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Background: Breast reduction surgery often concern women of childbearing age. However, it can interfere with the ability to breastfeed, whereas the benefits of breastfeeding are well known. Current data in the literature do not provide precise information on the possibilities of breastfeeding after breast reduction surgery., Objectives: The aim of this study was to assess long-term breastfeeding ability of women after breast reduction performed in our centre., Methods: This is a retrospective comparative study including patients treated with breast reduction at Saint-Louis Hospital between 2010 and 2017 and who have had children before or after surgery. Operative details were retrieved from medical records and ability to breastfeed was assessed during a phone interview. Breastfeeding before surgery was compared to breastfeeding after surgery., Results: We analysed 21 births before and 35 births after breast reduction. Breastfeeding initiation was similar in the two groups (90% vs. 83%, P=0.7), but the median duration was significantly shorter after breast reduction compared with before (3 weeks vs. 10 weeks; P<0.01), the rate of breastfed child at 3 months was lower after surgery (11% vs. 43%; P<0.01), the use of infant formula was higher after surgery (100% vs. 74%, P<0.01), and we found a higher rate of discontinuation caused by hypogalactia (69% vs. 11%; P<0.001)., Conclusion: Breastfeeding is possible but more difficult to sustain over time after breast reduction. Patients need to be made aware of that before surgery, and patients who still want to breastfeed should be encouraged at the maternity., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: More than 300,0000 breast plastic surgery procedures are performed annually worldwide, of which more than 100,000 are reduction mammoplasties carried out in the United States. Although most patients tend to be satisfied with the immediate outcomes of this procedure, there is increasing concern among surgeons as well as patients with regard to breast sensibility and the postoperative recovery.The objectives of this study were to assess the variation in the sensibility in patients undergoing hypertrophic breast surgery by quantification of the impact of various variables and to evaluate its progression from before the surgery to between 3 and 6 months and 1 year postoperatively., Methods: We carried out a nonrandomized, monocentric, prospective study. All of the patients were examined by the same evaluator using a set of 20 von Frey monofilaments on the day before the surgery and at 3 to 6 months and 1 year postoperatively. The breast skin, areola, and nipple sensibilities were tested. Age, body mass index, tobacco use, and the breast volume were recorded., Results: We did not find any significant effect of the body mass index, tobacco use, or age on breast sensibility. The nipple and areola complex (NAC) sensibility was inversely correlated with the degree of hypertrophy before the surgery, but this difference disappeared in the postoperative evaluations. After the surgery, the NAC sensibility decreased at the first follow-up at 4.5 months and returned to normal after 1 year., Conclusions: The inverse relationship between breast volume and sensibility in the preoperative evaluation disappeared after mammaplasty reduction. In the early postoperative period, the sensibility decreased on the NAC but returned to normal after 1 year., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Baker grade III and IV breast prosthesis capsular contractures represent a major problem for patients undergoing mammoplasties. The risk factors involved in recurrence are debated, and the best surgical approach for their prevention is not established. The objective was to identify these., Materials and Methods: We carried out a retrospective study of patients operated on for capsular contracture at the Saint-Louis Hospital in Paris from 2012 to 2014. The characteristics at inclusion were compared so as to determine the risk factors of recurrence. The surgical approaches were compared between the patients with recurrence and those without at 5 years., Results: Of the 100 patients included, 24 had a recurrence. The minimal follow-up was 5 years. No risk factors of recurrence of capsular contracture were identified. The surgical approach associated with the lowest rate of recurrence was anterior capsulectomy [OR total capsulectomy = 2.36 (0.73; 8.037) OR capsulotomy = 4.33 (1.37; 14.81)] (p < 0.040) with alteration of the volume of the implant, whether greater or less than initially [OR greater volume = 0.30 (0.096; 0.83); OR smaller volume = 0.14 (0.008; 0.85)] (p < 0.018)., Conclusion: The occurrence of capsular contracture is a major problem with prosthetic breast surgery. The main risk factors identified to date are essentially in regard to the occurrence of a first episode. No significant risk factors for recurrence were identified. The best prevention appears to be an anterior capsulectomy with reducing the volume of the implant., 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 . IV.

Background: Breast sensitivity is a significant issue in preoperative consultation prior to reduction mammoplasty. Although a range of techniques is used, recovery of sensation is usually evaluated using the inferior pedicle. Our objective was to evaluate and compare the change in breast sensitivity using the superomedial versus the superior pedicle., Methods: We performed a non-randomized, monocentric, prospective study. Thirty-six patients were examined by a single evaluator with von Frey monofilaments on the day prior to the surgery, at 3-6 months, and at 1 year postoperatively. The breast skin, areola, and nipple sensitivity were tested. The breasts were classified into two groups depending on whether the superior pedicle (S) or the superomedial pedicle (SM) technique was used., Results: The differences between the two groups indicate that the SM group had better sensitivity at 4.5 and 12 months postoperatively. The thresholds for the size filaments that could be felt at the first follow-up on the skin, the areola, and the nipple for the S group vs. the SM group were 2.55 vs. 2.41 (p = 0.41), 4.57 vs. 4.45 (p = 0.28), and 4.17 vs. 3.81 (p = 0.04) size units, respectively. At 1 year postoperatively, the respective values were 2.62 vs. 2.52 (p = 0.49), 4.28 vs. 4.05 (p = 0.04), and 3.63 vs. 3.38 (p = 0.10)., Conclusion: The nerve fibers appear to be better preserved in the superomedial pedicle than in the superior pedicle. However, these differences were not clinically relevant. The choice of the technique should be made on the basis of the size and the shape of the breast, the patient morphology, and the operator's preference rather than being on the basis of the recovery of sensitivity., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Zosteriform rash in cancer patients provides objective clues to the process of reinnervation of the reconstructed breast. This rash should also raise suspicion for metastasis, which can be confused with herpes zoster., Objectives: The aims of this study were to explain the reconstruction flap sensory reinnervation mechanism based on the clinical findings and provide a diagnostic and management algorithm of zosteriform rash in breast cancer patients., Methods: On November 15, 2017, we conducted a search of published articles in MEDLINE and Cochrane databases. All the articles describing a zosteriform rash in a patient with a history of breast cancer were included in this review., Results: Eleven articles from the literature and 1 case from our practice were selected for inclusion in this systematic review. Five patients had a breast reconstruction with a flap. The flap skin was affected by the rash in 4 of these patients, providing an objective proof of the reinnervation of the reconstructed breast. In 6 patients, the presentation was typical, and the diagnosis of herpes zoster was made without additional diagnostic testing. In 4 cases, the eruption was atypical, and a biopsy was done to confirm the diagnosis of a cancer metastasis. In 2 patients, the rash was multidermatomal, and a polymerase chain reaction was done to confirm the diagnosis of disseminated herpes zoster., Conclusions: Zoster reactivation in breast reconstructed patients is an objective proof of the reinnervation of the skin flap. Moreover, zosteriform rash in cancer patients should raise suspicion for metastasis, which can be confused with herpes zoster.

Introduction: The sub-muscular placement of cosmetic breast implants leads to substantial pain due to the muscular distention. The aim of this study was to assess the efficiency of intraoperative ropivacaine instillation to reduce postoperative pain the day after surgery., Material and Methods: We conducted a prospective, controlled, single-blinded study comparing the intraoperative instillation of 7.5mg of ropivacaine through Redon drains with the standard procedure in 72 patients undergoing sub-muscular cosmetic breast augmentation for the first time., Results: Pain at the awakening on postoperative day 1 was 4.8 on a simple numeric pain scale in the treatment group and 5.1 in the control group (P>0.05). On postoperative day 3, pain at awakening was 3.7 in both groups (P>0.05), and on postoperative day 5, pain was 2.8 in the treatment group and 2.7 in the control group (P>0.05)., Conclusion: Local instillation of ropivacaine in the implant pocket during surgery did not decrease postoperative pain on day 1, day 3 and day 5. From now on, we are able to tell to patients that the postoperative pain after sub-muscular cosmetic breast implants surgery is about 5/10 on postoperative day 1, 4/10 at day 3 and 3/10 at day 5., Level of Evidence: Level II., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Delayed breast reconstruction with tissue expansion may be risky after radiotherapy, due to the poor skin quality. To permit the use of the tissue expansion procedure, we propose a scarless latissimus dorsi flap to bring tissue trophicity, by a healthy vascularized muscular interface with no donor scar and no patch effect. The objective of this study is to assess the outcome of the tissue expansion technique with scarless latissimus dorsi flap after post-mastectomy radiotherapy., Methods: All the patients who had benefited of a delayed breast reconstruction after radiotherapy using tissue expansion technique with scarless latissimus dorsi flap, between January 2000 and January 2013, were reviewed. The exclusion criteria were: prior breast reconstruction, or interruption of breast reconstruction procedure due to active metastatic disease requiring ongoing oncological treatment. The complications were identified: failures of reconstruction, implant exposure, wound dehiscence, capsular contracture, deflation of implant, hematoma, infection, and skin necrosis., Results: One hundred and twenty-two breasts were reviewed. The average time between the flap and the expander intervention was: 194±114 SD (28-1051) days. The mean volume of inserted expander was 633±111 SD (350-1100) mL and the mean inflation volume was 578±190 SD (170-1160) mL. The average time between insertion of the expander and insertion of the permanent implant was 132±76 SD (49-683) days. The mean inflation of the implant volume was 368±105 SD (130-620) mL. Forty patients developed at least one complication. The most common complication was the appearance of a capsular contracture requiring a capsulectomy: 11 (9.2%) with permanent implants and 6 (4.9%) with expander. Deflation of implants occurred with six permanent implants and with one expander. There were 3 breast reconstructions failures (two infections and one exposure of implants)., Conclusion: This procedure offers the advantages that there is no unattractive scar, and that there are low rates of exposure or failed reconstruction., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Aims of the Study: One of the most frequently used flap in breast reconstruction after mastectomy is the latissimus dorsi musculocutaneous flap. We present a novel method of sampling by extending the mastectomy scar back until the skin paddle. On the one hand, this technique facilitates the transfer of the flap in thoracic region, on the other hand, it allows for larger skin paddle and maximize new breast contour reintegrating the ear skin during the modeling., Patients and Methods: The data of 37 patients operated by this technique between 2006 and 2009 were reviewed retrospectively. Cosmetic results were analyzed from photographs by a plastic surgeon who was not the operator., Results: The results were highly satisfactory in 45% cases, satisfactory in 40% of cases, fair in 12% of cases and inadequate in 3% of cases., Conclusion: The main advantage of this technique is to collect large skin paddle with a larger width at the ends through increasing opportunities for modeling., (Copyright © 2012. Published by Elsevier SAS.)

Background: A full-thickness skin graft is often performed by tie-over dressing to compress and immobilize it., Objective: The aim of this study was to compare the results of a full-thickness skin graft with tie-over dressing performed with the classic technique and with simple dressing., Methods and Materials: This was a prospective study in which 25 patients had tulle gras jelly tie-over dressing and 25 patients had a simple tulle gras dressing after full-thickness skin graft for nipple areola reconstruction., Results: Graft success on the fifth day was evaluated at 100% for patients with a simple dressing and at 99% for those with tie-over dressing., Conclusions: In this study, simple dressing appeared to be at least as effective as the tie-over dressing. Simple dressing, however, was faster and left fewer residual marks than the tie-over dressing.

Background: After mastectomy for breast cancer, especially when combined with radiation, inadequate wall thickness and insufficient elasticity of the skin are problems frequently encountered in breast reconstruction. We describe a reconstruction method using a latissimus dorsi muscle flap, followed by expansion, that creates no additional scar., Methods: This retrospective study included 30 patients who underwent this 4-surgery reconstruction: the muscle flap was raised and drawn through the mastectomy scar; the expander was inserted; expander replacement with the definitive prosthesis and concomitant symmetrization of the contralateral breast; finally, reconstruction of the nipple-areola complex., Results: Only 1 failure, prosthesis extrusion, was observed. A surgeon scored the outcomes as above average for 26 women, who were satisfied., Discussion: We noted an overall lower complication rate and a lower reconstruction-failure rate compared with reported results. This approach obtained better tissue quality; the flap provided better covering thickness and expansion, yielding a larger muscle-skin pocket., Conclusions: This reconstruction procedure seems reliable and extends the indications of skin expansion, with satisfactory results.

Summary: Aims of the study: One of the most frequently used flap in breast reconstruction after mastectomy is the latissimus dorsi musculocutaneous flap. We present a novel method of sampling by extending the mastectomy scar back until the skin paddle. On the one hand, this technique facilitates the transfer of the flap in thoracic region, on the other hand, it allows for larger skin paddle and maximize new breast contour reintegrating the ear skin during the modeling. Patients and methods: The data of 37 patients operated by this technique between 2006 and 2009 were reviewed retrospectively. Cosmetic results were analyzed from photographs by a plastic surgeon who was not the operator. Results: The results were highly satisfactory in 45% cases, satisfactory in 40% of cases, fair in 12% of cases and inadequate in 3% of cases. Conclusion: The main advantage of this technique is to collect large skin paddle with a larger width at the ends through increasing opportunities for modeling. [Copyright &y& Elsevier]