[Progress in immediate breast reconstruction with skin sparing mastectomy]. / Reconstruction mammaire immédiate: les progrès apportés par la mastectomie avec conservation de l'etui cutané

Skin sparing mastectomy (SSM) and subcutaneous mastectomy (SCM) are recent techniques. They are always associated with immediate breast reconstruction (IBR). Their safety from an oncologic point of view and indications are of great concern. In early breast cancer, SSM and SCM are associated with the same risk of local recurrence as a modified radical mastectomy, when correctly indicated. This has been validated by numerous studies. In these non-randomised studies, overall survival cannot be evaluated. Such techniques can now be validated in the oncologic setting when correctly indicated and when decision-making is always concerted and multidisciplinary. Skin-sparing techniques are obviously associated with better cosmetic results than secondary reconstructions. Thus SSM with IBR are ideally indicated for ductal carcinoma in situ, pure infiltrating or mixed carcinomas requiring mastectomy without subsequent radiotherapy. The selection criterion of no postoperative radiotherapy allows the right candidates to be chosen for SSM. But often this criterion cannot be obtained preoperatively. In such cases, performing a two-step operation could be a good option. The interval between operations can be used by the patient to obtain more information and to make a mature decision regarding her choice of treatment. It seems essential to be able to offer every patient SSM with IBR which are validated standardised indications. Such is not the case everywhere in France today. The organisation of primary care through professional networks should provide us with an opportunity to fulfil these needs.

Cutaneous expansion using enforced position in the treatment of large skin defects.

This paper presents a new method of reconstruction of a large skin defect, e.g., following excision of a giant pigmented nevus. By taking advantage of the flexibility of the joints and the extensibility of skin in the children, the large defects were closed in one stage by an enforced position that allows an easy closure of the wound. The scar was protected against stretching for 6 weeks to obtain sufficient strength. Later, free movements across the joints were permitted to allow gradual tension to the skin surrounding the scar. The final result is a permanent gain of the tissue replacing the defect.

[Technic of tissue expansion]. / Technique de l'expansion tissulaire.

The technique of tissue expansion is rapidly developing. It resolves certain problems encountered in plastic and reconstructive surgery, in the scalp, for example, which constitutes an ideal indication. A correct strategy and technique, together with well defined indications allows a very significant reduction in the complication rate. The choice of prosthesis and its location also play an important role. There are many indications in the scalp, but tissue expansion may also be useful in Poland's syndrome, in giant naevi in children and for expansion of certain flaps. Rapid intra-operative expansion also appears to be a promising technique.

[Double triangular resection technique at the feet of the cartilaginous arch in the correction of the nasal tip. "Do not touch the dome"]. / Technique de la "double résection triangulaire aux pieds de l'arche" dans la correction de la pointe du nez. "Touchez pas au dôme".

Retropulsion and modelling of the nose tip can be obtained very simply without touching the dome by means of double triangular resection at the feet of the cartilaginous arch formed by the two alar cartilages. Static and dynamic effects are obtained retropulsion, elimination of the prominence of the superior border of the alar cartilage (without shortening resection) allowing creation of a finer nose tip; rounding of the nasal orifices, improving respiratory function; suppression of labial dependence of the tip a factor responsible for secondary ptosis of the tip.