[Discovered of breast cancer in adolescent during the plastic surgery: a case report]

Preoperative imaging prior to breast reconstruction surgery: benchmarking bringing together radiologists and plastic surgeons. Proposed guidelines

BACKGROUND

Prescription of preoperatory imaging assessment prior to planned breast reconstruction surgery (reduction or augmentation mastoplasty, correction of congenital breast asymmetry) is poorly codified. The objective of this study was to analyze the attitudes of French radiologists and plastic surgeons with regard to prescription of preoperative imaging in the framework of non-oncologic breast surgery.

MATERIAL AND METHODS

This is a descriptive and comparative observational study involving two groups, one consisting of 50 plastic surgeons (P) and the other of 50 radiologists (R) specialized in breast imaging. A questionnaire was handed out to radiologists during a conference on breast imaging at the Institut Gustave-Roussy in Paris (France) held on 17th December 2012. The same questionnaire was handed out to plastic surgeons at the National Congress of the French Society of Plastic and Reconstructive Surgery (SOFCPRE) held on 19th, 20th and 21st November 2012, also in Paris (France). The questionnaire focused on prescription of preoperative and postoperative imaging evaluation for non-oncologic breast surgery in patients with no risk factors for breast cancer or clinically identified indications.

RESULTS

Forty-six percent of the plastic surgeons considered an imaging exam to be recent when it had been carried out over the previous 6 months, while 40% of the radiologists set the figure at 1 year. Clinical breast density exerted no influence on 92% of the plastic surgeons and 98% of the radiologists. A majority of the plastic surgeons would prescribe a preoperative exam regardless of age (57% for breast reduction, 61% for breast implant placement and 61% for surgical correction of asymmetry) while the radiologists would prescribe exams mainly for patients over 40 years (50% for reduction, 44% for augmentation, 49% for asymmetry correction). The plastic surgeons would prescribe either ultrasound or mammograms (59% for reduction, 72% for augmentation, 66% for asymmetry correction) while radiologists would usually prescribe mammograms (64%, 57%, 64%). Most of the radiologists, along with the plastic surgeons, did not think that postoperative examination is justified (58% of P and 62% of R for reduction, 56% P and 68% of R for augmentation, 52% of P and 64% of R for asymmetry correction).

CONCLUSION

In 2012, there existed no French consensus on prescription of a preoperative imaging assessment in the framework of non-oncologic breast surgery in patients without risk factors for breast cancer. Active cooperation bringing together radiologists and plastic surgeons is likely to facilitate the harmonizing of their respective practices. In this paper, we propose guidelines that could help them to synchronize their efforts.

[Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft]

Two cases of juvenile gigantomastia treated by reduction mammaplasty with nipple-areola complex graft. Juvenile gigantomastia or virginal hypertrophy is a volume anomaly of breast of the teenager. It is unsightly. But often, it is pain, impaired spinal posture and the shoulder girdle and the psychological effects that bring the teenager to make an application for aesthetic surgery. We report two cases of juvenile and bilateral gigantomastia in adolescents aged 13 years old and unresolved. They have lost their hope before surgical procedure. In both cases, treatment consisted of a reduction mammaplasty with nipple-areola complex graft according to the technique of Thorek. The total resection was 3500 and 2900 g of breast tissue in one and 4000 g per breast in the other. Satisfaction regarding the shape, size and symmetry of the reconstructed breast was good. Although the effects on breastfeeding remain patent, the psychological impact was favorable in all cases.