[Oncoplasty by the Thorek technique for lower quadrant cancers in a condition of gigantomastia]. / Oncoplastie selon la technique de Thorek pour cancers des quadrants inférieurs en situation de gigantomastie.

OBJECTIVE: Describe our experience of Oncoplasty according to Thorek in gigantomastia with hard and less plastic breasts and a major ptosis. METHODOLOGY: Thirteen cases of breast carcinoma on gigantomastia operated using the Thorek technique between 2014 and 2019 in Burkina Faso were analyzed retrospectively. The operative indications, technique and results were considered. Breast Q was used to assess patient satisfaction. RESULTS: The indication of oncoplasty by the Thorek's technique was breast lower quadrants carcinoma, associated with a major ptosis, gigantomastia. There was a consequence on the spine in 9 over 13 cases. The breasts were hard and less plastic, making the other breast reduction techniques difficult. This technique helped remove the carcinoma, reduce the volume of the breast and address the ptosis. The patients were satisfied with the volume of the remaining breasts and their aesthetic look. The resection margins were safe. Two cases of aerolar dyschromia were noticed. CONCLUSION: The Thorek technique remains an alternative concerning tumours on gigantomastia, with hard and less plastic breasts and a major ptosis. The results combine carcinological and aesthetic requirements.

[Reduction mammaplasties on irradiated breasts: A litterature review]. / Réductions mammaires sur seins irradiés : revue de la littérature.

INTRODUCTION: Breast reduction is a very common intervention in plastic surgery. Its benefit on the quality of life of patients is certain. With the increasing number of conservative surgeries for breast cancer, the potential number of breast reduction on the irradiated breast has increased. The antecedent of irradiation is an absolute contraindication for the majority of breast reduction teams. The objective of this review of the literature is to evaluate the characteristics of the patients, the modalities, the complications and the overall satisfaction of the patients operated on breast reductions on irradiated ground. METHOD: A review of the literature according to the recommendations was carried out. A total of 207 articles were found with the appropriate keywords (Mammoplasty Reduction, Reduction Mammaplasty, Breast reduction crossed with the terms radiotherapy, irradiation). After selection, 11 articles were selected and analyzed. RESULTS: 126 patients were included. The average age was 50 years, the average BMI was 29kg/m2. The majority of patients were non-smokers and non-diabetics. The average resection weight was 507 grams. The average follow-up was 24.6 months. The delay between radiotherapy and surgery was 48 months. Five different surgical techniques were used. A complication rate of 50% is found. Overall satisfaction is good. CONCLUSION: This is the first review of the literature on breast reduction series on irradiated breasts. The results are inspiring and critical. Appropriate selection of patients seems essential. The publication of larger series and the description of a standardized technique would be interesting.

Skin-reducing oncoplasty: A new concept and classification in breast cancer surgery.

BACKGROUND AND OBJECTIVES: Breast-conserving surgery and skin-sparing mastectomy are nowadays widely accepted as the standard of care in selected patients with early breast cancer. After an accurate review of the literature, it appeared that no ordered list of the numerous techniques described for conservative breast surgery has been established so far. The aim of this study was to develop a simple classification of the different skin incision patterns that may be used in breast surgery. METHODS: A systematic review of the English literature was conducted using the PubMed database to identify all the articles reporting breast-conserving surgery and skin-sparring mastectomy techniques up to the 31st of December 2016. RESULTS: Among the 1426 titles identified, 230 were selected for review. Based on the reviewed papers, the skin-reducing oncoplasty incision pattern (SROIP) classification was elaborated. CONCLUSIONS: Breast cancer surgery should nowadays optimise aesthetic outcomes by improving the final breast shape, volume and scar location. This may be achieved using different procedures that we grouped together under the term skin-reducing oncoplasty (SRO). Depending on the breast cancer location, the SROIP classification helps in the choice of the best technique to be used.

[Not Available]. / Jusqu'où aller dans la désescalade thérapeutique en chirurgie du cancer du sein infiltrant : contre la désescalade.

THERAPEUTIC DE-ESCALATION IN BREAST CANCER SURGERY: CONS: Therapeutic de-escalation in breast cancer surgery is not recommanded for all patients. Concerning the axillary management, there are still some contraindications for practicing sentinel node, and avoiding axillary dissection is not safe for more than 3 positive sentinel nodes and in the absence of adjuvant treatment. Mastectomy can also be preferred by patients rather than conservative surgery, especially in case of genetic mutation, or for oncological reasons. Larger glandular resections, known as oncoplasties, should also be chosen in case of associated ductal carcinoma in situ and risky subgroups of local recurrence after neoadjuvant therapy. Finally, all patients will not benefit from ambulatory surgery.

[Oncoplastic breast surgery for the management of ductal carcinoma in situ]. / Place de l'oncoplastie dans la prise en charge des carcinomes canalaires in situ.

DCIS (Ductal carcinoma in situ) constitutes 15,2% of breast cancers. Conservative surgery coupled with adjuvant radiotherapy is often recommended. The rate of revision surgery is high, from 30 to 60%. The concern is a high quality resection within clear margins with a satisfactory aesthetic result. The objective of this review is to precise the place of oncoplastic surgery in DCIS care. Among risk factors of recurrence, tumoral invasion of surgical margins is capital. In histology, clear margins usually adopted for DCIS are 2mm, even though there is no international consensus. Recent studies show that a 10mm limit would be better. Aesthetic damage caused by surgery, often increased by radiotherapy, has a negative impact on women quality of life: oncoplastic surgery may minimize it. Techniques of plastic surgery, arranged into level 1 and 2, allow pushing back conservative treatment limits by removing a larger tumor with clear margins. Often used in invasive cancers, few data exist regarding oncoplastic surgery and DCIS. It allows to increase the dimensions of surgical resection by 20% and to decrease positive margins significantly therefore the rate of revision surgeries. Patients are satisfied with it. Specific indications need to be clarified according to age, size and "comedonecrosis" presence. Oncoplastic surgery should be developed in DCIS specific care.

[Glandular posterior flap of the breast for oncoplastic surgery]. / Apport du lambeau glandulaire postérieur du sein en chirurgie oncoplastique.

INTRODUCTION: Breast conservative surgeries, associated with radiotherapy within the framework of conservatives treatments for breast malignant tumors, can occur deformation of the breast in 10 to 15% of cases. The deformity can be more or less important according to the size of the initial lesion and the glandular reshaping reconstruction. Our experience in oncologic and reconstructive surgery of the breast reflects us about difficult cases of breast conservative surgeries in a glandular reshaping to obtain the best aesthetic result. In this approach, the posterior glandular flap of the breast was used in specific indications. The study aims to estimate the efficiency and the tolerance of the posterior glandular flap in difficult cases of breast oncoplastic surgeries. MATERIAL AND METHODS: We realized a consecutive serie of 24 breast oncoplastic surgeries. We noticed 15 breast conservative surgeries of superior quadrants. The posterior glandular flap was realized in 15 cases. We used the posterior part of the breast, vascularized by musculo-cutaneous intercostal arteries to give the volume lacking in the breast. We estimated efficiency and tolerance of the posterior glandular flap than one-year operating comment, as well as the oncologic follow-up long-term. RESULTS: In this serie of 15 cases, we did not note acute complications like infection, hematoma or cutaneous necrosis. We listed 13 cases of malignant tumors with indication of radiotherapy, and 2 cases of benign tumors. In one year, we found two patients presenting a cyst of cytosteatonecrosis (1cm and 3cm) in the site of surgery, compared to posterior flap. The glandular total average excision was 333g (30-1200). An oncologic surgical resumption was necessary in 2 cases (a case of preventive mastectomy for BRCA1, and a case of insufficient margins). We realized 12 cases of controlateral surgery at the same time for symmetry. The aesthetic result was judged at one year post-operatory: good or very good in 74% of the cases, correct in 20% of the cases, and insufficient in 6% of the cases. The oncologic follow-up did not find locoregional recurrence. CONCLUSION: The posterior glandular flap is an interesting contribution in oncoplastic surgery of superior quadrants of the breast to replace harmoniously the missing volume. This flap, reliable and reproductible, offers an alternative to bring of the custom-made volume without residual deformation of the breast. The aesthetic results allowed, in spite of the radiotherapy, to decrease the aftereffects of breast conservative surgery treatments, and this interesting approach deserves a wider distribution.