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Master Thesis

Mastectomie pour récidive locale avec ou sans reconstruction immédiate

Abstract : Purpose: Ipsilateral breast local recurrence (ILBLR) is a rare event, with an annual incidence rate of 0.6% for which there is very little data on the performance of mastectomy with immediate breast reconstruction (IBR). The objective was to report post-operative results of different types of mastectomy with or without IBR for ILBLR. Patients and methods: Two hundred and seven patients who get a mastectomy with or without IBR after breast conservative treatment were identified from January 2016 to April 2019. The characteristics of patients, surgery, complication rate, duration of surgery and anesthesia, postoperative hospitalization have been determined. Results: Of the 207 mastectomies for ILBLR, 32.8% had an IBR (68/207). Less reconstruction was performed for patients with body mass index ≥30 (OR 0.214), infiltrating ductal carcinomas (OR 0.272) and ASA-3 patients (OR 0.254). Types of mastectomy were 31 nipple-sparing mastectomy (NSM) (45.6%) and 37 skin-sparing mastectomy (SSM) (54.4%). IBR rates was 32.85% (68/207) for ILBLR. Reconstruction was performed by dorsal muscle flap (LDF) in 37 patients (54.4%) and with implants in 31 patients (45.6%). Twenty percent of NSM with implants and 71.4% of IBR by LDF were performed by robotic surgery (15/21). More IBR with dorsal muscle flap was performed when the mastectomy was of the NSM type (p=0.037). The overall complication rate was 37.4% (77/206), respectively 45.6% and 33.1% with and without IBR (p=0.056). Only dorsal muscle flap reconstruction compared to implant-IBR was associated with complications (OR 8.275, p=0.009, CI95% 1.7-40). No difference was found between robotic and open surgery (p=0.263). The only factor associated with a postoperative hospitalization >3 days was dorsal muscle flap reconstruction (OR 6.283 p=0,009) Conclusion: Salvage mastectomy with IBR is a good choice for local recurrence after BCT and did not contribute to higher surgical complications. NSM can be considered as a good treatment option in highly selected patients for ILBLR.
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Submitted on : Tuesday, June 15, 2021 - 6:39:07 PM
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  • HAL Id : dumas-03261612, version 1

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Pauline Simon. Mastectomie pour récidive locale avec ou sans reconstruction immédiate. Gynécologie et obstétrique. 2019. ⟨dumas-03261612⟩

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