[Morbidity of the trans rectus abdominis musculocutaneous flap in breast reconstruction. Retrospective study about 125 patients]. / Complications des lambeaux pédiculés musculocutanés du droit de l'abdomen en reconstruction mammaire: à propos d'une série rétrospective de 125 patientes.

OBJECTIVE: To evaluate, in our experience, the morbidity of the trans rectus abdominis musculocutaneous flap (TF), to determine the risks factors and the advantage of surgical delay procedure. PATIENTS AND METHODS: TF was used for 125 consecutive breast reconstructions. Thirty-eight patients (30,4%) had recidive after conservative treatment and 62 (49,6%) have been included in a procedure associating chemotherapy, radiation therapy and mastectomy with immediate breast reconstruction (IBR), 31 patients were obese (24,8%), 14 were smoker (11,2%), 118 (94,4%) had prior thoracic radiation, 97 (77,6%) had a surgical delay procedure by ligation of the inferior epigastric pedicle, 115 (92%) had IBR, 99 TF were unipediculed and 26 were bipediculed. RESULTS: Immediate morbidity was: 21 necrosis of the flap (16,8%) among 1 total necrosis (0,8%), 6 hematomas (4,8%). Secondary morbidity was: 14 fat necrosis (11,2%), 9 eventrations (7,2%), 6 hernias (4,8%). The only statistic factor founded for ischemic complication was obesity (P = 0,036). The abdominal repair with interposed mesh was the only factor who decreased significatively (P = 0,013) the wall complication rate. The surgical procedure delay did not reduce ischemic complication rate (P = 0,92). CONCLUSION: TF can be performed with an acceptable complication rate in institution who realise frequently breast reconstruction procedure. Surgical delay procedure in our experience must be reconsidered.

[Mastectomy with immediate reconstruction for invasive breast cancer. Comments on indications and technique. A series of 112 cases]. / Mastectomie avec reconstruction immédiate pour cancer invasif du sein. Réflexions sur les indications et les techniques A propos d'une série de 112 cas.

A series of 112 mastectomies with immediate breast reconstruction performed in women with invasive cancer of the breast were followed for a mean of 30 months to determine cancer outcome, morbidity and aesthetic results of the different surgical techniques. The patients were divided into 3 groups according to indications: 49 cases with local recurrence after conservative treatment; 37 cases of large or multifocal tumours operated after chemotherapy and radiotherapy; 26 cases after tentative conservative surgery with incomplete tumourectomy. A total of 98 patients (87.5%) were irradiated before mastectomy with immediate breast reconstruction. Twenty-eight simple implants, 50 musculocutaneous flaps using the latissimus dorsi with implant and 34 musculocutaneous flaps with the rectus abdominis. During follow-up 16 patients died and cancer relapsed in 13 surviving patients. Seven local recurrences were observed. In all cases of early relapse, which may have possibly been triggered by immediate breast reconstruction, the patients had very poor prognosis criteria. Surgery took longer for mastectomy with immediate breast reconstruction using the rectus abdominis flap and required transfusion in 88% of the cases. Combining all the techniques, 19% of the patients had postoperative complications and 25% late sequellae. The aesthetic results were considered as good immediately after surgery in 14% of the patients with a simple implant, in 45% of those with a latissimus dorsi flap and in 81% of those with a rectus abdominis flap. Second surgical procedures to improve the aspect were performed in half the patients with a simple implant giving 50% good results, in 40% of the patients with a latissimus dorsi flap giving 68% good results and in 12% of the patients with a rectus abdominis flap giving 84% good results. In this series, patient satisfaction was closely related to the aesthetic quality of the results. Integrated into a well-planned multidisciplinary protocol, mastectomy with immediate breast reconstruction does not appear to affect the cancer outcome. Immediate breast reconstruction is a complex procedure and requires experience in plastic surgery to reduce the number of complications and to improve aesthetic results. Reconstruction with a rectus abdominus flap appears as the superior technique.