The aesthetic results for breast reconstruction in 323 women after amputation of the breast for cancer

J. R. Garbay, M. Rietjens, J. Y. Petit

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34 Citations (Scopus)

Abstract

323 reconstructions of the breast were carried out at the Gustave-Roussy Institute and were analysed in order to assess the aesthetic results and the sequelae of these reconstruction operations. The majority of the patients were operated on between 1984 and 1989 with a median follow-up of 3.5 years (1 to 9 years). Three types of reconstruction were carried out: simple prosthesis behind the muscle (P, 69% of this population), latissimus dorsi flap (G.D., 11%), or transverse rectus abdominis flap (TRAM, 20%). These reconstructions were either carried out immediately (RMI, 23.5%) or later (RMD, 76.5%). The unanimous enthusiasm of the patients for reconstruction was the greatest encouragement for us to continue in this way. From the aesthetic point of view the transverse rectus abdominis flap (TRAM) proved to be superior to the others. Scar and functional sequelae of the latissimus dorsi flap (GD) were by no means nil in this series (table 9) in contrast with other studies that have been carried out. All the same the majority of these sequelae were larger scars. The functional poor sequelae were minor. TRAM sequalae were less frequent and usually mainly in the abdominal wall. A more accurate technique should lower the incidence. As far as the timing of surgery is concerned, immediate reconstruction did not alter the quality of results which were better (but not significantly statistically). This has already been published. On the other hand patients were more satisfied with RMD (p <10-4). The analysis of this unexpected result show the great significance of psychological factors in interpreting these results. We must take this into consideration before we decide on which surgical procedure is indicated. In the future, it will be necessary to form a consensus of opinion about how to evaluate the aesthetic results. This should be an important preliminary for every study of comparison even if they are carried out retrospectively.

Translated title of the contributionThe aesthetic results for breast reconstruction in 323 women after amputation of the breast for cancer
Original languageFrench
Pages (from-to)405-412
Number of pages8
JournalJournal de Gynecologie Obstetrique et Biologie de la Reproduction
Volume21
Issue number4
Publication statusPublished - 1992

Fingerprint

Rectus Abdominis
Mammaplasty
Esthetics
Amputation
Breast Neoplasms
Superficial Back Muscles
Cicatrix
Abdominal Wall
Prostheses and Implants
Consensus
Psychology
Muscles
Incidence
Population

Keywords

  • breast reconstruction
  • cancer of the breast
  • mastectomy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

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title = "RESULTATS ESTHETIQUES DE LA RECONSTRUCTION MAMMAIRE APRES AMPUTATION POUR CANCER. A PROPOS DE 323 CAS",
abstract = "323 reconstructions of the breast were carried out at the Gustave-Roussy Institute and were analysed in order to assess the aesthetic results and the sequelae of these reconstruction operations. The majority of the patients were operated on between 1984 and 1989 with a median follow-up of 3.5 years (1 to 9 years). Three types of reconstruction were carried out: simple prosthesis behind the muscle (P, 69{\%} of this population), latissimus dorsi flap (G.D., 11{\%}), or transverse rectus abdominis flap (TRAM, 20{\%}). These reconstructions were either carried out immediately (RMI, 23.5{\%}) or later (RMD, 76.5{\%}). The unanimous enthusiasm of the patients for reconstruction was the greatest encouragement for us to continue in this way. From the aesthetic point of view the transverse rectus abdominis flap (TRAM) proved to be superior to the others. Scar and functional sequelae of the latissimus dorsi flap (GD) were by no means nil in this series (table 9) in contrast with other studies that have been carried out. All the same the majority of these sequelae were larger scars. The functional poor sequelae were minor. TRAM sequalae were less frequent and usually mainly in the abdominal wall. A more accurate technique should lower the incidence. As far as the timing of surgery is concerned, immediate reconstruction did not alter the quality of results which were better (but not significantly statistically). This has already been published. On the other hand patients were more satisfied with RMD (p <10-4). The analysis of this unexpected result show the great significance of psychological factors in interpreting these results. We must take this into consideration before we decide on which surgical procedure is indicated. In the future, it will be necessary to form a consensus of opinion about how to evaluate the aesthetic results. This should be an important preliminary for every study of comparison even if they are carried out retrospectively.",
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AU - Rietjens, M.

AU - Petit, J. Y.

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N2 - 323 reconstructions of the breast were carried out at the Gustave-Roussy Institute and were analysed in order to assess the aesthetic results and the sequelae of these reconstruction operations. The majority of the patients were operated on between 1984 and 1989 with a median follow-up of 3.5 years (1 to 9 years). Three types of reconstruction were carried out: simple prosthesis behind the muscle (P, 69% of this population), latissimus dorsi flap (G.D., 11%), or transverse rectus abdominis flap (TRAM, 20%). These reconstructions were either carried out immediately (RMI, 23.5%) or later (RMD, 76.5%). The unanimous enthusiasm of the patients for reconstruction was the greatest encouragement for us to continue in this way. From the aesthetic point of view the transverse rectus abdominis flap (TRAM) proved to be superior to the others. Scar and functional sequelae of the latissimus dorsi flap (GD) were by no means nil in this series (table 9) in contrast with other studies that have been carried out. All the same the majority of these sequelae were larger scars. The functional poor sequelae were minor. TRAM sequalae were less frequent and usually mainly in the abdominal wall. A more accurate technique should lower the incidence. As far as the timing of surgery is concerned, immediate reconstruction did not alter the quality of results which were better (but not significantly statistically). This has already been published. On the other hand patients were more satisfied with RMD (p <10-4). The analysis of this unexpected result show the great significance of psychological factors in interpreting these results. We must take this into consideration before we decide on which surgical procedure is indicated. In the future, it will be necessary to form a consensus of opinion about how to evaluate the aesthetic results. This should be an important preliminary for every study of comparison even if they are carried out retrospectively.

AB - 323 reconstructions of the breast were carried out at the Gustave-Roussy Institute and were analysed in order to assess the aesthetic results and the sequelae of these reconstruction operations. The majority of the patients were operated on between 1984 and 1989 with a median follow-up of 3.5 years (1 to 9 years). Three types of reconstruction were carried out: simple prosthesis behind the muscle (P, 69% of this population), latissimus dorsi flap (G.D., 11%), or transverse rectus abdominis flap (TRAM, 20%). These reconstructions were either carried out immediately (RMI, 23.5%) or later (RMD, 76.5%). The unanimous enthusiasm of the patients for reconstruction was the greatest encouragement for us to continue in this way. From the aesthetic point of view the transverse rectus abdominis flap (TRAM) proved to be superior to the others. Scar and functional sequelae of the latissimus dorsi flap (GD) were by no means nil in this series (table 9) in contrast with other studies that have been carried out. All the same the majority of these sequelae were larger scars. The functional poor sequelae were minor. TRAM sequalae were less frequent and usually mainly in the abdominal wall. A more accurate technique should lower the incidence. As far as the timing of surgery is concerned, immediate reconstruction did not alter the quality of results which were better (but not significantly statistically). This has already been published. On the other hand patients were more satisfied with RMD (p <10-4). The analysis of this unexpected result show the great significance of psychological factors in interpreting these results. We must take this into consideration before we decide on which surgical procedure is indicated. In the future, it will be necessary to form a consensus of opinion about how to evaluate the aesthetic results. This should be an important preliminary for every study of comparison even if they are carried out retrospectively.

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