La maladie de Mondor : une complication de la chirurgie mammaire

Endermology treatment for breast cancer related lymphedema (ELOCS): Protocol for a phase II randomized controlled trial

OBJECTIVES

Secondary lymphedema is a serious and debilitating condition, which may cause a range of cutaneous, infectious and joint complications with major psychological and social consequences. There is no curative treatment available. Initial symptomatic treatment includes Intensive Decongestive Treatment (IDT), which involves the use of multi-layered compression bandages, along with manual lymph drainage, physical exercise and skin care. IDT leads to an average decrease in limb volume of 20-40%, when compared to the contralateral limb. A better reduction may be obtained through the use of new adjuvant techniques, of which endermology is an example. The aim of this phase II study is to validate an IDT protocol combining endermology with standard of care in breast cancer related lymphedema.

STUDY DESIGN

A standardised care protocol was proposed by the University Hospital of Toulouse's Lymphology team for the treatment of upper limb lymphedema after breast cancer surgery using Cellu M6 (LPG) Endermologie over 30 min. Every patient benefitted from IDT over 5 consecutive days, within the multidisciplinary Lymphology unit. Patients were randomised into three arms as follows: Arm 1: IDT for 5 days with bandages + manual lymphatic drainage. Arm 2: IDT with bandages + manual lymphatic drainage + Cellu M6 for 5 days. Arm 3: bandages + Cellu M6 for 5 days. During the study, patients will be followed-up for a period of 6 months. Use of LPG's Cellu M6 in combination with IDT may improve upper limb volume reduction compared with standard of care. By improving breast cancer related lymphedema, we expect to minimise further fluid build-up and to improve skin care, thus reducing the number of consultations and hospital admissions caused by this condition. The results of the present research protocol are expected to promote evidence supporting the use of endermology in the field of lymphology.

Mondor's Disease after Aesthetic Breast Surgery: A Case Series and Literature Review

Background:

Mondor’s disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor’s disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer.

Materials and Methods:

This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years.

Results:

We found three cases of Mondor’s disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2–3 weeks.

Conclusion:

Mondor’s disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.

Superficial thrombophlebitis (Mondor's Disease) after breast augmentation surgery

Although the aetiology of Mondor's disease remains unclear, the most commonly cited cause is trauma of some sort. Although surgical trauma has frequently been quoted, reports that specifically implicate aesthetic breast surgery are unusual in the literature. In this article, the authors report a case of superficial thrombophlebitis of the anterolateral chest wall secondary to breast augmentation surgery in a woman, five months after the procedure. The authors performed an analysis of the disease's main etiologic components and preponderant clinical aspects, and determined all appropriate therapeutic measures.

[Mondor's disease and breast plastic surgery]

AIM

Mondor's disease is a rare complication following breast plastic surgery.

CASE REPORT

We report the case of a 40-year-old woman with breast shape and volume asymmetry. She was treated by left breast submuscular prothesis augmentation followed by right breast mastopexy 6 months later. Following this surgery, she presented with subcutaneous painful abdominal cords on the right side or Mondor's disease.

DISCUSSION

We discuss the diagnosis, physiopathology and treatment of this disease in the light of scientific literature. The physiopathology is based on fascial origin in a context of local vascularitis.

CONCLUSION

Mondor's disease is a rare but benign pathology following breast plastic surgery. The treatment is symptomatic and the surgeon must reassure the patient on the benignity and the lack of consequence on the final cosmetic result.

Imperfections de résultats des implants mammaires

The non-perfect results of breast implants (i.e. preexisting asymmetries, skin wrinkling, implant displacement, anatomical implant rotation), sometimes temporary in nature, can induce some aesthetic doubts into the patients that might have implications for the patient-plastic surgeon relationship. Preexisting asymmetries (i.e. chest wall, nipple-areola complex and breast mound) considerably influence the final aesthetic result of breast augmentation. Thus, such asymmetries along with their related, even more pronounced, potential postoperative ones should be discussed with patients during the preoperative period. Skin wrinkling is closely related with filler material and implant texture. We believe that the recent, cohesive silicone gel-filled implants, which are of rough texture, might be associated with fewer incidences of skin wrinkling than other implants. Implant displacement, either upwards or downwards, could occur even many years after the operation. Capsular contracture, initial malposition and/or erroneous incision are the main causes of displacement. Anatomical implant rotation seems to be related to the mechanical and geometric features of the implant and to a reduction in adhesion factors. In these cases, implants should be replaced. We must understand that some properties of the implants are not well-known as is also the case of the implant long-run comportment inside the human body. These facts are probably responsible for the appearance of non-perfect, undesirable results. Plastic surgeons should be aware of such "inconveniences" and advise their patients.