[Poor esthetic results after conservative treatment of breast cancer. Technics of partial breast reconstruction]. / Déboires esthétiques après traitement conservateur pour cancer du sein. Les techniques de reconstruction mammaire partielle.

A wide consensus exists today in favour of breast saving procedures for the surgical treatment of small breast cancers. The goal of conservative treatment is to preserve the shape of the breast and consequently to avoid the psychological consequences of the mutilation. In this respect, the final esthetic evaluation of conservative treatment is a major point to be considered after the oncological results. To evaluate these cosmetic results, 89 patients treated more than five years ago were analyzed on a standard picture protocol and rated according to a rigorous scale previously defined. In this group, 45% were rated as excellent, 34% as fair and 21% as poor. These results were compared to the cosmetic results of a second group of patients evaluated after the surgical stage of their conservative treatment in order to precise the morphological damage due to the surgical procedure. In the second group, 73% were rated as excellent, 20% as fair and 7% as poor. This study underlines the frequency of skin contractions (16%) and glandular defects (20%). Several rules are proposed to prevent such sequelae at the time of the tumorectomy. The difficulty of cosmetic improvement of the poor esthetic results is emphasized and the techniques of partial reconstructions are discussed in the light of our experience which includes 25 cases of partial reconstruction.

Breast reconstruction without implant: experience of 52 cases.

Reconstruction of the breast (BR) after mastectomy without using a prosthetic implant has always presented a challenge for plastic surgeons, allowing them to avoid complications due to foreign body and to provide a more natural reconstructed breast. Out of 66 women who underwent BR using the rectus abdominis musculocutaneous flap, 52 received no implant. Ten upper rectus (ERF) and 42 lower rectus (TRAM) were the two procedures applied. The ERF has been abandoned due to the 9% rate of complete necrosis encountered among the total series of rectus flap regardless of the implant inclusion. Partial necrosis was also the most frequent complication of the TRAM (28% among those not having received an implant), but the reconstruction was nevertheless possible in all the cases. The TRAM technique produced abdominal sequelae in 45% of the no-implant cases, though it also improved the cosmetic aspect of the abdomen in an equal number of cases, particularly in obese women. Overall cosmetic results were also better for the TRAM without implant than for the ERF (72% good vs. 51%). Moreover the BR without implant could be performed in only 48% of the total ERF, as compared to 93% of the total TRAM. The major advantage of such BR without implant is that it provides a reconstructed breast which appears more symmetrical to the contralateral breast and which remains even after several years of follow-up.

[Conservative treatment in cancer of the breast]. / Traitement conservateur dans le cancer du sein.

Conservative treatment combining breast saving surgical procedures and radiotherapy, is considered as the best treatment for small breast cancers. The purpose of the study is to define the most appropriate surgical technique in order to reach both the complete resection of the primary and the best cosmetic result. Terms corresponding to the type of resection will be define in order to facilitate the comparison between the different studies on tumorectomies for breast cancer. Technical problems will be analyzed in the light of our experience of the conservative treatment especially in what concerns the cosmetic results.