Apport du lambeau glandulaire postérieur du sein en chirurgie oncoplastique

Abstract

Breast conservative surgeries, associated with radiotherapy within the framework of conservatives treatments for breast malignant tumors, can occur deformation of the breast in 10 to 15% of cases. The deformity can be more or less important according to the size of the initial lesion and the glandular reshaping reconstruction. Our experience in oncologic and reconstructive surgery of the breast reflects us about difficult cases of breast conservative surgeries in a glandular reshaping to obtain the best aesthetic result. In this approach, the posterior glandular flap of the breast was used in specific indications. The study aims to estimate the efficiency and the tolerance of the posterior glandular flap in difficult cases of breast oncoplastic surgeries. We realized a consecutive serie of 24 breast oncoplastic surgeries. We noticed 15 breast conservative surgeries of superior quadrants. The posterior glandular flap was realized in 15 cases. We used the posterior part of the breast, vascularized by musculo-cutaneous intercostal arteries to give the volume lacking in the breast. We estimated efficiency and tolerance of the posterior glandular flap than one-year operating comment, as well as the oncologic follow-up long-term. In this serie of 15 cases, we did not note acute complications like infection, hematoma or cutaneous necrosis. We listed 13 cases of malignant tumors with indication of radiotherapy, and 2 cases of benign tumors. In one year, we found two patients presenting a cyst of cytosteatonecrosis (1cm and 3cm) in the site of surgery, compared to posterior flap. The glandular total average excision was 333g (30-1200). An oncologic surgical resumption was necessary in 2 cases (a case of preventive mastectomy for BRCA1, and a case of insufficient margins). We realized 12 cases of controlateral surgery at the same time for symmetry. The aesthetic result was judged at one year post-operatory: good or very good in 74% of the cases, correct in 20% of the cases, and insufficient in 6% of the cases. The oncologic follow-up did not find locoregional recurrence. The posterior glandular flap is an interesting contribution in oncoplastic surgery of superior quadrants of the breast to replace harmoniously the missing volume. This flap, reliable and reproductible, offers an alternative to bring of the custom-made volume without residual deformation of the breast. The aesthetic results allowed, in spite of the radiotherapy, to decrease the aftereffects of breast conservative surgery treatments, and this interesting approach deserves a wider distribution.