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Master Thesis

Apport de l'oxygénothérapie hyperbare pour la cicatrisation après chirurgie de reconstruction mammaire : expérience du Centre Antoine Lacassagne à propos d’une série de 39 patientes

Abstract : Background: Mastectomy affects the body's integrity and may cause aesthetic and psychological sequelae in women. This is the whole issue of breast reconstruction, which will improve quality of life and restore body image, and the result of which will depend on the quality of cicatrization. Hyperbaric oxygen therapy, through various mechanisms, plays an important role in the healing process. In the literature, many studies suggest its efficacy, but the overall quality of the studies is poor, and most of the studies done in the context of breast surgery are case reports. The main objective of the study is to evaluate the effectiveness of hyperbaric oxygen therapy in improving cicatrization in cases of delayed scarring after breast reconstruction, even for patients at high risk of delayed cicatrization.
Method: Hyperbaric oxygen therapy is a treatment that consists of inhaling pure oxygen at a pressure higher than atmospheric pressure in a multi-place hyperbaric chamber. A session lasts 90 to 120 minutes. This retrospective study, conducted at the Centre Antoine Lacassagne in Nice, included all women who had undergone reconstructive, carcinological or prophylactic breast surgery and had benefited from hyperbaric oxygen therapy sessions for scarring defects, from April 2015 to January 2020. There were no exclusion criteria.
Results: We included 39 patients. The mean age was 51 years (min = 33; max = 67), mean BMI was 25.36 (min = 18; max = 43), 33.3% it were smokers, and 31.3% had a history of radiation therapy on the breast undergoing surgery. A total of the 64 breasts treated included 82.8% mastectomies with immediate reconstruction. 90.6% of patients had prosthetic material (42.2% prostheses and 48.4% expanders). 46.9% had a nipple-areolar complex (NAC) graft and 43.8% had NAC conservation with skin sheath conservation. And there were 53.1% inverted T-scars. The mean interval between surgery and the beginning of the chamber sessions was 3.2 days (min = 0; max = 42) and the mean number of total sessions per patient was 27.44 (min = 2; max = 78). Of the 39 patients, 29 progressed favourably (74.4%), and there was a material removal rate of 17.2%, a partial NAC necrosis rate of 36.2%, a total NAC necrosis rate of 27.6% with a NAC resection rate of 5.2%. The only risk factors implicated in the unfavorable evolution were the history of radiotherapy on the reconstructed breast, the type of reconstruction with immediate breast reconstruction, the type of material with the prosthesis, and early termination of caisson sessions.
Conclusion: In our study we were able to suggest, in a non-significant way, the improvement of cicatrization after breast reconstruction thanks to hyperbaric oxygen therapy, even in the presence of risk factors of poor scarring. Obviously, a comparative study is necessary to affirm this. Other large-scale, prospective and randomized studies are therefore justified to further determine the usefulness of hyperbaric oxygen therapy in the healing process after mastectomy and breast reconstruction.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03021875
Contributor : Bibliothèque Universitaire de Médecine Nice <>
Submitted on : Tuesday, November 24, 2020 - 3:11:21 PM
Last modification on : Thursday, April 8, 2021 - 3:15:58 AM

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  • HAL Id : dumas-03021875, version 1

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Morgan Picard. Apport de l'oxygénothérapie hyperbare pour la cicatrisation après chirurgie de reconstruction mammaire : expérience du Centre Antoine Lacassagne à propos d’une série de 39 patientes. Médecine humaine et pathologie. 2020. ⟨dumas-03021875⟩

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