[Poly Implant Prothèse (PIP®) incidence of complications in breast reconstructive surgery: A retrospective comparative analysis]

INTRODUCTION

On 29 March 2010, the Poly Implant Prothèse (PIP(®)) breast prosthesis was withdrawn from the market by the ANSM. In this study we review our experience with PIP(®) implants in breast reconstruction. We compare our complications with other types of breast implants used during the same period at our institution.

PATIENTS AND METHOD

This is a retrospective study conducted at the Hospital René Huguenin of the Institut Curie (Paris, France). It includes 327 prostheses, from 268 patients who underwent surgery for breast reconstruction between February 2008 and February 2012: 69 PIP(®) (Group 1), 82 Mentor(®) (Group 2) and 179 Allergan(®) (Group 3). The objective of the study was to compare the rates of early and late complications for each prosthesis. Our results are compared with the current literature.

RESULTS

With regard to the rate of early complications (hematoma, infection, seroma, wound dehiscence), no difference was observed between the three groups (P not significant). However, the study found that 100% of the 13 PIP(®) implants with early complications required surgical revision. There were too few late complications (capsular contracture, prosthetic rupture) in our cohort to allow statistical comparison between the three groups (P not significant). We compare our results with the current literature.

CONCLUSION

This study highlights the lack of significant difference in the occurrence of early adverse events between the three groups of implants. This may explain the time taken for surgeons to become aware there was a problem with the PIP(®) implants. The low rate of late complications in our series does not allow statistical analysis between the three groups of implants.

Immediate breast reconstruction using a laparoscopically harvested omental flap

Use of an omental flap to reconstruct the breast after cancer surgery was first reported by Kiricuta in 1963. Since then, the omentum has been widely used in cancer surgery to cover extensive thoracic defects associated with radionecrosis. In contrast, for breast reconstruction or augmentation mammaplasty, rectus abdominis and latissimus dorsi flaps have been used far more often than omental flaps. This article describes a new technique for immediate breast reconstruction using laparoscopically harvested omentum and reports the results obtained in 10 patients. Nine patients underwent immediate breast reconstruction after subcutaneous mastectomy. In the other patient, omentum was used in combination with skin grafting to cover a postmastectomy defect. Follow-up exceeded 16 months in the first patients. The results suggest that breast reconstruction using a laparoscopically harvested omental flap may be extremely dependable in terms of vascular supply (there was one case of partial necrosis, which healed with local management alone). The postoperative course of all patients was uneventful, and the use of laparoscopy reduced the hospital stay to less than 7 days. Donor-site scars were minimal. There was no residual loss of function, and there were no cases of incisional ventral hernia. Cosmetic results were satisfactory, with a soft breast that was both natural in appearance and stable in volume. However, in two patients the amount of omentum was found to be inadequate during the procedure; consequently, an implant was inserted under the omental flap. Breast reconstruction using a laparoscopically harvested omental flap is a new technique that allows autogenous reconstruction without disfigurement of the do-nor site and that results in a soft, natural-looking breast.

[Value of reduction mammoplasty in the conservative treatment of breast neoplasms. Apropos of 70 cases]

Breast cancer surgery is on the increase. Until now conservative treatment has been limited to tumors less than 3 cm; it is now extending to surgery on reduced tumors after chemotherapy or radiotherapy. Some cancers still require mastectomy because a carcinologic satisfactory tumorectomy would create a major deformity not compatible with conservative treatment. It is technically possible to perform major tumor resection with good cosmetic results using the reduction mammoplasty technique well known in plastic surgery. Between 1983 and 1991, 70 patients were treated at Henri Mondor Hospital for breast cancer with breast reduction mammoplasty and irradiation. We present the result with an average five years follow-up in terms of the cosmetic results relapses and survival rate. The actuarial local relapse was less than 10%, the survival with local relapse was 86% after 5 years, cosmetic results were good in 81% of cases. The association of reduction mammoplasty and radiotherapy seems to be a good extension of conservative treatment in some large breast tumors.

[Temporal muscle flap in cranio-facial reconstructive surgery. Apropos of 32 cases]

The temporalis muscle flap is used in craniofacial reconstructive surgery to repair defects, to restore facial contours and to cover bone grafts. These possibilities of reconstruction are analysed in the light of 32 cases. After reviewing the anatomy and the surgical technique, this series is presented as a function of the various types of defect: cranio-orbital (9 cases), defects of the malar area (6 cases), maxillary defects (7 cases), mandibular defects (7 cases), malar and parotid soft tissues defects (2 cases), mastoid defects (1 case). This study indicates that the temporalis flap possesses several advantages: great vascular reliability, associated with simplicity of flap raising and an easily available tissue volume. The arc of rotation constitutes the limiting factor. Romberg's syndrome does not constitute an ideal indication of choice, as the muscle may be atrophied. Similarly, when the defect requires thin cover, it would be wiser to use a thinner flap, such as fascia temporalis superficialis. Donor site sequelae are negligible. Limitation of mouth opening (3 cases) and frontal paralysis (2 cases) are usually transient. The field of application of this flap can be extended by continuing the flap as far as the pericranium or calvarium, allowing complex reconstructions.

[Increased viability of skin flaps using naftidrofuryl. An experimental study in the Wistar rat]

The effect of a vasodilator (naftidrofuryl) was evaluated in an experimental study in rats concerning the viability of a skin flap. The reference flap is a dorsal skin flap deliberately shaped very long in order to obtain necrosis of its distal extremity. This necrosis is measurable and sufficiently reproducible. Using a comparative study between a control group of ten rats and a group of rats treated by intraperitoneal injections of naftidrofuryl for ten days, the authors demonstrated a significant difference between necrosis in the two groups. Naftidrofuryl treatment increases the length of the viable part of the skin flap in rats. This product achieves a kind of medicinal autonomy much easier than a surgical autonomy.