T. Delaporte

Breast fat grafting (lipomodelling) after extended latissimus dorsi flap breast reconstruction: a preliminary report of 200 consecutive cases.

BACKGROUND The efficacy of fat grafting has long been a controversial issue. Breast lipomodelling after extended latissimus dorsi flap reconstruction was first attempted at the Plastic and Reconstructive Surgery unit of Leon Berard Cancer Centre in 1999. We present the results of a retrospective report of the first 200 consecutive patients treated at our institution from 1999 to 2003. METHODS We identified specific requirements of the patients, and collected information on the surgical techniques used and the volumes of fat tissue injected. We analysed and compared the results of a total of 244 lipomodelling sessions. RESULTS The graft consisted of 70% fat graft, 13% oily supernatant and 17% serum residues. Approximately 30% was lost during centrifugation. On average, 176 ml of fat were injected in each breast. Very satisfactory results were obtained in 94.5% of the cases, with a majority of patients (80%) being very satisfied with the procedure and only 1.5% complications. CONCLUSION Our results demonstrate the safety and feasibility of breast lipomodelling. It is a new approach to improve reconstructive outcome after extended latissimus flap breast reconstruction.

Immediate nipple reconstruction during immediate autologous latissimus breast reconstruction.

Background: Creation of the nipple-areola complex is the final step in surgical restoration of the breast. Often considered as a secondary complement to breast reconstruction, nipple-areola reconstruction is usually done after an interval of several months and makes use of composite graft techniques involving the opposite nipple or local flaps. Methods: Because the position of the nipple-areola complex is defined from the outset in skin-sparing mastectomy and because of the disappointing results obtained by classic nipple reconstruction techniques, the authors propose immediate nipple reconstruction using the skin paddle of the latissimus dorsi flap. Once the flap has been raised and placed in the skin-sparing mastectomy site, its paddle is folded back onto itself to form a cone. Two dermal-fat flaps are lifted at the top of the cone and sutured together to form the new nipple. Results: Thirty patients (mean age, 49 years; range, 43 to 60 years) underwent immediate nipple reconstruction between May of 1999 and December of 2001. A retrospective study of the 30 cases was conducted with a mean follow-up of 16.5 months (range, 2 to 31 months). Mean residual projection was 7.8 mm after 1 year in 20 patients and 6.8 mm after 2 years in eight patients. Patient satisfaction with nipple projection was studied by means of a questionnaire. Seventy percent of patients considered the result very good, 23.3 percent considered it good, 6.6 percent considered it medium, and none considered it poor. Conclusions: On a psychological level, immediate nipple reconstruction seems to help assimilation of the reconstructed breast in the body image and leads to considerable patient satisfaction. Nipple reconstruction should no longer be considered as a secondary complement to immediate breast reconstruction. From the patient’s viewpoint, the nipple appears to be an essential component of breast reconstruction.

Reconstruction mammaire par transfert graisseux exclusif : à propos de 15 cas consécutifs

UNLABELLED BACKGROUND OF STUDY: The purpose of this prospective study is to detail the preliminary results, the advantages and drawbacks of a new iterative fat transfer protocol in selected breast reconstructions. MATERIAL AND METHODS Fifteen patients had breast reconstruction following mastectomy for breast cancer by this iterative lipomodeling protocol, between 2002 and 2007. Clinical and technical aspects are described. Indications, advantages, drawbacks, complications and morphological results are discussed. RESULTS Mean age at first stage procedure was 50 years (min: 41, max: 57). Indications were eight delayed breast reconstructions, three salvage reconstructions after flap failure, two restorations following primary chest wall reconstruction, two immediate breast reconstructions. Two to five sequential procedures were necessary to obtain a satisfactory breast volume (mean: three procedures). Mean total transferred fat volume was 600 cm(3) (min: 266 cm(3), max: 926 cm(3)). Multiple procedures were performed: restoration of breast skin envelope by abdominal advancement fasciocutaneous flap, breast contours liposuction, controlateral breast symmetrisation, nipple areola complex reconstruction. Mean follow-up was 28 months. The aesthetics results have been judged as very good in 10 patients, good in four patients and poor in one patient. The satisfaction rate of the patients is high: 10 patients are pleased, four patients are satisfied and one patient is moderately satisfied. CONCLUSION Fat transfer alone can efficiently restore breast volume after mastectomy, granting all advantages related with autologous reconstruction. No donor site morbidity is present; in fact some secondary benefits are observed thanks to the correction of eventual disgraceful lipodystrophies. These secondary benefits strengthen patient compliance improving iterative procedures tolerance. Lack of available adipose tissue and high breast volume are the major morphological limits of the technique. In our experience, fat transfer appears to be a promising technique for breast reconstruction. Long term results still have to be evaluated before it can become a standard.

Patient Information Before Aesthetic Lipomodeling (Lipoaugmentation): A French Plastic Surgeon's Perspective

Fat grafting to the breasts has long been controversial among aesthetic surgeons. We have developed a new, safe, effective, and reliable lipomodeling method to be used in breast augmentation. This method grew out of our clinical and radiologic experience acquired since 1998 with fat injections to the breast. The aim of the present report is to provide facts and data concerning lipomodeling and to document our procedures for ensuring that clear, consistent, up-to-date information is given to the patients who are undergoing aesthetic lipomodeling. The key element in our preparation is our commitment to avoid missing the diagnosis or altering the presentation of a preexisting or newly arising breast cancer. We must also ensure that the patient understands the need to comply with follow-up recommendations, such as a specific radiologic examination before and one year after the procedure, as well as a biopsy evaluation of any lesion that is considered suspicious during the physical examination. The patient must sign a confirmation that she has received the appropriate information and that she understands the notice provided by the surgeon at her first visit. This notice must deliver clear, complete, objective, evidence-based information, must be written clearly and understandably, and must not contain any unrelated or confusing information.

Reconstruction mammaire bilatérale par lambeau myocutanéograisseux de grand dorsal (31 cas consécutifs)

PURPOSE OF THE STUDY The purpose of this study was to analyse the advantages, disadvantages and results of bilateral breast reconstruction by autologous latissimus dorsi flap. MATERIAL AND METHOD Thirty-one two-stage consecutive bilateral breast reconstructions were performed by the same operator between 1993 and 2001. All the reconstructions, in immediate or delayed manner, were indicated after radical or skin sparing mastectomy for breast cancer. We used the autologous latissimus dorsi flap for all cases. The reconstruction of the second breast was always delayed of a few months to avoid backs complications. We reviewed the charts of these patients retrospectively. Preoperative data, postoperative complications, dorsal seroma occurrence, morphological results and patients satisfaction were evaluated. Median follow-up was 22 months. RESULTS The results confirm the procedures reliability. Comparative rates of postoperative complications are not significantly different between first and contralateral breast reconstruction. Functional after-effects of bilateral latissimus dorsi harvesting are moderate. The aesthetics results have been judged as very good in 84% of cases and good in 16%. The satisfaction rate of the patients is high: 90,3% are pleased, 6,5% are satisfied and 3,2% are moderately satisfied. CONCLUSION The autologous latissimus dorsi flap allows a two-stage bilateral breast reconstruction. This procedure is not indicated for simultaneous bilateral breast reconstruction; it is the main drawback of this technique. So we believe that this procedure is an excellent alternative in all the indications of sequential bilateral breast reconstructions.

Un risque inhabituel de la liposuccion : la liposuccion d’une tumeur maligne. À propos de 2 cas

Resume La lipo-aspiration est un moyen elegant et simple de traiter certains excedents de tissu graisseux ; son utilisation s’est rapidement etendue au traitement des lipomes et de certaines gynecomasties. Le but de cet article est de presenter 2 observations d’un risque exceptionnel de la liposuccion : la liposuccion de tumeurs malignes. Les cas cliniques de 2 patients, adresses dans le service pour la prise en charge de cette complication, sont etudies pour illustrer ce propos : la liposuccion d’une « gynecomastie » chez un patient porteur d’un cancer du sein, et la lipo-aspiration d’un « lipome » de la cheville chez une patiente presentant en fait un liposarcome. Pour eviter de lipo-aspirer et disseminer une tumeur maligne, l’examen preoperatoire doit s’orienter vers la recherche de particularites cliniques evoquant le diagnostic : une gynecomastie unilaterale, irreguliere, indolore ou dure chez un homme d’âge mur doit faire preferer une exerese chirurgicale classique, de meme qu’un lipome recidivant, dependant des plans profonds, volumineux ou rapidement extensif, situe sur les membres ou dans la region scapulohumerale. Des examens paracliniques peuvent etre discutes. Il faut recuser d’emblee les cas douteux, qui doivent imperativement beneficier d’une exerese chirurgicale avec marges de securite strictes et examen anatomopathologique complet de la piece. La liposuccion est devenue un outil d’appoint tres utilise en chirurgie plastique ; ses nombreux avantages ne doivent pas faire oublier le risque de liposucer une tumeur maligne, c’est-a-dire de disseminer un cancer meconnu au moment de l’intervention. Tout chirurgien doit garder a l’esprit ce risque et preferer au moindre doute une exerese chirurgicale.

Article originalReconstruction mammaire bilatérale par lambeau myocutanéograisseux de grand dorsal (31 cas consécutifs)Bilateral breast reconstruction with the autologous latissimus dorsi flap (a retrospective study of 31 consecutive cases)

PURPOSE OF THE STUDY The purpose of this study was to analyse the advantages, disadvantages and results of bilateral breast reconstruction by autologous latissimus dorsi flap. MATERIAL AND METHOD Thirty-one two-stage consecutive bilateral breast reconstructions were performed by the same operator between 1993 and 2001. All the reconstructions, in immediate or delayed manner, were indicated after radical or skin sparing mastectomy for breast cancer. We used the autologous latissimus dorsi flap for all cases. The reconstruction of the second breast was always delayed of a few months to avoid backs complications. We reviewed the charts of these patients retrospectively. Preoperative data, postoperative complications, dorsal seroma occurrence, morphological results and patients satisfaction were evaluated. Median follow-up was 22 months. RESULTS The results confirm the procedures reliability. Comparative rates of postoperative complications are not significantly different between first and contralateral breast reconstruction. Functional after-effects of bilateral latissimus dorsi harvesting are moderate. The aesthetics results have been judged as very good in 84% of cases and good in 16%. The satisfaction rate of the patients is high: 90,3% are pleased, 6,5% are satisfied and 3,2% are moderately satisfied. CONCLUSION The autologous latissimus dorsi flap allows a two-stage bilateral breast reconstruction. This procedure is not indicated for simultaneous bilateral breast reconstruction; it is the main drawback of this technique. So we believe that this procedure is an excellent alternative in all the indications of sequential bilateral breast reconstructions.

Lambeau médiodorsal du nez de transposition en îlot cutané de texier modifié. À propos de quatre cas de réparations alaires

First described by Texier in 1994, the mediodorsal transposition flap of the nose is an island flap. The paramedian dorsal arteries (anastomosed to the interdomal plexus) ensured the axial vascularisation in SMAS plane. The authors will discuss their personal approach to the surgical procedure for the improvement of final result, with four clinical cases. This flap can be used for aesthetic unit reconstruction of cutaneous or mucosal different alar defect (partial or complete, full-thickness or not). This reliable flap represents an alternative technique of composed grafts, of different nasolabial flaps, and of forehead flap.

Note techniqueLambeau médiodorsal du nez de transposition en îlot cutané de Texier modifié. À propos de quatre cas de réparations alairesModified Texier mediodorsal transposition island skin flap of the nose. Report of four cases of ala nasi reconstruction

First described by Texier in 1994, the mediodorsal transposition flap of the nose is an island flap. The paramedian dorsal arteries (anastomosed to the interdomal plexus) ensured the axial vascularisation in SMAS plane. The authors will discuss their personal approach to the surgical procedure for the improvement of final result, with four clinical cases. This flap can be used for aesthetic unit reconstruction of cutaneous or mucosal different alar defect (partial or complete, full-thickness or not). This reliable flap represents an alternative technique of composed grafts, of different nasolabial flaps, and of forehead flap.