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The treatment of breast cancer very often goes through surgery. Between 25 and 35% of patients will indeed undergo a mastectomy, that is to say a partial or total removal of one or both breasts. However, after surgery, few women, about 20%, are rebuilt after. Professor Fabien Reyal, Head of the Department of Surgery for Seniors, Gynecology and Reconstrucers of the Institut Curie, presented in "Sans Rendez-vous" on Europe 1 the different techniques that can be used.
And the one that will be chosen depends on many factors: the morphology of the patients, that of the breast, the medical history, the antecedents ... "All this plays in the choice of the technique which one will use", underlines Fabien Reyal . "It is an accumulation of a reflection on several elements: the morphology, the consumption of tobacco, elements which can hinder healing such as diabetes, is there a heavy history or not, what were the treatments? associated (radiotherapy, chemotherapy ...) ".
Breast prostheses
"Breast prostheses are used volumetrically in most cases," says the professor. "But there is a very big evolution in progress because the PIP affair and then the discovery of large cell anaplastic lymphomas, which are a type of disease very clearly induced by certain (textured) implants, leads us to change our practices." The symptoms of this type of lymphoma may be swelling of the breast, redness, nodules on examination such as ultrasound or MRI, says Fabien Reyal. The risk is estimated at 1 in 300,000, a rare risk but "unbearable especially since we are in a context of reconstruction after cancer". This has caused the textured implants, which have an irregular surface, to be removed from the market. Today, micro-textured prostheses remain, and according to the doctor, cancer centers today are pushing much more towards autologous reconstruction methods, that is to say from the tissues of the patient and without breast implant.
The technique of the latissimus dorsi flap
Among these so-called autologous techniques, there is that of the latissimus dorsi flap. "It's a question of taking this muscle from the back to the vertebrae, rotating it, using it to put it in front and recreating a shape and consistency of the breast." Difficult as to imagine the rendering, but according to Fabien Reyal, the operation, which lasts about two hours and a half to three hours, gives good results: "For a majority of patients, we have little or no symptoms at the level of the back ", although sometimes discomfort at this level is noted. "It can produce very nice results, when it is in immediate reconstruction, keep the container, so the skin and possibly the areola and the nipple, then fill with the muscle.When it is in secondary reconstruction, after mastectomy [...], there are a few more scars. "
The technique of the DIEP
The DIEP (Deep Inferior Epigastric Perforator, or inferior epigastric perforating artery in French) is a microsurgery that consists of recovering fat, artery and vein at the abdominal level to transpose it to the level of the chest wall.
This is a rather heavy surgical technique, but according to the professor, it gives "very good results because these structures are flexible and will have an extremely natural appearance". According to him, serious complications are also "very infrequent". "It's surgery that stays on the surface of the body", but that can "totally fail in 3 or 4% of cases, because we will connect an artery to an artery and a vein to a vein, which are 1mm, so blood flow can be disrupted. The aesthetic result is however according to him the best.