[Prevention of the post-surgical insatisfactions and possible medico-legal complications]. / Prévention des insatisfactions postopératoires et des éventuelles complications médico-juridiques.

The purpose of this work is to better understand the reasons for post-surgical instability and what makes up the bed of medico-legal complications. Beyond technical competence, it is essential to observe a very high degree of rigor in listening to the real motivations in order to give the most accurate possible surgical indications and in particular to know to detect and never to operate certain patients who, whatever we do, will always be dissatisfied. The quality of information is one of the essential elements of prevention: information is part of the care and there is no therapeutic success without a successful relationship between a caregiver and a carereceiver. Before the surgery, it is essential to pre-establish written proof of the proper delivery of the information by signing a receipt and an informed consent document. However, the information does not stop at the time of the operative gesture and it is necessary to be able to provide complete and timely information about any post-surgical complications. Furthermore, aesthetic medicine is well understood and rigorously implemented, contributes to the prevention of surgical and medico-legal complications, reducing the heaviness of certain surgical gestures. The question of e-reputation should in no way be neglected. From this point of view, prevention consists in controlling as much as possible the Internet environment. Indeed, where, in the past, in the presence of a dissatisfied patient awaited us, the fear of word-of-mouth or trial is added to the risk of harm E-reputation whose implications can be very damaging. At a time when the intensive use of the Internet allows anyone to get out of anonymity, we must also control these tools at the risk of sacrificing our expertise at the coronation of amateurs.

[Patient counseling in case of postoperative complication leading to emergency reintervention in plastic surgery. What is the current situation? How to improve? Retrospective study of counseling modalities and traceability in a series of 16 patients who needed emergency reintervention within a cohort of 402 patients]. / Information du patient dans le cadre d'une complication postopératoire nécessitant une reprise chirurgicale en urgence en chirurgie plastique. Quel est l'état des lieux? Comment améliorer notre pratique? Étude rétrospective des modalités et de la traçabilité de l'information sur une série de 16 patients réopérés en urgence issus d'une cohorte de 402 patients.

AIM: Preoperative counseling is structured and well defined. Nevertheless, in the event of a complication leading to a new emergency surgical procedure, counseling is not well defined. We conducted a retrospective study of information delivered in this situation at our institution. PATIENTS AND METHODS: We included all the patients who underwent emergency reintervention because of hematoma or operative site infection between November 2013 and October 2014. Sixteen patients were included over the 402 patients operated during this period. RESULTS: Information before initial surgery: all patients had at least two preoperative consultations, and all preoperative informed consents were obtained. Complications leading to reintervention were mentioned in the consultation record in 31% of cases, and in a letter to another practitioner in 19% of cases. SofCPRE information card was delivered in 63% of cases. Information before reintervention: reintervention indication was mentioned in the hospitalization report in 81% of cases, and in the operative report in 88% of cases. Blood count results were mentioned in 55% of cases when it had been done. Patients were orally informed of reintervention in 100% of cases, and this new information was mentioned in 50% of cases. A new informed consent was signed in 31% of cases and postoperative letter was written in 25% of cases. CONCLUSION: Information delivery traceability is mandatory. In case of complication leading to emergency reintervention, traceability should be done in the same way as prior to initial surgery.

[The surgical innovation: From the legal framework through the veritable ethics innovation - Technical aspects and practical applications]. / L'innovation chirurgicale : du cadre légal à une véritable éthique de l'innovation. Aspects théoriques et applications pratiques.

Grace to the creativity of surgeons and the introduction of new technologies, second half of the XXth century opened the era of innovations and decisive progress. At the same time, however, is born the feeling of distrust and claiming which has come with the graving and threatening juridiciarisation. The evolution of complex structures of our society joined the ingenuity researchers unlimited makes formal law and the legal framework constantly to adapt oneself to circumstances. In the field of surgery, it's necessary to make work in integrity the innovation and protection at the patient's and their dignity. The legal framework that governs today innovation in surgery must still to go further and will precise. Dignity, compelling paradigm for all those who seek to better understand and better protect human starred as impassable limit any search and any experimentation. To make this chapter more alive, we have supplemented it and illustrated by the testimony some of the most fruitful French last years innovative in order to enrich our thinking of the fruit of their large and brilliant experience.

[Information and assent: presentation of 32 information cards concerning plastic and aesthetic surgery]. / Information et consentement éclairé : présentation de 32 fiches d'information concernant la chirurgie plastique et esthétique.

Obligation to deliver full information and obtaining enlightened assent are now, for the whole French practitioner, a necessary preliminary to each operation. Henceforth, in case of suit, the practitioner must prove the reality and the quality of preoperative information. The authors propose 32 information cards corresponding to the most currently operations of plastic and aesthetic surgery. They will being clear and simple, with a large agreement, strictly informative and yearly up to date. They have the label and therefore the scientific guaranty of the French Society of Plastic Reconstructive and Aesthetic Surgery.

[Lipomodelling for correction of breast conservative treatment sequelae. Medicolegal aspects. Expert opinion on five problematic clinical cases]. / Lipomodelage et correction des séquelles du traitement conservateur du cancer du sein Aspects médicolégaux. Le point de vue de l'expert à partir de cinq cas cliniques délicats.

In our unit, breast cancer patients suffering mild sequelae of conservative cancer treatment receive fat transfer (lipomodelling), following a precise protocol, based on mammographic and ultrasound examinations and MRI. Available data do not seem to indicate any deleterious impact on patient outcome, notably in view of radiological images, but recurrence (or rather occurrence of new ipsilateral or contralateral cancer) is frequent. The correlation between new or recurrent breast cancer and lipomodelling is high; misinterpretations are possible and frequently arise. The present paper is a description of five complex clinical cases and a discussion of the medicolegal issues that may possibly arise; it also provides tentative expert evaluation of the cases. Clinical findings are reported and analyzed. The second step is a discussion of the radiological impact of lipomodelling, and of the problems caused by the transfer of potentially malignant cells when no preoperative diagnosis of recurrence is made; the morphological and esthetic benefits of the method are described, as well as the potential beneficial impact of fat transfer, notably associated with lower breast density and injections of fat stem cells. Our conclusion is that specialized radiologists, as well as plastic surgery and oncology experts should address the question of fat transfer in operated breast cancer patients and give their reasoned opinion about potentially litigious cases. This would help minimize or solve the conflicts between patients, doctors and experts. Establishing common ground between the different stakeholders would allow the development of the technique, as lipomodelling is, according to our experience, a tremendous advance in the treatment of sequelae from conservative breast cancer surgery.

[Mammary augmentation surgery and psychology. Clinical reports]. / Bases psychologiques de la demande en chirurgie d'augmentation mammaire. Observations cliniques.

With the clinical observations, the women having request at surgical operations of putting the breast implants, the authors define two groups of requests, by which the women suffered from their breast alterations or hypoplasies. In the different cases the suffering takes the form of identity fault of their feminity. What brings to the reflection on the final definition and formation of the women's identity feelings, the breast implants playing the positive part of reidentification the women's image.

[Information of the patient: the characteristics of implant breast augmentation]. / Information de la patiente: les particularités de l'augmentation mammaire par prothèse.

Delivering full information and obtaining enlightened assent is an unavoidable stage before each operation. This paper presents the different "rules" that defines this information duty in France. The assimilation of these different elements: sources, contents and the weight of the information can help the surgeon to carry out the consultation before breast augmentation with more efficiency and objectivity. This preoperative consultation can be divided into 10 steps. Each step is submitted to specific directives, which will depend on the scientific, the law, and the jurisprudence evolution. Therefore, in addition to this article, one can find the new information card concerning implant breast augmentation of the French society of plastic reconstructive and aesthetic surgery. This card is the first update of the previous information cards published in 2002. This card guarantees clear, simple and complete information being a base for information duty.

[Retrospective study of medicojuridical complications through the expertise. Elements to take into consideration by plastic surgeons]. / Etude rétrospective des complications médicojuridiques au travers des expertises. Eléments à prendre en compte par les chirurgiens plasticiens.

The majority of the incidents declarations made to Afssaps are the flats and the ruptures of the breasts implants, but this incident type is rarely the lawsuit. So, the litigation origins brought in front of the courts, we find more often a result of imperfection, a prothetic malposition or even the succession of interventions bringing about an increase insatisfaction. To condemn the surgeon, the Magistrate is generally based on the defect of information. This one, underline the necessity to have delivered full information and to have a writing proof and signed of the effective delivery of this information.

[Injectable collagen]. / Collagène injectable.

The aim of this paper is to evaluate the so-called "American" injectable collagen, produced since 1975 by Collagen Corporation. Main interest of that work concerns an actual follow-up on millions of patients, treated since 25 years, with more than 280 clinic studies published throughout international literature. Everybody knows that--in human therapeutic--a very long follow-up and a great number of patients is a warranty for a complete security. This Collagen is natural, extracted from bovine dermis; this is the first "true cosmetic drug". Therefore, rigorous practice conditions have to be respected.

[The therapeutic function of the aesthetic surgery]. / La fonction thérapeutique de la chirurgie esthétique.

By its definition and its etymology, aesthetic surgery is as much a surgery for the soul as for the body. Aesthetic surgery is a true "armed" therapy that essentially targets the psychology of the patient. This therapeutic "arsenal" preserves and/or restores the health of the patient according to its different aspects as defined by the World Health Organization. The plastic surgeon is always concerned about his patient as a whole, and as a human being, of whom he takes charge. Indeed there lies his specificity: He is as well a surgeon and a physician. We identify and analyze, in this chapter, the particular quality of patient-surgeon relationship on a surgical, psychological and juridical level. It is interesting to note that this collaboration results from a spontaneous convergence. The surgeon, the main interested figure, asserts himself mainly as a physician that is totally involved in a dialogue with his patient. He multiplies the interviews and he sharpens his clinical approach, and his own reactions, with regard to the demand for plastic surgery. The psychiatrist establishes the theoretical and practical aspects of the patient demand. The jurist, far from the barren dissertation of the law, reconsiders the environment of the demand and legitimates the generating wish: he insists on the necessary information but also on assuming responsibility. The therapeutic function of the plastic surgery appears essentially related to the success of a psychic repair solicited by the patient but that is scarcely specified by him as such, and of which he is, most probably, rarely fully aware. The process is to listen and to gather the information that guarantees mutual understanding. Plastic surgery is considered irreplaceable by many of our patients, and indisputable by us. It brings incomparable social and human fertility. It is, however, an ambitious and difficult project that is highly demanding. It is far from the impression of facility reflected by the media. Every actor of this scene, where the patient takes the center stage, must be aware of it.

[Liposuction and liposculpture]. / Lipo-aspiration et liposculpture.

Liposuction set a watershed in the evolution of plastic and cosmetic surgery, by allowing permanent removal of excess fat localized underneath the skin. Many body areas, once considered as untouchable, are now accessible since liposuction grew superficial and circular. Liposuction, generating skin retraction, made shorter scars feasible in most cosmetic surgery procedures, and opened up the way to liposculpture of the face and the body. Constantly improving therapeutic means have been succeeding one another: use of sharp followed by blunt cannula, laser/ultrasound-assisted liposuction, as well as rotary and vibrating cannula: what will remain in a few years em leader ? It is today taken for granted, that liposuction, now becoming sculptured, cannot be ignored anymore, and numerous ongoing research studies ensure that it still has a long life ahead.

[Cards of information and informed consent. Proposal of 14 information cards for plastic and aesthetic surgery]. / Fiches d'information et consentement éclairé. Proposition de 14 fiches d'information concernant la chirurgie plastique et esthétique.

Obligation to deliver full information and obtaining enlightened assent are now, for the whole French practitioner, a necessary preliminary to each operation. Henceforth, in case of suit, the practitioner must prove the reality and the quality of preoperatoire information. The National Medical French Council (CNOM) called scientific societies attention to propose to their members some index standard cards, corresponding to mail medical and surgical records. The National Agency for Accreditation and Evaluation in Health (Anaes) defined the main characteristics of these documents. The authors propose fourteen information cards corresponding to the most currently operations of plastic and aesthetic surgery. They will being clear and simple, wtih a large agreement, strictly informative and yearly up to date. They have the label and therefore the scientific guarantee of French Society of Plastic Reconstructive and Aesthetic Surgery.

[Information cards and informed consent. A proposal of 12 information cards for plastic and esthetic surgery]. / Fiches d'information et consentement éclairé. Proposition de 12 fiches d'information concernant la chirurgie plastique et esthétique.

Obligation to deliver full information and obtaining enlightened assent are now, for the whole french practitioner, a necessary preliminary to each operation. Henceforth, in case of suit, the practitioner must prove the reality and the quality of preoperative information. The National Medical French Council (CNOM) called scientific societies attention to propose to their members some index standard cards, corresponding to main medical and surgical records. The National Agency for Accreditation and Evaluation in Health (Anaes) defined the main characteristics of these documents. The authors propose twelve information cards corresponding to the most currently operations of plastic and aesthetic surgery. They will being clear and simple, with a large agreement, strictly informative and yearly up to date. They have the label and therefore the scientific guaranty of French Society of Plastic Reconstructive and Aesthetic Surgery.

[Information cards and enlightened assent. Proposition of twelve informant cards for plastic and aesthetic surgery]. / Fiches d'information et consentement éclairé. Proposition de 12 fiches d'information concernant la chirurgie plastique et esthétique.

Obligation to deliver full information and obtaining enlightened assent are now, for the whole french practitioner, a necessary preliminary to each operation. Henceforth, in case of suit, the practitioner must prove the reality and the quality of preoperative information. The National Medical French Council (CNOM) called scientific societies attention to propose to their members some index standard cards, corresponding to main medical and surgical records. The National Agency for Accreditation and Evaluation in Health (Anaes) defined the main characteristics of these documents. The authors propose twelve information cards corresponding to the most currently operations of plastic and aesthetic surgery. They will being clear and simple, with a large agreement, strictly informative and yearly up to date. They have the label and therefore the scientific guaranty of French Society of Plastic Reconstructive and Aesthetic Surgery.

[Information cards and informed consent. Proposal of 12 information cards for plastic and aesthetic surgery]. / Fiches d'information et consentement éclairé. Proposition de 12 fiches d'information concernant la chirurgie plastique et esthétique.

Obligation to deliver full information and obtaining enlightened assent are now, for the whole French practitioner, a necessary preliminary to each operation. Henceforth, in case of suit, the practitioner must prove the reality and the quality of preoperative information. The National Medical French Council (CNOM) called scientific societies attention to propose to their members some index standard cards, corresponding to main medical and surgical records. The National Agency for Accreditation and Evaluation in Health (Anaes) defined the main characteristics of these documents. The authors propose twelve information cards corresponding to the most currently operations of plastic and aesthetic surgery. They will being clear and simple, with a large agreement, strictly informative and yearly up to date. They have the label and therefore the scientific guaranty of French Society of Plastic Reconstructive and Aesthetic Surgery.

["Vertical, triangular mammaplasty technique". Description, indications, six year retrospective study]. / A propos des plasties mammaires verticales: la méthode verticale triangulaire ou "verticale triangulaire technique". Description, indications, étude rétrospective sur six ans.

The authors present a new mammaplasty technique with a vertical scar: the vertical triangular technique (VTT). A retrospective study was carried out on 82 patients, for six years, with a minimal hindsight of one year, an average glandular resection of 190 g and average liposuction of 60 mL. The technical principles are based on mammary liposuction of the basis, the inferior pole and the axillary extension, the glandular cavity of the inferior pole of the breast, the conical shape of the breast and the lower scar cutaneous bursa. The pitfalls and traps to avoid are described: the liposuction must be large enough except concerning segment IV, the cutaneous pinch must be hyper-corrected, the lower subcutaneous mastectomy must be complete, while a perfect suture of the glandular pillars conditions the shape of the future mammary cone. Short-term complications (7.5%) are the slackening of the bursa and seroma. Medium-term complications (< 10%) are the residual distortion of the bursa, an insufficiently tightened pinch, and a glandular resection defect. Analysis of the results of the VTT makes it possible to determine the long-term stability of the shape of the breasts, and to notice that the scar gain does not affect the morphological quality.