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L'objectif de cette étude est d'évaluer la satisfaction des patientes après une reconstruction mammaire immédiate (RMI), en fonction de la technique chirurgicale employée. Les patientes incluses dans l'étude devaient avoir été opérées d'une RMI entre 2012 et 2017 et avoir fini leur reconstruction depuis au moins 1 an. Les patientes ont été soumises au questionnaire Breast Q par téléphone. Selon la technique chirurgicale dont elles avaient bénéficié, les patientes ont été réparties en 5 groupes : DIEP, gracilis, grand dorsal autologue (GDA), prothèse mammaire définitive (PMD) et prothèse d'expansion initiale (PE). Les techniques ont été regroupées en 2 autres catégories : lambeaux libres et prothèses. Les techniques de reconstruction du mamelon ont également été évaluées : greffe de pulpe d'orteil, dédoublement de mamelon et lambeau local. Quatre-vingt-quinze patientes sur les 103 éligibles ont accepté de répondre au questionnaire. La satisfaction à propos des seins était statistiquement plus élevée dans le groupe lambeaux libres (72,6/100) par rapport au groupe prothèses (62,7/100), (p < 0,01). Le bien-être physique et notamment thoracique était meilleur dans le groupe lambeaux libres que pour les prothèses (92,2/100 vs 85,2/100, p = 0,02). La reconstruction du mamelon par dédoublement et par lambeau local apportait une meilleure satisfaction que la greffe de pulpe d'orteil (75,3/100 et 73,5/100 vs 47,8/100, p < 0,01). Les RMI par lambeaux libres donnent à court terme une satisfaction au niveau des seins reconstruits statistiquement plus élevée que les implants. Les reconstructions de mamelon par lambeau local et dédoublement de mamelons apportent aussi une meilleure satisfaction. The purpose of this study is to evaluate patients' satisfaction after immediate breast reconstruction (IBR) according to the surgical technique. Included patients had an IBR between 2012 and 2017 and finished their reconstruction since a year. Patients were contacted by phone and their satisfaction was evaluated with the Breast Q questionnaire. According to the surgical technique, patients were divided into 5 groups: DIEP, gracilis, Latissimus Dorsi flap, definitive implant and expander implant. Techniques were grouped into two categories: free flaps and prothesis. Nipple reconstruction techniques were also evaluated: toe pulp grafting, nipple sharing and local flap. Nighty-five patients on the 103 who were eligible accepted to answer the questionnaire. Satisfaction with breasts was stastistically higher in the free flap group (72.6/100) than in the prothesis group (62.7/100) (P < 0.01). Physical well-being (chest) was better for the free flap group than for the prothesis group (92.2/100 vs. 85.2/100, P = 0.02). Nipple reconstructions with nipple sharing and free flap give a better satisfaction for patients than toe pulp grafting (75.3/100 and 73.5/100 vs. 47.8/100, P < 0.01). IBR with free flap give, in a short time, a statistically higher satisfaction for breast than prothesis. Nipple reconstructions with free flap and nipple sharing give a better satisfaction too. [ABSTRACT FROM AUTHOR]

Résumé Introduction Cette étude analyse les suites postopératoires des différentes techniques de reconstructions mammaires immédiates : DIEP, gracilis, grand dorsal autologue, prothèse d'expansion et prothèse définitive. Matériel et méthodes Toutes les patientes opérées d'une RMI entre 2012 et 2017 au CHU de Strasbourg ont été incluses dans cette étude rétrospective. Les principaux paramètres recueillis étaient le temps de cicatrisation, les complications, reprises et échecs. Ces données ont été comparées entre les cinq techniques de reconstructions à la recherche de différences significatives. Ces techniques chirurgicales ont été regroupées en deux groupes : les lambeaux libres et les prothèses. Les données de ces deux groupes ont été comparées également. Résultats Cent quatre-vingt-treize patientes ont été prises en charge entre 2012 et 2017. Parmi celles-ci, 44 ont bénéficié d'une reconstruction bilatérale (23 %). Les complications précoces et peu graves étaient moins fréquentes dans le groupe prothèses que dans le groupe lambeaux libres : 8,6 % vs 33,3 % (p < 0,01) pour les RMI unilatérales et 10,9 % vs 38,9 % (p < 0,01) pour les bilatérales. Aucun échec n'était reporté dans le groupe lambeau libre contre 6,2 % pour les prothèses définitives et 3,6 % pour les prothèses d'expansion. La cicatrisation était plus longue dans le groupe lambeaux libres que dans le groupe prothèses : 5,6 semaines vs 4,2 semaines (p < 0,01). Conclusion La RMI par lambeau libre est associée à un risque plus important de complications précoces et peu graves à type de trouble de la cicatrisation, qui prolongent la durée des soins locaux. En revanche, le taux d'échec n'est pas supérieur avec les lambeaux libres. Summary Introduction This study analyzes postoperative course of different immediate breast reconstruction techniques: deep inferior epigastric perforator flap (DIEP), gracilis, latissimus dorsi flap, expander implants and definitive implants. Methods All women operated on IBR between 2012 and 2017 in the CHU Strasbourg were included in this retrospective study. The main data collected were healing time, complications, surgical revisions and failure rates. These data were compared between the five IBR techniques to find a significant difference. Two groups were distinguished according to the surgical techniques: free flaps and implants. Data of those groups were compared too. Results One hundred and ninety three patients have had a breast surgical treatment between 2012 and 2017. Among them, 44 had a bilateral IBR (23%). Early and unserious complications, were less frequent in the implants group than in the free flaps group: 8.6% vs. 33.3% (P < 0.01) for unilateral reconstructions and 10.9% vs. 38.9% (P < 0.01) for bilateral reconstructions. No surgical failures were found in the free flaps group versus 6.2% for definitive implants and 3.6% for expander implants. Healing time was longer for the free flaps group than for the prothesis group: 5.6 weeks vs. 4.2 weeks, (P < 0.01). Conclusion IBR with free flaps is associated with a higher risk for early and unserious complications as healing disorders, which extend the dressings time. However the failure rate is not higher with free flaps. [ABSTRACT FROM AUTHOR]

Aim: The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT).Materials and Methods: Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence.Summary Recommendations: The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF). [ABSTRACT FROM AUTHOR]

Abstract: Purpose of the study: Elderly breast cancer (EBC) patients are often denied adjuvant chemotherapy because of age. Breast cancer is among the most frequent cancer in Western Countries and recent data suggest that adjuvant chemotherapy could be active in selected elderly patients. We investigated the impact of age and comprehensive geriatric assessment (CGA) among other variables taken into account in tumor boards to recommend adjuvant chemotherapy in EBC patients. Method(s): We retrospectively reviewed breast cancer tumor board records of all consecutive EBC patients (over 70 years old) discussed from July 2006 to July 2009 in our institution. The recorded variables included age, comorbidities, tumor stage, grade, ER/PR and HER2 status, treatment characteristics and CGA conclusions. Agreement with breast cancer treatment guidelines was verified. Reasons for deviations were recorded. Result(s): A total of 192 early EBC patients files (mean age 76.7 years, range 70–98) were analyzed. Elderly patients were less likely to receive adjuvant chemotherapy even when deemed appropriate by guidelines (p <.001). Out of 118 patients with ≥1 risk factors (pT2–4, N+, RH−, SBR III), 70 were proposed adjuvant chemotherapy. In multivariate analysis, age >80 years, but not CGA result, was an independent variable associated with a decreased likelihood to receiving adjuvant chemotherapy. Moreover, 93 patients (48.4%) underwent CGA, of whom no Balducci''s class III patient received adjuvant chemotherapy. An appropriate treatment was administered in only 69% and 42% of Balducci''s class I and II patients, respectively. Conclusion(s): Our results suggest that age remains an independent variable associated with a decreased use of adjuvant chemotherapy. However, in our series systemic adjuvant chemotherapy was probably underused in “fit” patients. Further efforts are needed to better integrate CGA into tumor boards proposals for early EBC patients. [Copyright &y& Elsevier]

Abstract: As a consequence of breast imaging development and increased interventional radiology, benign epithelial breast diseases (BEBD) represent a growing percentage of breast pathology diagnoses. BEBD include numerous entities such as cysts, fibrosis, adenosis, duct ectasia, which require neither surgery nor follow-up. Some BEBD have to be individualized (radial scars, papillomas, complex sclerosing adenosis, lobular intraepithelial neoplasia, flat epithelial atypia, atypical hyperplasia), being preinvasive lesions or markers of increased breast cancer risk, or being associated with suspect radiological aspect. BEBD should be managed in a pluridisciplinar way and correctly diagnosed by percutaneous biopsies or surgical specimens. The goals of surgery vary according to lesions. It always allows a complete surgical specimen analysis and therefore a search for atypical or cancerous cells. Surgery can also have a preventive role by reducing the risk of potential malignant transformation. Finally, it enables in some cases the excision of a radiologically suspect mass. So the aim of this review is to give a clinical and morphological description of most common BEBD, underlying their cancer risk, specific diagnosis, therapeutic, follow-up and psychological repercussions. [Copyright &y& Elsevier]

Dans le cancer du sein, la radiothérapie est un élément majeur de la prise en charge. Toutefois, les indications de l'irradiation de la chaîne mammaire interne et de l'aire axillaire sont débattues. L'évolution actuelle des pratiques est à une désescalade thérapeutique dans la prise en charge de l'aire axillaire dans le cancer du sein. L'irradiation mammaire permettrait de diminuer le taux de récidive axillaire en apportant une couverture des niveaux I, II et III. Une revue de la littérature a été réalisée grâce à PubMed et à la bibliothèque de données Cochrane pour identifier les articles réalisant une évaluation dosimétrique de la couverture des niveaux axillaires I, II et III avec différentes techniques lors de l'irradiation du sein afin de déterminer les implications thérapeutiques potentielles. Onze articles ont été retenus pour un total de 375 plans de traitement. Les résultats étaient très hétérogènes concernant la technique d'irradiation choisie, la dose initiale prescrite dans le sein, les volumes des niveaux axillaires délinéés et la dose reçue aux trois niveaux axillaires. En radiothérapie conformationnelle tridimensionnelle (RT3D) par faisceaux tangentiels standard, la dose moyenne délivrée était comprise entre 24 Gy et 43,5 Gy, 3 Gy et 32,5 Gy et 1,0 Gy et 20,5 Gy respectivement pour le niveau I, II et III. En radiothérapie conformationnelle tridimensionnelle avec par faisceaux tangentiels hauts, la dose moyenne délivrée était comprise entre 38 Gy et 49,7 Gy pour le niveau I, entre 11 Gy et 47,1 Gy pour le niveau II et de 5 Gy pour le niveau III (résultat disponible dans une seule étude). Enfin, la dose moyenne délivrée par radiothérapie conformationnelle avec modulation d'intensité (RCMI) était comprise entre 14,5 Gy et 42,6 Gy, 3,4 Gy et 35 Gy et entre 1,2 Gy et 25,5 Gy pour le niveau I, II et III respectivement. La dose incidente délivrée à l'aire ganglionnaire axillaire est substantielle, mais ne semble pas suffisante pour être thérapeutique quelle que soit la technique d'irradiation. Il existe des différences entre RCMI et radiothérapie conformationnelle tridimensionnelle. In breast cancer, radiotherapy is an essential component of the treatment. However, indications of irradiation of the internal mammary chain and axillary area are debatables. Axillary recurrence in patients with invasive breast carcinoma remains an issue. Currently, the substitution of axillary lymph node dissection by sentinel node biopsy leads to revisit the role of axillary irradiation. Breast irradiation including level I, II and III might decrease the risk of axillary recurrence. A literature search was performed in PubMed and the Cochrane library to identify articles publishing data regarding dose-volume analysis of axillary levels in breast irradiation aiming to determine the potential therapeutic implications. Eleven articles were retained. A total of 375 treatment plans were analyzed. The results concerning the irradiation technique, initial dose prescribed to breast, delineated volumes and dose received at axillary levels were heterogeneous. The average dose delivered to axilla levels I–III with 3D-conformal radiotherapy using standard fields were between 24 Gy and 43.5 Gy, 3 Gy and 32.5 Gy and between 1.0 Gy and 20.5 Gy respectively. The average doses delivered to axilla levels I–III with 3D-conformal radiotherapy using high tangential fields were between 38 Gy and 49.7 Gy, 11 Gy and 47.1 Gy and 5 Gy 38.7 Gy, 32.1 Gy and 5 Gy (result available for only one study) respectively. Finally, the average doses delivered to axilla levels I–III with intensity modulated radiation therapy were between 14.5 Gy and 42.6 Gy, 3.4 Gy and 35 Gy and between 1.2 Gy and 25.5 Gy respectively. Incidental axillary dose seems insufficient to be therapeutic regardless of the irradiation technique. There are meaningful differences between intensity modulated radiation therapy and 3D-conformal radiotherapy. [ABSTRACT FROM AUTHOR]