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Barranger E, Ihrai T. Comment on: Sentinel Node Biopsy Using Magnetic Tracer Versus Standard Technique: The SentiMAG Multicentre Trial. Ann Surg Oncol 2017; 24:593. [PMID: 29168095 DOI: 10.1245/s10434-017-6191-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Emmanuel Barranger
- Breast and Gynecological Surgical Oncology Unit, Centre Antoine Lacassagne, University of Nice Sophia-Antipolis, 33 avenue de Valombrose, 06189, Nice Cedex 2, France.
| | - Tarik Ihrai
- Breast and Gynecological Surgical Oncology Unit, Centre Antoine Lacassagne, University of Nice Sophia-Antipolis, 33 avenue de Valombrose, 06189, Nice Cedex 2, France
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Camuzard O, Foissac R, Clerico C, Fernandez J, Balaguer T, Ihrai T, de Peretti F, Baqué P, Boileau P, Georgiou C, Bronsard N. Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application. J Bone Joint Surg Am 2016; 98:457-65. [PMID: 26984913 DOI: 10.2106/jbjs.o.00760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow. METHODS Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators. RESULTS A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months. CONCLUSIONS The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction. CLINICAL RELEVANCE The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.
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Affiliation(s)
- Olivier Camuzard
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France UMR E-4320 MATOs CEA/iBEB/SBTN-CAL, Université Nice Sophia Antipolis, Faculté de Médecine, Nice, France
| | - Rémi Foissac
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Cyril Clerico
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Jonathan Fernandez
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Thierry Balaguer
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Tarik Ihrai
- Service de Chirurgie Oncologique Réparatrice, CAL, Nice, France
| | - Fernand de Peretti
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France
| | - Patrick Baqué
- Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France
| | - Pascal Boileau
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Charalambos Georgiou
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Nicolas Bronsard
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France
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Clerico C, Fernandez J, Camuzard O, Chignon-Sicard B, Ihrai T. Hyperhidrose axillaire, traitement par injection de toxine botulique de type A : revue de la littérature. ANN CHIR PLAST ESTH 2016; 61:60-4. [DOI: 10.1016/j.anplas.2014.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
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Barranger E, Antomarchi J, Chamorey E, Cavrot C, Flipo B, Follana P, Peyrottes I, Chapellier C, Ferrero JM, Ihrai T. Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients With Locally Advanced Breast Cancer Requiring Initial Mastectomy. Clin Breast Cancer 2015; 15:e231-5. [PMID: 25887149 DOI: 10.1016/j.clbc.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/04/2015] [Accepted: 03/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the rate of breast-conserving surgery (BCS) after neoadjuvant chemotherapy (nCT) in patients for whom mastectomy (MT) was, initially, the only conceivable surgical option. PATIENTS AND METHODS Between 2007 and 2012, 168 patients from a single center received nCT. Among these patients, we focused on the ones who received nCT (n = 119, [70.8%]) to decrease tumor size and thus to potentially allow a conservative surgical treatment. For these patients, MT was initially the only possible surgical treatment. RESULTS Among the 119 patients included, 118 presented with an invasive ductal carcinoma. The mean tumor size before nCT, measured using magnetic resonance imaging, was 41.6 mm (range, 15-110 mm) and 25.3 mm (range, 0-90 mm) after nCT. Eighty-six patients (72.3%) underwent BCS, and oncoplastic techniques were used in 29 patients (33.6%). Only 4.3% (5 patients) of patients who were treated with BCS needed additional surgery because of positive surgical margins. The median follow-up was 41.1 months (95% confidence interval [CI], 35.2-48.3). Five-year overall survival after BCS and MT were 77% (95% CI, 63-92) and 77% (95% CI, 63-95) respectively. Five-year disease-free survival after BCS and MT were 74% (95% CI, 64-86) and 59% (95% CI, 40-89) (not significant), respectively. CONCLUSION nCT for selective patients with "chemosensitive" breast tumor leads to a significant "MT to BCS" conversion rate. The type of surgery does not seem to affect the patient's overall and disease-free survival rates. Oncoplastic procedures can help to extend BCS after nCT.
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Affiliation(s)
- Emmanuel Barranger
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France.
| | - Julie Antomarchi
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
| | - Emmanuel Chamorey
- Département de recherche Clinique et innovation et statistiques, Centre Antoine Lacassagne, Nice, France
| | - Constance Cavrot
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
| | - Bernard Flipo
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
| | - Philippe Follana
- Département d'oncologie médicale, Centre Antoine Lacassagne, Nice, France
| | - Isabelle Peyrottes
- Département d'anatomie-pathologique, Centre Antoine Lacassagne, Nice, France
| | | | - Jean Marc Ferrero
- Département d'oncologie médicale, Centre Antoine Lacassagne, Nice, France
| | - Tarik Ihrai
- Département de chirurgie oncologique, Centre Antoine Lacassagne, Nice, France
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Antomarchi J, Cavrot C, Chamorey E, Ihrai T, Flipo B, Peyrottes I, Follana P, Chapellier C, Ferrero J, Barranger E. Effect of Neoadjuvant Chemotherapy on the Surgical Treatment of Patients with Locally Advanced Breast Cancer Requiring Initial Mastectomy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu328.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barranger E, Delmas M, Ihrai T, Flipo B, Darcourt J. Technique d’identification du ganglion sentinelle dans le cancer du sein par traceur magnétique : étude préliminaire. ACTA ACUST UNITED AC 2014; 42:490-3. [DOI: 10.1016/j.gyobfe.2014.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/07/2014] [Indexed: 02/05/2023]
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Barranger E, Ihrai T. Response to the article by Thill et al.: “The Central-European SentiMag study: Sentinel lymph node biopsy with supermagnetic iron oxide (SPIO) vs. radioisotope”. The Breast 2014. Breast 2014; 23:297. [DOI: 10.1016/j.breast.2014.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 03/09/2014] [Indexed: 10/25/2022] Open
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Genebes C, Chand ME, Gal J, Gautier M, Raoust I, Ihrai T, Courdi A, Ferrero JM, Peyrottes I, Hannoun-Levi JM. Accelerated partial breast irradiation in the elderly: 5-year results of high-dose rate multi-catheter brachytherapy. Radiat Oncol 2014; 9:115. [PMID: 24886680 PMCID: PMC4045692 DOI: 10.1186/1748-717x-9-115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 04/27/2014] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate clinical outcome after accelerated partial breast irradiation (APBI) in the elderly after high-dose-rate interstitial multi-catheter brachytherapy (HIBT). Methods and materials Between 2005 and 2013, 70 patients underwent APBI using HIBT. Catheter implant was performed intra or post-operatively (referred patients) after lumpectomy and axillary sentinel lymph node dissection. Once the pathological results confirmed the indication of APBI, planification CT-scan was performed to deliver 34 Gy/10f/5d or 32 Gy/8f/4d. Dose-volume adaptation was manually achieved (graphical optimization). Dosimetric results and clinical outcome were retrospectively analyzed. Physician cosmetic evaluation was reported. Results With a median follow-up of 60.9 months [4.6 – 90.1], median age was 80.7 years [62 – 93.1]. Regarding APBI ASTRO criteria, 61.4%, 18.6% and 20% were classified as suitable, cautionary and non-suitable respectively. Axillary sentinel lymph node dissection was performed in 94.3%; 8 pts (11.5%) presented an axillary involvement. A median dose of 34 Gy [32 – 35] in 8 to 10 fractions was delivered. Median CTV was 75.2 cc [16.9 – 210], median D90 EQD2 was 43.3 Gy [35 – 72.6] and median DHI was 0.54 [0.19 – 0.74]. One patient experienced ipsilateral recurrence (5-year local free recurrence rate: 97.6%. Five-year specific and overall survival rates were 97.9% and 93.2% respectively. Thirty-four patients (48%) presented 47 late complications classified grade 1 (80.8%) and grade 2 (19.2%) with no grade ≥ 3. Cosmetic results were considered excellent/good for 67 pts (95.7%). Conclusion APBI using HIBT and respecting strict rules of implantation and planification, represents a smart alternative between no post-operative irradiation and whole breast irradiation delivered over 6 consecutive weeks.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jean-Michel Hannoun-Levi
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 33, avenue de Valombrose, Nice 06189, France.
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Ihrai T, Quaranta D, Fouche Y, Machiavello JC, Raoust I, Chapellier C, Maestro C, Marcy M, Ferrero JM, Flipo B. Intraoperative radiological margin assessment in breast-conserving surgery. Eur J Surg Oncol 2014; 40:449-53. [DOI: 10.1016/j.ejso.2014.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/28/2013] [Accepted: 01/04/2014] [Indexed: 10/25/2022] Open
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Foissac R, Ihrai T, Cegarra-Escolano M, Chignon-Sicard B, Flipo B. ["V" axillary incision for the management of tumors of upper outer quadrant and axillary tail of the breast: retrospective study and technical description]. ANN CHIR PLAST ESTH 2014; 59:320-6. [PMID: 24673937 DOI: 10.1016/j.anplas.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/17/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tumors of the upper outer quadrant of the breast represent the most common location of breast malignant tumors. Although the choice of surgical approach should be dictated primarily by an imperative of oncological safety, esthetic and practical considerations of the surgeon as well as the esthetic demands of patients have become increasingly important with the development of breast conservative surgery. MATERIALS AND METHODS In this retrospective study, we reviewed 30 patients (mean age: 62.3 years) who were operated for a tumor of the upper outer quadrant (50 %) or the axillary tail (50 %) of the breast and who received a "V" axillary incision between 2008 and 2012. The incision draws a "V" that comprises a horizontal incision in an axilla fold associated with a vertical arcuate incision in a Langer line of the breast. The number and type of postoperative complications were collected. Patients were asked about the quality of their scar, position of the areola and breast shape was notified during consultations control. RESULTS The mean follow-up of patients was 32.7 months. No postoperative complications were observed. A percentage of 86.6 % of patients rated their scar result as excellent. We found no areolar malposition and no morphological deformation of the breast. The surgeons who performed this technique were very pleased with the wide exposure and the uniqueness of this incision fully respecting the architecture of the breast. CONCLUSION "V" axillary incision is a useful and easily reproducible technical option for the management of tumors of the upper outer quadrant and the axillary tail of the breast.
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Affiliation(s)
- R Foissac
- Unité de chirurgie sénologique, Centre Antoine-Lacassagne, 06189 Nice, France.
| | - T Ihrai
- Unité de chirurgie sénologique, Centre Antoine-Lacassagne, 06189 Nice, France
| | - M Cegarra-Escolano
- Unité de chirurgie sénologique, Centre Antoine-Lacassagne, 06189 Nice, France
| | - B Chignon-Sicard
- Unité de chirurgie sénologique, Centre Antoine-Lacassagne, 06189 Nice, France
| | - B Flipo
- Unité de chirurgie sénologique, Centre Antoine-Lacassagne, 06189 Nice, France.
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Hannoun-Levi J, Genebes C, Chand M, Gal J, Gautier M, Raoust I, Ihrai T, Flipo B, Ferrero J, Courdi A. PO-1002: APBI in the elderly: 5-year results of high-dose-rate interstitial multicatheter brachytherapy. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31120-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clough KB, Oden S, Ihrai T, Massey E, Nos C, Sarfati I. Level 2 oncoplastic surgery for lower inner quadrant breast cancers: the LIQ-V mammoplasty. Ann Surg Oncol 2013; 20:3847-54. [PMID: 23838910 DOI: 10.1245/s10434-013-3085-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oncoplastic surgical techniques offer an option of breast conserving surgery for larger tumors with the use of glandular reshaping to prevent postoperative deformity. A technique for the excision of lower inner quadrant tumors via a V incision is described, the lower-inner quadrant-V (LIQ-V) mammoplasty, and the results of a pilot study are reported. METHODS Retrospective collection of pre- and postoperative data was collected from patients undergoing a LIQ-V mammoplasty for a LIQ tumor. RESULTS Twenty-two patients were operated on between 2004 and 2011 at a mean age of 58 years. The mean follow-up was 55 months. The mean resection weight was 101 g for tumors ranging in size from 4 to 31 mm. The margins were clear in 95% of cases. There was one case of local recurrence and metastatic disease. The cosmetic outcome was judged as excellent in 68% of cases, and no patient required further ipsilateral or contralateral symmetrizing surgery. DISCUSSION The deformity often associated with tumors of the LIQ is adequately addressed by this new technique. It has a complication rate comparable to other mammoplasty series and a high rate of clear resection margins. Many oncoplastic surgery techniques are based on inverted T mammoplasty, but these are not suited for all tumor locations. The LIQ-V mammoplasty is an adaptation of the standard techniques that best suit the LIQ. It is oncologically safe and provides disease-free margins, and although the resection volumes are large, the cosmetic outcome is not compromised.
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Ihrai T, Georgiou C, Machiavello JC, Chignon-Sicard B, Figl A, Raoust I, Bourgeon Y, Fouche Y, Flipo B. Autologous fat grafting and breast cancer recurrences: Retrospective analysis of a series of 100 procedures in 64 patients. J Plast Surg Hand Surg 2013; 47:273-5. [DOI: 10.3109/2000656x.2012.759583] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hannoun-Levi JM, Ihrai T, Courdi A. Local treatment options for ipsilateral breast tumour recurrence. Cancer Treat Rev 2013; 39:737-41. [PMID: 23465859 DOI: 10.1016/j.ctrv.2013.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 02/04/2013] [Accepted: 02/07/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE In case of ipsilateral breast tumour recurrence (IBTR), radical mastectomy represents the treatment option frequently proposed. A second conservative treatment (2ndCT) has been proposed using either lumpectomy alone or associated with a re-irradiation of the tumor bed. However, in both clinical situations, the proof level of such therapeutic approaches remains low, based on cased-series or retrospective studies (level C). MATERIAL AND METHODS In order to assess the different strategies of local treatment proposed in case of IBTR, a PubMed literature review was performed using the following keywords: breast cancer, ipsilateral recurrence, mastectomy, radiation therapy, brachytherapy. Four different salvage options were analyzed: (a) salvage mastectomy alone; (b) salvage mastectomy with postoperative re-irradiation; (c) 2ndCT with surgery alone; (d) 2ndCT with re-irradiation. RESULTS The rate of second local recurrence is about 10% [3-32%], about 25% [7-36%] and about 10% [2-26%], after salvage mastectomy, salvage lumpectomy alone or combined with a re-irradiation of the tumor bed respectively. However, the 5-year overall survival rates after salvage mastectomy and 2ndCT seem to be equivalent (≈75%) mainly influenced by distant metastatic progression. CONCLUSION In terms of Evidence Based Medicine, different options can be discussed such as Phase III or II randomized trials comparing salvage mastectomy versus 2ndCT, retrospective studies based on a matched-pair analysis or observatory studies. Those study designs need to be carefully analyzed to be able to propose new treatment options for women who experience an IBCR.
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Affiliation(s)
- Jean-Michel Hannoun-Levi
- Department of Radiation Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, France.
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Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg 2012; 99:1389-95. [PMID: 22961518 DOI: 10.1002/bjs.8877] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The majority of published techniques for oncoplastic surgery rely on an inverted-T mammoplasty, independent of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant-per-quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique dependent on tumour location, which reduces the risk of postoperative complications and delay to adjuvant therapy. METHODS From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant-specific oncoplastic techniques. All complications and any delay to adjuvant treatment were recorded prospectively, along with local and distant cancer recurrences. Cosmetic outcome was evaluated using a five-point scale. RESULTS A total of 175 patients were analysed. The median tumour size, after histological examination, was 25 (range 4-90) mm. Twenty-three patients (13.1 per cent) had involved margins. Seventeen of these patients were treated by mastectomy and three had a re-excision. Complications occurred in 13 patients (7.4 per cent), which led to a delay to adjuvant treatment in three (1.7 per cent). After a median follow-up of 49 (range 23-96) months, three patients had developed a local recurrence. The mean score after cosmetic evaluation was 4.6 of 5. CONCLUSION A quadrant-per-quadrant approach to oncoplastic techniques for breast cancer was developed that tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide for breast surgeons, and extends the possibilities for breast conservation for large or poorly limited cancers, with a low complication rate and good cosmetic results.
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Affiliation(s)
- K B Clough
- The Paris Breast Centre--L'Institut du Sein, Paris, France.
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Sarfati I, Ihrai T, Duvernay A, Nos C, Clough K. [Autologous fat grafting to the postmastectomy irradiated chest wall prior to breast implant reconstruction: a series of 68 patients]. ANN CHIR PLAST ESTH 2012; 58:35-40. [PMID: 23158103 DOI: 10.1016/j.anplas.2012.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION After radiotherapy, breast reconstruction with an implant carries a high risk of failure and complication. Clinical and experimental studies have demonstrated that grafting adipose tissue (lipofilling) in an irradiated area enhances skin trophicity. Thus, we have started performing preliminary fat grafting to the irradiated chest wall prior to implant reconstruction in order to limit complications and failure risk. PATIENTS AND METHODS Patients were included in this study from 2007 to 2011. All patients had had mastectomy and irradiation for breast cancer. They all had one or more sessions of lipofilling prior to breast implant reconstruction. These patients were prospectively followed up in order to collect the following data: postoperative complications; cosmetic result; local breast cancer recurrences. RESULTS Sixty-eight patients were included. The mean number of fat grafting sessions was 2.3 (range 1-6). An average volume of 115mL (70-275) was injected each time. The mean volume of breast implants was 300mL (185-400). The mean follow-up was 23months (450). No breast cancer local recurrence was diagnosed during follow-up. Implant explantation was performed in one case (1.47%) The mean cosmetic result was 4.5/5. CONCLUSION Fat grafting to the irradiated chest wall prior to implant placement might be an alternative to flap reconstruction for patients who are not suitable or who refuse this option.
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Affiliation(s)
- I Sarfati
- L'institut du sein, 7, avenue Bugeaud, 75016 Paris, France
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Massey E, Ihrai T, Oden S, Kaufman G, Nos C, Clough K. P88. A consecutive series of oncoplastic surgery for breast cancer based on a quadrant-per-quadrant atlas. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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18
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Georgiou CA, Ihrai T, Chamorey E, Flipo B, Chignon-Sicard B. A formula for implant volume choice in breast reconstruction after nipple sparing mastectomy. Breast 2012; 21:781-2. [PMID: 23079561 DOI: 10.1016/j.breast.2012.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022] Open
Abstract
Implant choice after Nipple Sparing Mastectomy (NSM) is a problematic perioperative issue. In this retrospective study, the authors searched for a correlation between mastectomy weight and implant volume choice after NSM. A mathematical expression of this correlation was found that might help surgeons decide implant volume after NSM.
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Affiliation(s)
- Charalambos A Georgiou
- Breast Cancer and Reconstructive Surgery Unit, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice cedex 2, France.
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Clerico C, Ihrai T, Raoust I, Chignon-Sicard B, Georgiou C, Flipo B. [Mastectomy and immediate breast reconstruction using a prosthesis and lower dermal flap: description of five cases]. ANN CHIR PLAST ESTH 2012; 57:606-11. [PMID: 22868066 DOI: 10.1016/j.anplas.2012.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 06/13/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION When performing mastectomy involving immediate reconstruction with prosthesis, it is required to obtain a complete cover of the implant. However, this is hardly ever possible for patients having a significant breast volume, despite the use of the skin-reducing technique. Using the lower dermal flap makes it possible to fully cover the implant for these patients. PATIENTS AND METHODS We will describe five cases of patients on whom skin-reducing mastectomy and immediate reconstruction with prosthesis and lower dermal flap were performed. Preoperative drawings were made following the so-called "Saint-Louis" pattern. During surgery, the future skin flap representing the skin cover of lower breast quadrants was de-epidermised. Mastectomy was then performed via an incision at the upper limit of the future flap. Then, a retro-pectoral pocket was created by lifting the pectoralis major muscle. The implant was introduced into this pocket and covered up at its lower part by the dermal flap, the upper edge of which was sutured to the lower edge of the pectoralis major muscle. The implant was thereby fully covered. Finally, the skin was closed with inverted T-scars. RESULTS Postoperative effects were minor. Two patients suffered from skin pain at the junction between the vertical and horizontal scars of the inverted T. These injuries were treated via healing by secondary intention. We have not observed any infection. Cosmetic results assessed by the patients and surgical team were considered as satisfactory. CONCLUSION Mastectomy with immediate reconstruction using a prosthesis and lower dermal flap makes it possible to fully cover the implant in patients who require the skin-reducing technique. This technique seems to minimise the risk of major complications and generates satisfactory cosmetic results.
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Affiliation(s)
- C Clerico
- Centre Antoine-Lacassagne, Nice, France.
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Ihrai T, Quaranta D, Fouche Y, Raoust I, Machiavello J, Maestro C, Chapellier C, Flipo B. 612 Intraoperative Radiological Evaluation of Margins in Breast Conserving Surgery: Analysis of 140 Cases. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70677-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barrière J, Mari V, Follana P, Largillier R, Chamorey E, Lescaut W, Flipo B, Ettore F, Raoust I, Peyrottes I, Figl A, Marcy M, Ihrai T, Courdi A, Ferrero J. Long-term responders to trastuzumab among patients with HER2-positive metastatic breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e11062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hannoun-Levi J, Ihrai T, Flipo B, Courdi A, Ettore F, Chapellier C, Figl A, Raoust I. 751 poster DO WE MUST CONSIDER MASTECTOMY AS THE STANDARD SALVAGE THERAPY FOR IPSILATERAL BREAST CANCER RECURRENCE? Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70873-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Sarfati I, Ihrai T, Kaufman G, Nos C, Clough KB. Adipose-tissue grafting to the post-mastectomy irradiated chest wall: preparing the ground for implant reconstruction. J Plast Reconstr Aesthet Surg 2011; 64:1161-6. [PMID: 21514910 DOI: 10.1016/j.bjps.2011.03.031] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 02/07/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Breast implant reconstruction after radiotherapy carries a high risk of failure and complication. Nevertheless, it may be the only alternative for patients who are not suitable for autologous reconstruction or who refuse this option. As clinical and experimental studies have demonstrated that grafting adipose tissue (lipofilling) in an irradiated area improves the quality of the skin, we made the assumption that preliminary fat grafting of the chest wall might reduce the complication and failure rates of implant reconstruction by improving the implant coverage. PATIENTS AND METHODS From 2007 to 2009, 28 patients had fat transfer to the chest wall, prior to implant reconstruction. All patients had had mastectomy and irradiation for breast cancer. Lipofilling was initiated 6 months after the end of radiotherapy. The mean number of fat-grafting sessions was 2 (range 1-3). An average volume of 115 cc (70-275 cc) was injected each time. Once the chest wall's skin seemed to have gained enough thickness, implant reconstruction was performed. RESULTS The mean follow-up period was 17 months. Three minor complications occurred. Implant explantation was performed in one case for exposition. The cosmetic results were good and very good in >80% of the cases. CONCLUSION This study points out the benefits of fat grafting to the irradiated chest wall prior to implant placement and demonstrates that lipofilling prepares the ground to implant breast reconstruction. This approach could be considered as an alternative to flap reconstruction for selected patients.
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Affiliation(s)
- I Sarfati
- Paris Breast Center, L'Institut Du Sein, Paris, France.
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Médard de Chardon V, Balaguer T, Chignon-Sicard B, Ihrai T, Lebreton E. Les asymétries constitutionnelles en chirurgie d’augmentation mammaire esthétique : incidence, satisfaction et applications chirurgicales. ANN CHIR PLAST ESTH 2009; 54:340-7. [DOI: 10.1016/j.anplas.2009.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2008] [Accepted: 01/16/2009] [Indexed: 11/29/2022]
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Balaguer T, David S, Ihrai T, Cardot N, Daideri G, Lebreton E. Histological staging and Dupuytren's disease recurrence or extension after surgical treatment: a retrospective study of 124 patients. J Hand Surg Eur Vol 2009; 34:493-6. [PMID: 19675030 DOI: 10.1177/1753193409103729] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dupuytren's disease has a high rate of recurrence after treatment. In this study we have assessed the usefulness of histological staging in the prediction of recurrence. We have also verified whether there is a correlation between histological staging and features of Dupuytren's diathesis. We studied 139 hands in 124 Caucasian patients treated between 1997 and 2004. There was a significant difference in the recurrence rate between the three histological types (P = 0.04). Histological staging was independent of features of Dupuytren's diathesis. This study confirms that histological staging is a reliable method for predicting recurrence. However, it should be used in association with clinical data to determine precisely the prognosis of patients suffering from Dupuytren's contracture.
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Affiliation(s)
- T Balaguer
- Nice Sophia Antipolis University, Nice, France
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Ihrai T, Balaguer T, Monteil MC, Chignon-Sicard B, Médard de Chardon V, Riah Y, Lebreton E. [Surgical management of traumatic ear amputations: literature review]. ANN CHIR PLAST ESTH 2008; 54:146-51. [PMID: 19042071 DOI: 10.1016/j.anplas.2008.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 08/07/2008] [Indexed: 11/28/2022]
Abstract
Traumatic ear amputation (TEA) is a complete avulsion of a part or of the total auricular tissue. TEA are rare (only 74 cases have been described in the literature) and their handling is complex. The surgeon's objective is to obtain the best cosmetic result without demolishing the auricular area in order to allow future ear reconstruction in case of replantation failure. Many techniques of ear replantation have been described in the literature during the last 30 years: microsurgical replantation, pocket techniques and reattachment techniques. Microsurgical replantation should be achieved every time it is possible. When it is not possible, the surgeon can choose between ear reattachment and a pocket technique according to two clinical features: the size of the amputated part and the involvement of the ear lobe. Ear reattachment can be achieved when the amputated part is smaller than 15 mm or when amputation involves the earlobe. Pocket techniques, which are appropriate for the replantation of the auricular cartilage, can be used when the amputated part is bigger than 15 mm and does not comprise the earlobe.
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Affiliation(s)
- T Ihrai
- Service de chirurgie plastique et réparatrice, chirurgie de la main, hôpital Saint-Roch, CHU de Nice, université de Nice Sophia-Antipolis, 5, rue Pierre-Devoluy, 06000 Nice, France.
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