouse 16%. The main reasons for implant removal were patient dissatisfaction due to aesthetic problems (43.2%), infection (22.2%), and capsular contracture (13.6%). Two years after implantation, 82% of Pérouse implants, 79% of PIP, and 79% of Allergan were still in situ. There was no difference in removal rate among implant brands. Conclusion. Before the ANSM alert concerning the higher rupture rate of PIP breast implants, our implant removal rate did not predict PIP implant failure related to the use of nonapproved silicone gel

Quilting sutures reduces seroma in mastectomy

Background Drainage duration and seroma formation occurring after mastectomy with or without axillary surgery lengthens hospitalization and delays adjuvant treatment. The aim of the study was to evaluate the effect of quilting in the prevention of seroma after mastectomy for breast cancer. Patients and Methods Eighty-two breast cancer patients about to undergo mastectomy with or without axillary surgery lymphadenectomy were enrolled in the study. We conducted an observational comparison between 41 patients in whom quilting with closed suction drainage was used and 41 patients in whom drainage only was used. Results The mean drained volume was significantly lower in the quilting group compared with the control group on days 1 and 2 (day 1: 107.1 mL vs. 156.5 mL; P =.02; day 2: 108.4 mL vs. 162.8 mL; P =.01). The mean drainage period was shorter in the quilting group (4.6 vs. 5.3 days; P =.046). There were fewer needle aspirations for seroma in the padding group (n = 14, 34.1% vs. n = 24, 58.5%; P =.03). Conclusion The use of padding after mastectomy seems to reduce seroma formation, volume drained, and length of drainage tim

3D-conformal Accelerated Partial Breast Irradiation treatment planning: the value of surgical clips in the delineation of the lumpectomy cavity

Abstract Background Accurate localisation of the lumpectomy cavity (LC) volume is one of the most critical points in 3D-conformal Partial breast irradiation (3D-APBI) treatment planning because the irradiated volume is restricted to a small breast volume. Here, we studied the role of the placement of surgical clips at the 4 cardinal points of the lumpectomy cavity in target delineation. Methods Forty CT-based 3D-APBI plans were retrieved on which a total of 4 radiation oncologists, two trainee and two experienced physicians, outlined the lumpectomy cavity. The inter-observer variability of LC contouring was assessed when the CTV was defined as the delineation that encompassed both surgical clips and remodelled breast tissue. Results The conformity index of tumour bed delineation was significantly improved by the placement of surgical clips within the LC (median at 0.65). Furthermore, a better conformity index of LC was observed according to the experience of the physicians (median CI = 0.55 for trainee physicians vs 0.65 for experienced physicians). Conclusions The placement of surgical clips improved the accuracy of lumpectomy cavity delineation in 3D-APBI. However, a learning curve is needed to improve the conformity index of the lumpectomy cavity.</p

Surgical management of soft tissue tumors of the abdominal wall: A retrospective study in a high‐volume sarcoma center

peer reviewed[en] BACKGROUND: The aim of the study is to evaluate functional and oncological outcomes of patients undergoing abdominal wall soft tissue tumors (AWSTT) surgery. METHODS: All consecutive patients that underwent surgery for malignant and intermediate AWSTT from 1999 to 2019 were retrospectively analyzed. RESULTS: Ninety-two patients were identified, 20 (22%) operated on for a desmoid tumor and 72 (78%) for a soft tissue sarcoma (STS). Fifty-two patients (57%) had in toto resection of the abdominal wall (from the skin to the peritoneum) and 9 (10%) required simultaneous visceral resection. The closure was direct in 28 patients (30%) and requiring a mesh, a flap or a combination of the two in respectively 42, 16, and 6 patients (47%, 17%, 6%). The postoperative complications rate was 26%. Thirteen patients (14%) developed an incisional hernia after a median delay of 27 months. After a median follow-up of 40 months, out of the 72 patients operated on for STS, 7 (10%) developed local recurrence and 11 (15%) distant recurrence. The median recurrence-free and overall survivals were 61 and 116, months respectively. CONCLUSIONS: Management of AWSTT requires extensive surgery but allows good local control with an acceptable rate of incisional hernia