Pink October: how to do without a breast prosthesis for breast reconstruction?

Europe 1 8:30 p.m., October 05, 2021

While breast reconstruction techniques were closely linked to prostheses a few years ago, the rise of surgery with autologous tissues allows affected patients to take better care of themselves.

On the occasion of Pink October, the aesthetic doctor Oren Marco takes stock of the current alternatives to these prostheses.

INTERVIEW

Does breast cancer directly lead to breast reconstruction via a prosthesis? This is the thesis against which Oren Marco stood up on Tuesday in

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 on Europe 1. The aesthetic doctor explains that at present, breast reconstruction no longer systematically involves this technique, with now use of tissues that belong to the patient. A way to avoid the problems too often encountered with a prosthesis, defends the specialist at the microphone of Mélanie Gomez and Julia Vignali while the month of October corresponds to raising awareness about breast cancer.

“There is a lot of talk about breast cancer prevention this October. I wanted to talk about breast reconstruction techniques because there are not enough women who are reconstructed after breast cancer. Breast cancer still affects a little more than one in ten women in France and not all women who are affected are reconstructed.

The prosthesis was something that we were really almost systematically before, but we had problems when there was irradiation of the breast.

Previously, we could have stiffened breasts with slightly painful prostheses and we did not have a very nice symmetry with the lateral breast which was not affected.

Samples elsewhere on the body

Now, we are instead using what is called autologous tissues, that is to say, we will use the patient's own tissues. We have the flap technique: we will take it from another part of the body. In the back, there is the muscle flap, the latissimus dorsi muscle. And on the rest of the body, the most common is the DIEP (Deep Inferior Epigastric Perforator), that is to say that we will take the skin of the belly with the fatty tissue and we reconnect the vessels. These are microsurgical techniques.

We reconnect the abdominal vessels at the thoracic level and we can recreate a breast with a shape and a curve which is very natural, without prostheses at all, with this DIEP launched several several years ago.

Now, we also take the inner side of the thigh or an area of ​​the buttock.

Indeed, there is an area that is donor where there will be a scar.

But depending on the patient's morphology, one can choose a particular flap.

When you do a flap, it's an operation, and we don't talk about it anymore.

Areola, a special area

There is also a current boom in fat injections. The advantage is that we do not have a scar in the donor area. The interventions are multiple, that is to say that you have your operation several times, but very short interventions. It is for patients who have a rather thin morphology, with a little bit of fat, but not necessarily a lot of extra skin. So we can take the fat, we purify the fat, we centrifuge it and it becomes transferable.

For the aerole, for a very long time, it was skin grafts that were taken from the inner side of the thigh.

The nipple was also reconstructed by making a small flap.

Often, cancers are found behind the areola, a fairly affected area.

Now we have dermopygmenters or tattooists.

These are great techniques and they also allow patients to move on.

You have been operated on, you are not yet going back to the hospital to do the areola.

At least you're going to a slightly different setting.

Psychologically, it's very cool. "

Triple negative breast cancer treatment soon

The Minister of Health announced Tuesday that a promising new treatment against an aggressive form of breast cancer, called "triple negative", would be authorized and available in France from November 1.

"Finally, there is a promising treatment produced by an American laboratory, called Trodelvy," said Olivier Véran during the question-and-answer session in the Assembly.

"France was the first European country to be able to benefit a few patients while waiting for production to increase; I can confirm that it will be authorized in early access and available in France from November 1, 2021", continued the minister, speaking of "good news".

Trodelvy is an antibody treatment combined with chemotherapy, manufactured by the Gilead laboratory.

A particularly aggressive form of the disease, triple negative breast cancer is the least common, but accounts for about 15% of cases, or some 9,000 people each year.

The HAS has granted an early access permit to Trodelvy for one year.