Reconstructions mammaires après mastectomie pour cancer du sein : quelles indications retenir ?

[Contralateral breast outcome after breast reconstruction for carcinoma]

OBJECTIF: Since the treatment of breast cancer must be followed by a rigorous surveillance of the contralateral breast, especially in breast reconstruction context, we sought to determine contralateral breast cancer frequency after breast reconstruction during the ulterior surveillance.

PATIENTS AND METHODS

Retrospective cohort survey of 273 breast reconstructions led at Tours regional and university hospital. Cumulative incidence of sequential contralateral breast cancer has been evaluated.

RESULTS

For 6.6 follow-up, the prevalence was 1.8% and cumulated incidence at 4.6 ‰ person/years.

DISCUSSION AND CONCLUSION

The probability of localization to contralateral breast after a primitive tumor of the breast is raised. The diagnosis of a sequential cancer must not be delayed by mammaplasty scars overhauls.

[Patients' preferences and decision-making: state of the art and applications in cancer]

BACKGROUND

This paper deals with the physician-patient encounter. In France, the current legal framework allows patients to be informed (patients' rights to health information) and to participate to decisions regarding their own health. In such a context, this paper aims to give the reader the broad key components of the so-called 'patient treatment preferences elicitation process' in breast cancer, our research area.

METHODS AND RESULTS

We first present the general context, with a definition of the different physician-patient models. We then present decision aids, tools that aim to provide high-quality information to patients in the decision-making process. Finally, based on our previous studies and on examples drawn from the international literature, we present the empirical process of patients' preferences elicitation, which not only increases patients' knowledge of and satisfaction with the decision made, but also allows patients to be part of their disease management.

CONCLUSION

Far from being a phenomenon in the air supported by a legal system, this method developed in the 90s allows patients and more generally healthcare users to be autonomous without constraining them to a choice.

Apport du bistouri à ultrasons dans la reconstruction mammaire autologue par lambeau de grand dorsal

OBJECTIVE

To study the ultrasonic energy dissection technique in breast reconstruction with the autologous latissimus dorsi flap and to evaluate its effect on seroma formation and other postoperative complications.

MATERIALS AND METHODS

Prospective monocentric study, between October 2003 and April 2004, including all the patients with breast reconstruction with the autologous latissimus dorsi flap performed with Ultracision Harmonic Scalpel. The patients were followed daily for one month and postoperative drainage volume, seroma formation, local infection or other wound complications were noted.

RESULTS

Twenty-one patients, aged 47 to 62 years old, underwent breast reconstruction with this technique. The median operating time was 74 minutes. The median drainage volume was 102.2 ml/day for the first week, 58.1 ml/day for the second week, and 28.4 ml/day for the third week. The last drain was removed at the 25th day postoperatively, half of the patients were drain free at the 20th day. No blood transfusion was necessary. The postoperative complications were dehiscent scars in two patients, with a wound infection in one case. Only one patient (4.8%) required two seroma punctures.

CONCLUSION

The ultrasonic energy dissection technique in breast reconstruction was found to be an interesting alternative to the conventionnal scalpel with less seroma formation and no additional disadvantages.