Evaluation of satisfaction and the quality of life after bilateral breast reconstruction using the BREAST-Q questionnaire.

BACKGROUND: The demand of breast reconstruction is growing, the purpose of this study is to evaluate the satisfaction and quality of life of patients who underwent bilateral breast reconstruction. METHODS: In this cohort retrospective study, patients who underwent bilateral breast reconstruction in our department between September 2009 and December 2019 were asked to complete BREAST-Q questionnaire based on the timing of the reconstruction received following mastectomy, thus dividing them into three groups: (1) bilateral immediate breast reconstruction(BIBR), (2) immediate breast reconstruction in one side and delayed reconstruction on the other side (mixed group), (3) bilateral delayed breast reconstruction(BDBR). Surgical techniques were divided into prosthesthetic (permanent implant and expander), flaps (pedicle or free), mixed technique (associating flap and prosthesis). RESULTS: Seventy-one out of 94 patients responded to our BREAST-Q questionnaire, with a response rate of 84.5%. A high score is associated with a better result, except in physical well-being where a lower score indicates better outcome. The average score for psychosocial well-being is 63.0 (±17.2) achieving the lowest among the BDBR group. Physical well-being score is 26.0 (±18.6) scoring the highest in BIBR group. Sexual well-being score is 52.2 (±17.4) and seen highest among BDBR group. Satisfaction with breast score is 54.1 (±10.0) and was highest among mixed group. CONCLUSION: The therapeutic proposal was personalized based on patient profile and choice. The best reconstruction treatment enhancing the quality of life and patient satisfaction remains the option chosen by the patient and whose advantages and disadvantages are accepted by them.

[Gynécomastia. Management of diagnosis and therapy. Apropos of 148 cases]. / Gynécomastie : actualisation des données diagnostiques et thérapeutiques. À propos de 148 patients.

Gynecomastia is the most frequently breast lesion in males. 148 patients (mean age 24,7 years) operated in our department were reviewed with a mean follow-up of five years. Gynecomastia occurred most frequently during puberty (77,7 %), was bilateral (86,5%) and idiopathic (89,9%). The size of the enlargement was evaluated according to Simon's-classification based on breast-volume and skin-redundancy. 17 (11,5%) stage 1, 77 (52%) stage 2A, 32 (21,6%) stage 2B, 22 (14,9%) stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 17 (11,5%) subcutaneous mastectomies, 4 (2,7%) liposuctions, 110 (74,3%) liposuctions associated with subcutaneous mastectomy, 17 (11,5%) total mastectomy. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination «liposuction and subcutaneous mastectomy¼, as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.

[Is it legitimate to propose surgery of the breast area before the end of puberty?] / Est-il légitime de proposer une chirurgie de la région mammaire avant la fin de la puberté ?

Breast surgery is usually recommended for women who have completed puberty. Indeed, during adolescence the breast is constantly changing, the patient's weight is often unstable, the risk of inflammatory scars (hypertrophic or keloid) is higher and disturbances of areolar sensitivity can affect the patient's quality of sexual life. In addition, the risk of infection is not negligible, especially during an acne outbreak. In case of early implant placement, iterative changes should be planned. Finally, the result obtained is not always stable but above all the lack of psychological maturity and the legal need to obtain the agreement of both parents are obstacles to early surgery. However, the authors argue for the possibility of surgical correction of the breast around puberty, in particular because of the very clear positive psychological impact. Other arguments are also detailed: to ensure a breast reconstruction in successive stages started early, to limit the repercussions of hypertrophy, to correct thoracic or skin anomalies. These indications are illustrated by numerous clinical cases demonstrating the need for customized surgery on a case-by-case basis.

[Mohs micrographic surgery for skin cancers: A 10 year - single-center series of 548 patients treated by formalin-fixed tissue Mohs surgery assessing the impact of reduced margins]. / Prise en charge des tumeurs cutanées selon la technique Slow Mohs « en gâteau ¼ : étude rétrospective monocentrique sur 10 ans de 548 patients évaluant l'impact de la diminution des marges.

AIM: Only few robust studies specify the indications of Mohs Surgery techniques in skin tumors. The aim of this work was to carry out a review of almost 10 years of experience, assessing the impact of reduced margins on reconstruction, and proposing a management algorithm in the light of the literature. PATIENT AND METHODS: All the records of patients having benefited from a Mohs technique in our center were retrospectively compiled from January 2011 until January 2020. A formalin-fixed tissue Mohs surgery was used. An impact assessment of reduced margins was made both on the excisional surface but also on the improvement of the reconstruction. RESULTS: 548 patients were included. Complete tumour clearance was achieved with one surgical stage in 71% of cases. The excisional surface of tumours located in the periorbital and nasal areas was significantly more often reduced compared to other areas (P=0,020). The improvement of the reconstruction was deemed significant in the periorbital and nasal areas; as well as for tumours located on limbs and trunk linked with Dermatofibrosarcoma management. CONCLUSION: This study underlines the interest of assessing the clinical relevance of reducing margins depending on the tumor location. Our single-center experience feedback on a large series allows to clarify Mohs technique indications by means of a literature review.

[New surgical strategy in breast reconstruction with implants for bilateral prophylactic mastectomies with BRCA gene mutation]. / Nouvelle stratégie chirurgicale dans les mastectomies bilatérales prophylactiques avec reconstruction par prothèses chez les patientes présentant une mutation du gène BRCA.

BACKGROUND: For the past decades, number of prophylactic bilateral mastectomies using reconstruction with implants increases. We describe a new surgical strategy and analyse its safety and feasability. METHOD: It is a retrospective, descriptive and monocentric study. The first step of surgery consisted in obteining a peri-prosthetic capsule with implants and if there was a mammary hypertrophy and/or ptosis, it was corrected at the same time. The second step of surgery was the nipple-sparing mastectomy with change of implants for bigger ones. Third step consisted in a lipofilling. RESULTS: Seven patients were included. 6 women had a BRCA1 gene mutation. Mean age was 35.6 year-old [29.6; 41.6], mean BMI was 23.8kg/m2 [20.6; 27], mean chest circumference was 93.7cm [87.4; 100], mean cup was C- [B-; D-]. 4 women had mammary hypertrophy and/or ptosis. Mean number of procedure per woman was 3.6 [2.5; 4.7]. Mean volume of implants used at the first step was 248.6ml [211.3; 285.9]. The second step was performed mean 33.9 weeks [22.3; 45.5] later. Mean increase of implants volume was 120ml [80.4; 159.6]. 4 patients had complications including 1 who had implant exposure. Six patients had lipofilling of mean volume per breast of 175ml [116; 234]. CONCLUSION: This new strategy could decrease complication rate, improve aesthetic outcome and decrease psychological impact of surgery.

[Gluteal flap harvest for breast reconstruction]. / Technique de prélèvement du lambeau fessier pour la reconstruction mammaire.

The lower gluteal flap is an autologous microsurgical breast reconstruction procedure using the soft tissue of the region of the gluteal sulcus. The perineal extension increases the volume of the sample. The pedicle with one artery and two large veins extends up the ischial notch and can reach 8 to 12cm. The two operative positions, the relative shortness of the pedicle and the firm tissues transferred are balanced by the discretion of the sequelae of the donor site and the volume which is always enough even in the slim woman. The best indication of this technique is two-sided breast reconstruction but it also provides a solution in case of contraindication of other autologous flaps, especially DIEP.

[Breast asymmetry of the teenager and the young adult. Stability of the result in time. About 144 patients]. / Asymétrie mammaire de l'adolescente et de la jeune adulte. Stabilité du résultat dans le temps. À propos de 144 patientes.

INTRODUCTION: Breast asymmetry is defined by a difference in breast shape and/or volume. The goal of this study was to assess the stability of the surgical results and to highlight predictive factors for deterioration in results. MATERIALS AND METHODS: This retrospective and monocentric study included all patients presenting constitutional isolated asymmetry, Poland's syndrome, asymmetric tuberous breast or pectus excavatum treated between 1980 and 2015. RESULTS: The statistical analysis included 144 patients and contained two parts. The first analysis compared patients with or without breast implant. Results were significant only for symmetry of shape, with better outcomes without breast implant (P=0.0170). The second analysis compared the subgroups of patients with breast asymmetry, according to the etiology. Patients with tuberous breasts and constitutional isolated asymmetry have been compared. We found a significant difference only regarding the long-term results (P=0.0091). Patients with tuberous breasts had deteriorating in results over time. Patients with Poland's syndrome, compared to patients with constitutional isolated asymmetry, had significantly less good results for symmetry of volume, of shape, of areola, and for early results (P<0.025). Concerning patients with pectus excavatum, the early and long-term results and the stability were good for most patients. CONCLUSION: Better results have been obtained with similar surgical procedures on both sides. Predictive factors for instability of results were the use of unilateral breast implant, weight variations, pregnancies and breast-feeding, the use of hormonal treatments, ageing and tuberous malformation.

[Axillary hidradenitis suppurativa: a single-stage surgical treatment]. / Hidrosadénite axillaire : une stratégie thérapeutique en un temps.

INTRODUCTION: Hidradenitis suppurativa is a chronic inflammatory disease, particularly incapacitating. Wide surgical excision of the whole affected skin is the only radical and successful treatment that can be offered. Coverage of the defect is then generally obtained with a split-thickness skin graft after a period of granulation. We expose a single-stage procedure which reduces the number of surgical times and the period of recovery. PATIENTS AND METHODS: We have documented a series of five patients who underwent uni- (three cases) or bilateral (two cases) axillary hidradenitis suppurativa, between December 2008 and December 2009. Surgical procedure included excision of the lesions and coverage with a split-thickness skin graft. The graft was meshed in a ratio of 1.5:1, and secured with a negative-pressure dressing. This dressing, which provided a continuous subatmospheric pressure of -75 mmHg, was removed after five days. Then, complete healing was obtained with conventional vaseline gauze dressings. RESULTS: After removal of the negative-pressure dressings, the graft take was 90% on average (80-100%). Complete healing was obtained within an average of 34 days (20-43 days), with a good quality of scar tissue, no retraction and no limitation of arm's abduction. CONCLUSION: This technique, enabled by negative-pressure dressings, provides a quick and good quality healing, with only one surgical stage. It has many advantages: reduced morbidity, faster healing, higher level of patient's comfort, and lower costs.

[Retrospective study of 184 superior pedicle breast reductions without drainage]. / Étude rétrospective de 184 réductions mammaires bilatérales à pédicule supérieur et sans drainage postopératoire.

BACKGROUND: The safety of non-drainage has already been proven on inferior pedicle breast reduction techniques while other authors said that the superior pedicle breast reduction techniques increase the risk of postoperative drainage. We want to prove that non-drainage of superior pedicle breast reduction techniques is as safe as the non-drainage of inferior pedicle breast reduction techniques. METHODS: We made a retrospective study of 184 superior pedicle breast reductions in the last 5 years at the hospital of Lille. The complications were compared with the review of inferior pedicle breast reduction on the previous studies. RESULTS: We observed: 1.35% of hematomas, 0.54% of fat necrosis, 0.27% of infections, 4.1% of wounds dehisences, 0.81% of nipple loss and no seroma. No significant statistical difference between the complication rate of these two breast reductions techniques was found. CONCLUSION: Non-drainage in superior pedicle breast reduction techniques is as safe as the non-drainage in inferior pedicle breast reduction techniques and can be considered as reliable.

[The inferior gluteal musculocutaneous flap: Short and long-term results for 69 patients]. / Le lambeau fessier inférieur libre en reconstruction mammaire : analyse des résultats de 69 lambeaux.

The inferior gluteal musculocutaneous flap described by Shaw then Le-Quang offers the possibility of harvesting a large amount of tissue with a well-concealed scar in the inferior fold. Since 1996, we used this flap for breast reconstruction without implant. The purpose of this study was to assess short and for long-term results in our patients. Between 1996 and 2005, 64 patients underwent 69 musculocutaneous flaps by two seniors surgeons, for secondary unilateral reconstruction (57 cases, 51 total mastectomy, three partial mastectomy, three constitutional breast asymmetry), five bilateral reconstruction or one thoracic skin ulceration after radiotherapy. The average flap weight and size was respectively 360g and 18 × 7cm. For short results, the assessment was based on flap success and surgical morbidity. For long-term results, the assessment was based on breast result (shape, volume, symmetry, skin and scar) and donor-site morbidity (scar, contour deformity, muscle function and sensation). Patients and surgeons global satisfaction were compared. Minimal follow-up was three years for 60 patients. Two patients died with metastasis. Sixty-three flaps succeeded. We had five flap necrosis, one after general complication (pulmonary embolism), four after venous thrombosis during the first period of our experience. Forty patients underwent a second procedure on the flap or on the other breast (25 cases). For the patients, the global result was excellent in 20 cases, good in 32 cases, fair in nine cases. For surgeons the global result was excellent in 13 cases, good in 32 cases, fair in 13 cases and poor in three cases. Concerning the donor-site, only one patient had an asymmetry of the buttock. Mostly, the scar of the donor site was good. Five cases needed a new surgery for poor scar. Five patients had functional complaints (for bicycle and squatting). Twenty-three patients noticed the hypoesthesia in the territory of the posterior femoral cutaneous nerve. For breast reconstruction, the gluteal region is an acceptable donor site with low morbidity and stable results. This technique needed a relative long learning curve, especially for the venous pedicle. We recommend to use a large vein dissected from the arm and axillary vessels. We also reduce the harvesting volume of the muscle to preserve the function. The reconstructive breast had a good shape, sufficient volume and acceptable symmetry.