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Objectives: In breast cancer, retroareolar tumors are observed in 5 to 20% of cases; mammectomy is the conventional treatment. Conservative surgery was used in this series of 36 patients with retroareolar cancer situated less than 2 cm from the areola., Patients and Methods: Tumorectomy with resection of the areolar plaque was followed by radiotherapy. Six patients had Paget's disease of the nipple, 64% were in classes T0 or T1 and 36% in T2. Chemotherapy or radiotherapy was given for tumor reduction prior to surgery in 8 patients. Wide tumorectomy with resection of the areolar plaque and gland remodeling was performed in all patients. Three plastic surgery techniques were used. Mean tumor size was 17.3 mm (8 to 33 mm). The areola was invaded in 16 patients (44%) and the derma or retroareolar ducts in 26 (72%)., Results: The mean distance between the tumor and skin surface was 3.8 mm. The section surface was in healthy tissue in 31 patients and 2 patients underwent subsequent surgery for mammectomy. All patients had either pre-operative (n = 4) or post-operative (n = 32) radio-therapy. Secondary reconstruction of the nipple was performed in 14 patients., Conclusion: Histology findings and esthetic results suggested that this conservative approach can be proposed when the tumor is located close to the areola, as confirmed by our series and results from other teams using the same technique.

Objectives: Routine screening mammography has greatly increased the number of breast cancers detected in the form of clumped microcalcifications without a palpable tumour., Methods: From 1964 to 1989, 315 breast cancers revealed by microcalcifications without contralateral cancer, treated at the Institut Curie. Cancers were observed in 40% of the microcalcifications excised. Treatment was conservative in 57.5% of cases and mutilating in 42.5% of cases; these rates have changed only very slightly with time. Histologically, 50% of the tumours were intraductal cancers, 25% were microinvasive, 24% were infiltrating and 1% were lobular in situ carcinomas. The therapeutic indication can be defined on the basis of the histological result of the initial tumour excision, as the initial examination underestimated the lesions in only 5.6% of cases. Lymph node invasion was observed in 1.8% of intraductal cancers, 5.3% of microinvasive cancers and 14.8% of invasive cancers., Results: The overall survival was 99% at 5 years and 89.9% at 10 years. The prognosis of invasive cancer was less favourable than that of intraductal and microinvasive cancers (p = 0.03). Survival was not influenced by the radical or conservative nature of treatment. The presence of lymph node invasion severely worsened the prognosis. The 5 year recurrence rate was 4.2% for intraductal, 4.6% for microinvasive and 6.1% for invasive. The incomplete nature of the resection increased the local recurrence rate: 11.9% at 5 years instead of 5%., Conclusion: Conservative treatment of cancers revealed by microcalcifications without a palpable tumour therefore appears to be justified provided the lesion is radiologically localized, with a histologically satisfactory resection and in the absence of residual microcalcifications on postoperative mammography.

Radiotherapy as primary treatment is one of the means of increasing the rate of conservative treatment in patients with a breast tumour more than 3 cm in diameter. Between 1980 and 1986, 232 patients were treated in the Curie Institute by irradiation followed by conservative surgery for T2NO or T2N1a tumours wider than 3 cm, which accounted for 66 percent of the cases; 126 of these 232 tumours were located in the upper and outer quadrant. Axillary dissection was combined with tumoral excision in 63 percent of the cases. Conservative surgery was performed in patients who, after preoperative irradiation (50 Gy), had a persistent tumour less than 3 cm in diameter. Tumorectomy was complete in 96 percent of the cases, and the operative specimen was sterilized in 20 percent. The mean follow-up period was 46 months. The overall survival rate was 83 percent at 5 years (91 percent for T2NON1a). No local recurrence was observed in 92 percent of the patients at 3 years and 87 percent at 5 years. Nine percent of these women developed lymphoedema of the upper limb. The cosmetic result was good in 70 percent of the cases, fair in 25 percent and poor in 5 percent. The survival rate being the same with this treatment as with mastectomy, and the local recurrence rate being relatively low (13 percent at 5 years), we feel authorized to suggest that this post-radiotherapy conservative surgery should be used, at least in women with T2NON1a breast cancer.

Closed suction drainage is widely used after modified radical mastectomy to prevent accumulation of serum or lymph and to promote adherence of the skin flaps to the chest wall. However, between 5 and 35% of the patients develop seroma, which may prolong their stay in hospital and require more frequent post-operative outpatient visits. The prospective study reported demonstrate a significant correlation between the incidence of post-operative seromas, the duration of suction drainage and the amounts of fluid drained. The incidence of seroma also correlated significantly with the patient's age, the size of the breast removed, the presence of arterial hypertension and the post-operative use of heparin. Pre-operative radiotherapy and the TNM type of the tumour had no effect on the duration and volume of drainage nor on the occurrence of seromas. A drainage of short duration and a short stay in hospital are advocated for most mastectomy patients. Delayed mobilization of the shoulder should decrease the volume of accumulated fluid and the incidence of seromas.

Four hundred and ten women with serous or bleeding nipple discharge without palpable mass were treated by surgery in the Curie Institute between 1970 and 1984. The cancer rate in this group was 12.2 per cent. Galactography was of anatomical interest as it showed the canal at the origin of the discharge. Malignant cells were observed at cytological examination in only 17 per cent of intragalactophoric cancers. Surgical excision is necessary if the nipple discharge is uniporous and easily reproducible by areolar pressure, particularly in the post-menopausal period when the frequency of cancer is highest (17.7 per cent).

A retrospective study of 65 patients with unpalpable breast cancer revealed by microcalcifications on mammography showed that 18 had presented with infiltrating epithelioma. The contralateral epithelioma was revealed by mammography. Three deaths from metastases had occurred in this group. The 65 carcinomas discovered by mammography were treated by excision of the microcalcified area. This was followed by mammectomy in 34 cases and by irradiation in 25. Close surveillance only was suggested in 6 cases. Histological studies showed 6 lobular carcinomas in situ and 59 duct epitheliomas, 26 of which were infiltrating. The prognosis of isolated duct epitheliomas is highly favourable, and no dissemination was observed. The 2 local recurrences observed after secondary irradiation concerned infiltrating epitheliomas; these patients are now alive without sign of recurrence after mammectomy. After conservative treatment (tumorectomy followed by irradiation), no recurrence was observed among patients with non-infiltrating duct carcinomas.