Incidence of occult contralateral carcinomas of the breast following mastoplasty aimed at symmetrization.

INTRODUCTION: Breast carcinomas are the most frequent form of cancer in French women. Following a total mastectomy, only an estimated 25% of patients wish to undergo breast reconstruction. After mammary volume reconstitution, the plastic surgeon often attempts to harmonize the two breasts by carrying out contralateral reduction mammaplasty (CRM). In the literature, the incidence of occult contralateral carcinomas incidentally discovered in surgical specimens ranges from 1.12 to 4.5%. The main objective of this study was to evaluate occurrence of carcinoma in the CRM specimens in the framework of a breast reconstruction operation. The secondary objective was to determine the consequences of the incidentally discovered carcinoma in the contralateral breast. MATERIAL AND METHODS: This was a 6-year, bicentric, retrospective study involving women having undergone breast cancer surgery who later underwent contralateral reduction mammaplasty (CRM), that is to say reconstruction aimed at harmonization of the two breasts. RESULTS: Three hundred and nineteen patients were included in the study. Mean age during the CRM was 55years (29-79). Mean weight of the surgical specimens was 323grams (12-2500). Incidence of occult carcinomas found in the specimens was 0.94% (3 patients). The mean age for these 3 cases was 58years (47-64). All 3 patients had superior pedicle mammaplasty. One of the patients benefited from monobloc resection with orientation of the surgical specimen. In the other 2 cases, there existed 3 surgical resection specimens; in one case, they were oriented; in the other, they were not. In all 3 cases, the histological findings were unifocal ductal carcinomas in situ (DCIS). Mean tumor size was 5.7mm (3-9). Only the patient having had monobloc resection with orientation of the specimen underwent salvage surgery, which consisted in partial mastectomy, otherwise known as secondary lumpectomy. Adjuvant radiotherapy was administered to all of the patients. After 17months of mean follow-up (12-22), no recurrence was found in any of the three cases. CONCLUSION: Incidence of occult contralateral breast carcinomas after symmetrization CRM approximates 1%. Our observations are in agreement with the data in the literature. Incidence is greater than in mammaplasty carried out for esthetic or functional reasons; this is probably due to the higher age and the previous breast cancer history of the breast reconstruction population. Monobloc resection and orientation of the surgical specimens with surgeon's knots facilitate precise pinpointing of the occult carcinoma. A secondary lumpectomy may take place when margins of excision are invaded or inadequate.

[Thoracodorsal pedicled perforator flap for chest wall and breast reconstruction in children: Illustration with two clinical cases]. / Utilisation du lambeau perforant thoracodorsal dans les séquelles traumatiques cutanées thoracomammaires de l'enfant : illustration par deux cas cliniques.

Perforator flaps represent a new approach in reconstructive surgery including the thoracodorsal perforator flap. It can be used as a free or pedicled tissue transfer. By exposing two clinical cases, we demonstrate that this flap is an interesting option for children and adolescents chest wall skin coverage with less morbidity compared to myocutaneous latissimus dorsi flap.

[Free temporoparietal flap in hand coverage. Report of three cases]. / Les transferts vascularisés de fascia temporalis dans les pertes de substance de la main. A propos de trois cas.

Hands defect coverage needs thin and pliable flaps. Few free flaps such as free temporoparietal flap are adequate. It provides moderate donor scar and unique range of motion for tendinous coverage. We expose three cases of hand reconstruction: two dorsal coverage with tendinous exposition and reconstruction and one thumb coverage. The postoperative results were satisfactory concerning hands. One patient developed alopecia and dysesthesis on scalp. We think that this flap is a good alternative for serratus free fascial flap.

[Controversies regarding the orbital septum]. / Controverses sur le septum orbitaire.

The orbital septum, a well-known structure since a long time ago, is a controversy object anyway. Its physiological, anatomical and pathological importance is undeniable. However, it will be difficult not to consider it as a part of the whole structure which organizes the general system of the soft tissues of the face, in which the orbital frame is one of the pivots.

[Results of long-term treatment of cystine lithiasis with D-penicillamine]. / Résultats du traitement au long cours de la lithiase cystinique par la D-pénicillamine.

Eight patients with cystine stones (7 adults, 1 children) are treated by D-penicillamine since at least 5 years and at the most 9 years. The goal of the treatment is to obtain free cystinuria concentration less than 200 mg/l by the conjunction of a high urine flow and D-penicillamine. Cystinuria is measured by automatic analyser chromatography. In 2 patients, lithiasis got worse and cystinuria remained highly pathologic because bad compliance. In the 6 other cases, no lithiasis recurrence was noted; 5 patients had renal unilateral or bilateral lithiasis before treatment. A partial stone dissolution was obtained in 3 patients and total stone dissolution in 1 patient. Despite important posology often used, D-penicillamine has been remarkably well tolered since the only side effect observed was erythrodermia in 1 case at the beginning of the treatment.