DEBOIRES ESTHETIQUES APRES TRAITEMENT CONSERVATEUR POUR CANCER DU SEIN. LES TECHNIQUES DE RECONSTRUCTION MAMMAIRE PARTIELLE

A wide consensus exists today in favour of breast saving procedures for the surgical treatment of small breast cancers. The goal of conservative treatment is to preserve the shape of the breast and consequently to avoid the psychological consequences of the mutilation. In this respect, the final esthetic evaluation of conservative treatment is a major point to be considered after the oncological results. To evaluate these cosmetic results, 89 patients treated more than five years ago were analyzed on a standard picture protocol and rated according to a rigorous scale previously defined. In this group, 45% were rated as excellent, 34% as fair and 21% as poor. These results were compared to the cosmetic results of a second group of patients evaluated after the surgical state of their conservative treatment in order to precise the morphological damage due to the surgical procedure. In the second group, 73% were rated as excellent, 20% as fair, and 7% as poor. This study underlines the frequency of skin contractions (16%) and glandular defects (20%). Several rules are proposed to prevent such sequelae at the time of the tumorectomy. The difficulty of cosmetic improvement of the poor esthetic results is emphasized and the techniques of partial reconstructions are discussed in the light of our experience which includes 25 cases of partial reconstruction.