Réductions mammaires sur seins irradiés : revue de la littérature

Reduction Mammoplasties: Risk Factors and Early Complications-About 1442 Cases

BACKGROUND

Breast reduction surgery is a widely performed plastic surgery procedure. The incidence of such complications has been steadily decreasing in recent years but is still nonetheless 5.6%. The primary aim of this study was to analyze the incidence of the main postoperative complications of breast reduction surgery. In addition, we identified cause-and-effect links between complications and characteristics of the patients, such as smoking, age, weight resection, BMI, and wound drainage.

MATERIALS AND METHODS

This retrospective study was performed on a population of 1442 women who underwent breast reduction surgery between January 2016 and October 2022 in the plastic surgery unit at Saint-Louis Hospital, Paris, France. At the follow-up examination, we evaluated the patients for complications.

RESULTS

The average resection weight was 1297.7 g in a population for which the average BMI was 28.9. We found 19.9% rate of total complications, of which 3.5% were major complications. We found that only the resection weight was a risk factor for complications.

DISCUSSION

The main strength of our study is the size of our sample. The large number of patients allowed us to conduct numerous analyses and obtain significant results despite the rarity of certain events. This large cohort was also responsible for the high statistical power of our results.

CONCLUSION

The risk of developing a postoperative infection was 7.5% for resections of less than 2.4 kg, increasing to 13.9 % when greater than that. Thus, the administration of prophylactic antibiotic therapy to affected women to reduce the risk of infection is a distinct consideration. For the other factors, while none of them appeared to promote the occurrence of adverse events and, therefore, do not formally contraindicate breast reduction surgery, some preventive measures still strike us as being relevant, such as blade drainage, weight loss, diabetes control, and smoking cessation.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Inferior Pedicle Reduction Mammoplasty as Corrective Surgery after Breast Conserving Surgery and Radiation Therapy

Background/Aim—Twenty patients had corrective reconstruction surgery by means of a reduction mammaplasty or mastopexy after a previous BCS (Breast Conserving Surgery) and RT (Radiation Therapy); the risk factors and post-operative complications were reported in order to define a safe and effective technique for reduction mammaplasty in previously irradiated breast cancer patients. Materials and Methods—From June 2011 to December 2019, 20 pts. were operated on at the Breast Surgery Clinic of San Martino Policlinic Hospital, Genoa, Italy. Pre- and post-operative parameters included clinic-pathological features of the primary tumor; a lapse of time from primary radio-surgery; the extent of follow-up; the rate of post-operative wound infections; the persistence of breast asymmetry, and a post-operative patient satisfaction index by means of a BREAST-Q questionnaire. Results—Three patients (15%) developed minor complications in the irradiated breast, but no complication was observed into the non-irradiated breast. No statistically significant correlation was found between the post-operative complications and the risk factors. The statistical analysis of BREAST-Q questionnaire responses gave an average patient’s satisfaction index that was equal to 90.8/100 (range: 44 to 100). Conclusions—Inferior pedicle reduction mammoplasty is an effective reduction mammoplasty technique in regard to the extent of breast tissues that are to be removed both in irradiated and contralateral breast; moreover, the incidence of post-operative complications is clearly limited when a careful technique is adopted, and it can be reasonably applied also in patients with co-morbidity factors.

Delayed Mastopexy Following Breast-Conserving Surgery and Radiation Therapy: A Case-Control Study to Evaluate Safety and Versatility of the Central Mound Technique

INTRODUCTION

Breast remodeling following breast-conserving surgery (BCS) and radiation therapy (RT) is challenging and often burdened by complications due to irradiated tissue atrophy. The authors present a case-control study to compare the central mound mastopexy (CMM) to more conventional techniques, applying it to different patterns of skin excision.

METHODS

A variation of the original central mound technique is presented separately addressing glandular and cutaneous deformities. Between 2012 and 2018, 17 consecutive patients presenting defects following unilateral BCS and RT underwent breast remodeling with CMM technique. Immediate and long-term complications together with patient-reported outcomes were evaluated and compared to a matched control group of sixteen patients who underwent superior pedicle mammoplasty. Two independent plastic surgeons reviewed pre- and postoperative photographs and rated the cosmetic outcomes on a visual analog scale from 1 to 5.

RESULTS

In the study group, different patterns of skin excision, i.e., inverted-T pattern (41.2%), circumareolar (23.5%), skin-sparing type V (17.65%), omega (11.77%), and J (5.88%), were used to correct various breast deformities, and a decisional algorithm was developed. No major complications were registered. Retraction recurrence rate was higher in the control group (p = 0.037). Cosmetic results were considered more satisfying in the CMM group by both patients (4.18 vs 3.00, p<0.001) and surgeons (4.06 vs 2.69, p=0.001).

CONCLUSIONS

The CMM technique is an advanced approach that addresses breast remodeling after BCS-RT surgery yielding reliable results. Following our algorithm, several patterns of skin excision, tailored to pre-existing scars, can be considered and safely performed.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Reduction mammoplasty and mastopexy in the previously irradiated breast - a systematic review and meta-analysis

Breast cancer is the most common cancer diagnosed in women, and early stages are treated with lumpectomy and irradiation. Irradiation, however, leads to reduced vascularization and fibrosis, which may influence the cosmetic outcome unfavourably and increase complications after subsequent surgery on irradiated breasts. Patients with significant asymmetry after treatment may desire corrective reduction mammoplasty or mastopexy, but this may be associated with increased complication rates. This systematic review and meta-analysis aimed to investigate postoperative complication rates after bilateral reduction mammoplasty or mastopexy in women who had undergone unilateral lumpectomy and irradiation. PubMed, Medline, EMBASE and Cochrane databases were searched for eligible studies. After screening titles and abstracts, 14 full text studies were reviewed, and 7 of these were included in the analysis. The meta-analysis showed a significantly higher complication rate in the irradiated breast compared to the non-irradiated breast, rate ratio 4.82 (95% CI: 1.58, 14.70), p = 0.006. The complication rate was 54% in the irradiated breast (58/107) compared to 8% (9/107) in the non-irradiated breast (p = 0.034). This study suggests that reduction mammoplasty or mastopexy in the previously irradiated breast is associated with a significantly increased risk of complications. Careful patient selection and information are paramount in the treatment of this patient group.