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The authors report a very rare case of gestational gigantomastia and the pregnancy could be carried out in term. The patient has been operated of bilateral mastectomy with immediate reconstruction. Surgery is the only radical treatment. Mastectomy with secondary reconstruction is reserved to cases where the intervention must be fast. Mastectomy with immediate reconstruction is the advised intervention if there is a later desire of pregnancy. Mammary reduction is more aesthetic, and allows only one intervention, but exposes to an important risk of recurrence and is not recommended if there is a later desire of pregnancy.

The occurrence of lactation is a rare complication of breast plastic surgery. During the course of his practice, the plastic surgeon will probably encounter this complication. The goal of this article is to carry out a literature review of all published galactorrhea and/or galactocele cases following a breast-reduction or a breast-augmentation, representing a total of 34 cases reported in 21 articles. The physiopathology of this complication is linked to an inappropriate secretion of prolactin in a surgical context. The factors favoring this complication would be the number of pregnancies, a history of recent and extensive nursing, and the intake of certain medicines such as an oestro-progestative pill. The main symptom of this complication is the occurrence of a uni- or bilateral galactorrhea, on average 12.6 days after the surgery. The main differential diagnosis is a postoperative infection. The explorations presented a hyperprolactinemia in 69% of cases. No biological inflammatory syndrome was reported. A fluid collection evoking a galactocele was visible on the ultrasound in 65% of cases. One case of prolactin-secreting pituitary adenoma was reported. Depending on the case, the treatment varied from a simple surveillance to the association of a dopamine agonist, an antibiotic therapy, and a surgical revision. A diagnostic and therapeutic management strategy is proposed.

The authors report a very rare case of gestational gigantomastia and the pregnancy could be carried out in term. The repetition being inescapable, the mastectomy is the advised intervention if there is a later desire of pregnancy, in other cases a post-partum mammoplasty can be discussed.

The authors report a very rare case of necrobiosis lipoidica, histopathologically confirmed, which happened in the breast a few months following the insertion of a silicone implant (post-mastectomy reconstruction). This case raises two problems: the physiopathology (role of the silicone implant) and the treatment of this accident, resistant to current therapy.

Ritual sexual mutilations affect 140million of women around the world with over three millions new cases per year. France is not spared with 55,000 mutilated women living on our territory. There is a simple, reliable and reproductible reconstructive surgical technique described by the French urologist Pierre Foldès. This technique is still unknown by patients and plastic surgeons. Through a clinical case, the authors discuss the principles, results and key points of this procedure.

To determine the embryonic size at which cardiac activity is always seen in a normal early pregnancy, 398 endovaginal sonograms were evaluated in which the gestational sac contained a yolk sac and/or embryo of less than or equal to 12 mm in crown-rump length (CRL). In the 99 sonograms in which there was a yolk sac but no identifiable embryo, cardiac activity was absent in 75; 58 of these pregnancies progressed normally. Of the 299 sonograms where there was an identifiable embryo with CRL less than or equal to 12 mm, cardiac activity was absent in 31; 29 of these were proven to be failed pregnancies. In two cases the pregnancy progressed normally; the CRL was 2 mm in one case and 4 mm in the other. We conclude that once an embryo is seen by endovaginal sonography, the absence of cardiac activity usually indicates embryonic demise. However, when cardiac activity is absent, one should refrain from definitively diagnosing embryonic demise, based on a single sonogram, if the CRL is less than 5 mm.

Anomalies of systemic and pulmonary venous return are found as either isolated lesions or as part of a complex cardiac malformation. Specifically, these venous pathway malformations are associated frequently with the cardiac defects in asplenia or polysplenia. This report describes the prenatal ultrasound diagnosis of both anomalous pulmonary and systemic venous drainage in three late gestation fetuses with a splenic syndrome and complex congenital heart disease. In addition, the utility of color-flow Doppler as an aid in making the diagnosis is emphasized.

The authors report a very rare case of lipome extended to the superficial and deep lobes of parotid gland. MRI remains the best complementary examination to direct the diagnosis; however only the surgery will bring a histological proof formal.

Dercum's disease or adiposis dolorasa is unusual and unknown. Four symptoms are typical. It is characterized by painful subcutaneous fatty tumors in postmenopausal woman. We present this disease through the study of an uncommon clinical case: a sceptic choc following the "steato-cutaneous-necrosis" of a fatty tumor. The disease remains rare. The etiology is to this day unknown and different hypothesis (endocrinous, metabolic, genetics) are put forward. Multiple complications can occur but severe septicemia is rare. The treatment can be medical (loss of weight, corticoids, intravenous lidocaine) or surgical (surgical excision or liposuction).

One case of juxtacortical chondroma is reported, and the authors review the clinical, radiological, pathological and therapeutic data concerning this tumour which was first individualised by Lichtenstein and Hall in 1952 but never described in this location. Conservative surgery with complete excision of the chondroma usually results in permanent cure.

The authors compared the diagnostic yield of endovaginal color and pulsed Doppler ultrasound (US) in conjunction with endovaginal sonography with that of endovaginal sonography alone in patients prescreened to be at increased risk for ectopic pregnancy. Pelvic structures were evaluated for overall vascularity and for the presence of characteristic pulsed Doppler US velocity waveforms. The diagnostic sensitivity of the initial endovaginal sonographic examination increased with the addition of color and pulsed Doppler US, from 71% to 87% for ectopic pregnancy, from 24% to 59% for failed intrauterine pregnancy, and from 90% to 99% for viable intrauterine pregnancy. Specificities for endovaginal sonography with color and pulsed Doppler US ranged from 99% to 100%. Use of endovaginal color and pulsed Doppler US increased the percentage of diagnostic initial sonographic examinations from 62% to 82%. The improved diagnostic sensitivity of endovaginal color Doppler US for ectopic pregnancy may ultimately result in earlier treatment, with reduced morbidity and mortality.

Paclitaxel is a new antimitotic derived from yew-tree, used for the treatment of ovarian and breast cancers. The local toxicity of paclitaxel is still poorly known. We report one of the first observations of accidental subcutaneous extravastion of paclitaxel. Local epidermic necrosis was observed and evolution was good with local treatment only. Treatments of such extravasation are discussed.

Pulsed Doppler studies of left and right ventricular outputs were obtained over time in a hydropic fetus with erythroblastosis fetalis. Despite severe anemia, cardiac outputs were within the normal range and remained normal after in utero percutaneous intravascular transfusions, which reversed the hydrops. The measurement of cardiac output in utero provides direct evidence that high-output failure due to anemia is not the mechanism for hydrops in erythroblastosis fetalis.

The purpose of this study is to determine the origin of the hypoechoic rim around the fetal heart; this rim has been noted previously but there is disagreement as to its origin. Of 314 fetuses scanned, a four-chamber view was obtained in 290; a hypoechoic rim was present in 94% of these. In all cases in which a short-axis view could be obtained, the rim continued circumferentially through the ventricular septum. Because the rim continues through the septum, it cannot be pericardial fluid but is instead part of the myocardium. The presence as well as the origin of this normal hypoechoic rim around the fetal cardiac ventricles should be considered before diagnosing small pericardial effusions.

A prospective study was performed in 340 obstetric sonograms to evaluate the sonographic characteristics of the fetal thymus. The thymus was identified as a homogeneous structure in the anterior fetal mediastinum in 251 cases (74%). The thymus was categorized as either hyperechoic, isoechoic, or hypoechoic relative to fetal lung. Seventy one of 115 cases (62%) prior to 27 weeks gestation were hyperechoic relative to fetal lung whereas 100 of 136 cases (73%) after 27 weeks were hypoechoic relative to lung (p less than .0001). Thymic measurements and shape were also recorded. The anterior-posterior AP thickness, measured in the midline at the sternum, ranged from 2 mm at 14 weeks to 20.8 mm at term. This study demonstrates that the thymus can be imaged in most fetuses.