[Mammoplasty for hypotrophic tuberous breast augmentation using implants. One-stage surgical strategy without cutaneous-glandular dissociation]. / Mammoplastie d'augmentation des seins tubéreux hypotrophiques par implants. Stratégie chirurgicale en un temps sans dissociation cutanéo-glandulaire.

Among congenital breast malformations, the incidence of tuberous breasts is large, the shape abnormality is often accompanied by hypoplasia of the mammary gland and asymmetry. The psychological impact of this malformation is particularly important in these young girls at the end of puberty, in transit between adolescence and adulthood. The indication for augmentation by implants must be systematically associated with breast remodeling in order to obtain a good fit between the breast and the prosthesis. The increase in breast volume by implant remains relevant when fat reserves are insufficient to consider fat self-transfer. On the other hand, Augmentation by implants is a real challenge to obtain a good result and requires thinking and understanding the anomaly in order to follow a rigorous strategy that treats the different problems step by step. It is this strategy that we will develop with an original approach to glandular redistribution and management of areolar prolapse. This strategy is illustrated by a series of 145 patients operated between 2000 to 2021.

[Management of complications and unsatisfactory results of aesthetic mammary augmentation by implants]. / Complications et chirurgie secondaire de l'augmentation mammaire à visée esthétique par implants.

Complications of breast implants are rare in regard to the morphological and psychological benefits induced by this intervention. The main complications are; hematoma, infection, seroma with the absolute necessity to look for anaplastic large cell lymphoma associated with breast implants and capsular contracture. Apart from complications, the plastic surgeon may be faced with a bad result, from his surgery or after an intervention realised by a colleague. It is most often a malposition of the implant, primary or secondary ptosis of the breast. The rupture of the implant membrane is inevitable in the more or less long term and raises the problem of supervision and implants changes that will be expected in a very variable time. The author recalls the elements of diagnosis of complications or defects of aesthetic result and the conduct to take to avoid or treat them.

[Evaluation of the psychological benefits of breast augmentation for aesthetic purposes. Results of a multicenter prospective study of a series of 181 patients]. / Évaluation des bénéfices psychologiques de la chirurgie d'augmentation mammaire à visée esthétique. Résultats d'une étude prospective et multicentrique à partir d'une série de 181 patientes.

BACKGROUND: Cosmetic breast augmentation is becoming increasingly popular and acceptable to women in France. This prospective and multicenter study aims to investigate whether breast augmentation surgery for aesthetic purposes leads to improved body image, self-esteem, depression problems and sexuality. We also sought to analyze the sociodemographic profile of woman who underwent this surgery. PATIENTS AND METHODS: This study was conducted in France, from March 2009 to March 2011. One hundred and eighty-one patients were included in the survey. We used questionnaires to analyze body image, self-esteem, sexuality, depression, motivations and the sociodemographic profile of the patients before surgery and 6 months after. Questionnaires that were answered were returned in an anonymous way to the investigators to guarantee a blinded survey. RESULTS: The findings showed that women who underwent breast augmentation were mostly employed, married and aged between 20 and 30 years. Analyses revealed a significant improvement in body image, self-esteem and depressive symptoms, 6 months after surgery. Correlations between body image and self-esteem and between depression and self-esteem were also demonstrated. Only sexuality was almost unchanged after the procedure. Finally, a change of body image induced by breast augmentation surgery would improve self-esteem and thus reduce the signs for a depression. CONCLUSION: As with any request for aesthetic surgery, the desire for morphological breast surgery must be analyzed accurately and requires very thorough questioning by the plastic surgeon. The expected result is not only morphological but also psychological, as outlined in our study. The goal of breast augmentation surgery is to create a physical result that matches the expected body image in order to improve the patient's body image and self-esteem and so, bring the patient to recognize herself. Under these conditions, cosmetic breast augmentation surgery will assume a therapeutic function.

[Serratus anterior muscle flap: indications and sequelae. 26 cases and review of the literature]. / Lambeau de muscle serratus anterior: indications et séquelles. A propos de 26 cas et revue de la littérature.

The authors report their experience of the use of the serratus anterior flap. Between 1992 and 1997, this flap was used for 14 head and neck and 11 limb and 1 intra-thoracic reconstructions. Twelve patients were examined for functional evaluation of the donor site. When only 2 or 3 slips are raised donor site morbidity is limited to moderate winging of the scapula with no functional disorders. Because of its thinness, and the length and diameter of the vascular pedicle, the serratus anterior flap is our favourite option for small wounds of the distal limb or composite and large defects in association with flaps of the subscapular system.

[The principle of Colson's flap applied to facial reconstruction]. / Le principe du lambeau de Colson appliqué à la réparation faciale.

Reconstruction of facial skin defects after cancer surgery or trauma with conventional flaps can give a poor cosmetic result when a thick flap is used to replace thin skin. The thickness of the flap can be a disadvantage to replacing a thin skin. Defatting the flap can resolve these situations, using the principle of Colson's flap. This operative procedure is safe, and improves the cosmetic results. The authors report a series of 21 full-thickness skin defects located at the junction of two or three regional units. The defects were repaired with total or partial undermining flap (frontal, nasoiabial, cheek flaps). The viability of these reconstructions was perfect and the cosmetic results fairly esthetic in comparison with conventional flaps.

[Cervicofacial involvement of primary cutaneous neuroendocrine carcinomas or Merkel cell tumors: therapeutic considerations]. / Localisations cervico-faciales des carcinomes neuroendocrines cutanés primaires ou tumeurs à cellules de Merkel: considérations thérapeutiques.

Seven cases of primary skin neuroendocrine carcinoma or Merkel cell tumours with cervico-facial localization are reported. The poor prognosis of these tumours is essentially due to the potential for local recurrence and the frequency of locoregional and visceral metastasis. Surgical treatment is required but rarely sufficient to control the disease. Complementary radiotherapy, when performed early, can reduce the rate of locoregional recurrence. Lymph node resection is important to determine prognosis but has not been proven to improve outcome. In addition, parotid metastasis appears to result from blood stream dissemination and has a very poor prognosis. Exclusive radiotherapy may be discussed in such cases.

[Forum on tissue expansion. Breast reconstruction by expansion in a young woman with sequelae of thoracic amniotic disease. Apropos of a case]. / Forum: l'expansion tissulaire. Reconstruction mammaire par expansion chez une jeune femme porteuse d'une séquelle de maladie amniotique thoracique. A propos d'un cas clinique.

Amniotic disease or congenital skin sulci disease is a clinical entity covering a broad spectrum of malformations, usually involving the limbs, skull and face. This malformation is exceptional in the thorax. The authors report the case of a 22 year old woman with sequelae of thoracic amniotic disease, consisting of unilateral mammary aplasia, atrophy of the pectoralis major and latissimus dorsi muscles and deformity of the homolateral thoracic skeleton. They describe the breast reconstruction performed by tissue expansion in this patient.