Introduction. - Cytosteatonecrosis (CTN) is a frequent postoperative complication after breast autologous reconstruction using DIEP (deep inferior epigastric perforator) flap. CTN radiological diagnostic reveals different types of lesions, as nodes or extended fat necrosis, which become in some cases infected, or pass for tumor recurrence after breast cancer treatment. CTN is caused by intraoperative ischemia of the flap, and no current method can prevent postoperative CTN development after DIEP breast reconstruction. Mechanical ischemic preconditioning, consisting in intraoperative briefs consecutive cycles of ischemia reperfusion using vascular clamp upon the graft pedicle, is used in transplantation surgery. This procedure improves the graft tolerance towards ischemic surgical lesions. The aim of this retrospective observational study was to assess PCIM effects on CTN development after DIEP surgery, comparing CTN occurrence after breast reconstruction using DIEP flap with or without intraoperative PCIM. Material and methods. - All patients breats reconstructed using DIEP flap between novembre 2020 and may 2022, presenting 6 months postoperative breast echography were retrospectively included. Primary outcome was the ultrasonic existence of CTN, according to the Wagner classification. Clinical data, postoperative outcomes such as infection, hematoma or surgical revision, and length of stay in hospital were also recorded. Results. - Twenty nine patients among which 8 PCIM were included. CTN occurrence rate after PCIM (25%) was quite lower than CTN rate without PCIM (71,4%), although the difference was not significant (P = 0,088). Other postoperative complications rates were not significantly different with or without PCIM. Conclusion. - PCIM seems to improve CTN occurrence after DIEP breast reconstruction, improving fat flap tolerance to ischemic perioperative lesions. Those preliminary results need to be confirmed with clinical prospective study. (c) 2023 Elsevier Masson SAS. All rights reserved.

La cytostéatonécrose (CTN) ou nécrose graisseuse, est une complication postopératoire fréquente des reconstructions mammaires par lambeau graisseux type DIEP (deep epigastric perforator flap). Confirmée à l’imagerie, elle se présente sous diverses formes, nodules ou plages étendues de nécrose, peut s’infecter et mimer une récidive tumorale. Sa survenue est liée à l’ischémie peropératoire subie par le lambeau, et aucune méthode ne permet de la prévenir actuellement. Le préconditionnement ischémique mécanique (PCIM) des lambeaux libres est une méthode dérivée de la chirurgie de transplantation d’organe qui améliore la tolérance du greffon à l’ischémie reperfusion de la chirurgie. Le procédé consiste à effectuer de brefs cycles consécutifs d’ischémie reperfusion par clampage déclampage au niveau du pédicule du lambeau in situ. L’objectif de cette étude rétrospective observationnelle était d’analyser les effets du PCIM sur la survenue de CTN après reconstruction par DIEP, en comparant le taux de CTN postopératoire parmi les DIEP non preconditionnés, versus DIEP préconditionnés en peropératoire. Toutes les patientes opérées par DIEP avec ou sans PCIM entre novembre 2020 et mai 2022, présentant une échographie mammaire du sein reconstruit réalisée dans le service de radiologie hospitalier à 6 mois postopératoires ont été incluses. Le critère de jugement principal était la présence de CTN sur l’échographie à 6 mois, avec classification de cette CTN selon la classification de Wagner. Les caractéristiques cliniques des patientes, les complications postopératoires (hématome infection), les durées d’hospitalisation étaient recueillis. 29 patientes ont été incluses, dont 8 avec PCIM peropératoires. Le taux de CTN retrouvé après PCIM (25 %) était inférieur a celui retrouvé sans PCIM (71,4 %), sans différence significative (p = 0,088). Le taux des autres complications postopératoires n’était pas différent avec ou sans PCIM. Le PCIM semble avoir un effet bénéfique sur la survenue de CTN post opératoire en améliorant la tolérance de la graisse du lambeau de DIEP à l’ischémie peropératoire. Ces résultats préliminaires doivent être confirmés par une étude clinique prospective. Cytosteatonecrosis (CTN) is a frequent postoperative complication after breast autologous reconstruction using DIEP (deep inferior epigastric perforator) flap. CTN radiological diagnostic reveals different types of lesions, as nodes or extended fat necrosis, which become in some cases infected, or pass for tumor recurrence after breast cancer treatment. CTN is caused by intraoperative ischemia of the flap, and no current method can prevent postoperative CTN development after DIEP breast reconstruction. Mechanical ischemic preconditioning, consisting in intraoperative briefs consecutive cycles of ischemia reperfusion using vascular clamp upon the graft pedicle, is used in transplantation surgery. This procedure improves the graft tolerance towards ischemic surgical lesions. The aim of this retrospective observational study was to assess PCIM effects on CTN development after DIEP surgery, comparing CTN occurrence after breast reconstruction using DIEP flap with or without intraoperative PCIM. All patients breats reconstructed using DIEP flap between novembre 2020 and may 2022, presenting 6 months postoperative breast echography were retrospectively included. Primary outcome was the ultrasonic existence of CTN, according to the Wagner classification. Clinical data, postoperative outcomes such as infection, hematoma or surgical revision, and length of stay in hospital were also recorded. Twenty nine patients among which 8 PCIM were included. CTN occurrence rate after PCIM (25%) was quite lower than CTN rate without PCIM (71,4%), although the difference was not significant (P = 0,088). Other postoperative complications rates were not significantly different with or without PCIM. PCIM seems to improve CTN occurrence after DIEP breast reconstruction, improving fat flap tolerance to ischemic perioperative lesions. Those preliminary results need to be confirmed with clinical prospective study.

El aumento mamario es la intervención de cirugía estética más realizada en el mundo en la actualidad. El tratamiento quirúrgico de las pacientes que la solicitan obedece a una serie de principios que permiten evitar los defectos de los resultados y las complicaciones. Una doble consulta, además de ser una obligación medicolegal, es indispensable para evaluar la necesidad, realizar una exploración física, escoger la técnica más adecuada e informar a la paciente. La introducción de dos prótesis mamarias sigue siendo en la actualidad la solución más utilizada. Existen múltiples variantes técnicas, que obligan al cirujano a realizar la elección basándose en las preferencias personales de la paciente y en criterios clínicos o morfológicos. Debe decidir qué prótesis implantar, su forma y su volumen, escoger la vía de acceso y los planos de disección. En ocasiones, debe proponer un procedimiento complementario de mastopexia que deja unas cicatrices sobreañadidas si la hipoplasia se asocia a una ptosis mamaria. El lipomodelado estético de las mamas es actualmente una alternativa perfectamente válida que permite evitar los inconvenientes del cuerpo extraño al ofrecer una solución autóloga. Sin embargo, las indicaciones de esta técnica son limitadas y hay varias precauciones que deben conocerse. El aumento de volumen es moderado, por lo que a veces se requieren dos intervenciones quirúrgicas. El aumento mamario compuesto asocia las dos técnicas precedentes. Se trata de una solución que puede ser adecuada para algunas mujeres delgadas que deseen un aumento importante con un resultado más natural.

Les éléments anatomiques permettant la réalisation sécurisée et prédictible de chirurgie fronto orbitaire de féminisation faciale sont peu connus. L'objectif principal de cette étude était d'analyser les caractéristiques (dimensions, taux de pneumatisation et épaisseur de la paroi antérieure) du sinus frontal chez des patientes transgenres MtF. L'objectif secondaire était d'établir des critères reproductibles de mesures scanographiques pouvant orienter la planification préopératoire de l'impaction frontale dans les frontoplasties de féminisation (FF). Cinquante scanners de massif facial préoperatoires de patientes opérées d'une FF ont été inclus. L'âge moyen des patientes opérées était de 34 ans. La ligne F représentait l'inclinaison idéale du front en l'absence de bosse frontale. La hauteur, la largeur, la profondeur et l'épaisseur de la paroi antérieure du sinus étaient respectivement de 26,6 mm (±5,7), 49,5 mm (±11,3), 10,9 mm (±3,3) et 3 mm (±0,7). Le ratio moyen largeur du sinus/largeur du crâne était de 0,73 (±0,12). 6 % des patientes avaient une agénésie bilatérale des sinus frontaux. Une ostéotomie de la paroi antérieure du sinus frontal avait été réalisée chez les 64 % des patientes présentant une projection du sinus frontal en avant de la ligne F. L'émergence des nerfs supra orbitaires de l'os frontal se fait à travers une encoche osseuse dans 73,8 % des cas. La connaissance de l'anatomie du sinus frontal et l'étude préopératoire des scanners du massif facial est indispensable pour planifier les FF. Ces caractéristiques orientent la technique opératoire de remodelage osseux ainsi que le geste de libération des nerfs supraorbitaires. Little is known about the anatomical elements that allow safe and predictable performance of fronto orbital surgery for facial feminization. The primary objective of this study was to analyze the characteristics (dimensions, pneumatization rate, and anterior wall thickness) of the frontal sinus in MtF transgender patients. The secondary objective was to establish reproducible criteria for CT measurements that could guide preoperative planning of frontal impaction in feminization frontoplasty (FF). Fifty preoperative facial mass scans of FF surgery patients were included. The mean age of the operated patients was 34 years. The F line represented the ideal forehead tilt in the absence of a frontal hump. The height, width, depth, and thickness of the anterior sinus wall were 26.6 mm (±5.7), 49.5 mm (±11.3), 10.9 mm (±3.3), and 3 mm (±0.7), respectively. The mean sinus width to skull width ratio was 0.73 (±0.12). Six percent of patients had bilateral frontal sinus agenesis. An osteotomy of the anterior wall of the frontal sinus was performed in the 64% of patients with frontal sinus projection anterior to the F-line. The emergence of the supraorbital nerves from the frontal bone was through a bony notch in 73.8% of cases. Knowledge of the anatomy of the frontal sinus and preoperative study of the scans of the facial mass is essential for planning the FF. These characteristics guide the surgical technique of bone remodeling as well as the procedure for releasing the supraorbital nerves.

Purpose: Gender affirmation in trans men requires multiple staged procedures. The final masculinizing step involves phalloplasty or metoidioplasty and further incorporation of penile and testicular prostheses. However, these are functionally suboptimal and associated with high complication rates. Therefore, we sought to investigate the anatomical feasibility of one-stage genitourinary vascularized composite allotransplantation (GUVCA) for such gender- affirming surgeries.Methods: Twenty fresh cadaveric dissections were performed to delineate the neurovascular anatomy of the proposed GUVCA. Specifically, in donors (n = 14), besides the penis and scrotum, the GUVCA included an inferior bladder patch with the urinary sphincter, prostate, seminal vesicles, as well as a strip of the pubic bone. In trans men recipients, osteotomies of the pubic bone to match that of the donor GUVCA were required. Five cadaveric GUVCA transplants were then performed to simulate one-stage gender affirmation surgery.Results: The GUVCA required (1) vascular anastomoses between the recipient's deep inferior epigastric, external pudendal, and superficial circumflex iliac (or superficial inferior epigastric) vessels to the donor's internal pudendal, external pudendal and genitofemoral vessels re- spectively; (2) neurosynthesis between the recipient pudendal and dorsal clitoral nerves to the donor pudendal and genitofemoral nerves; and (3) urinary bladder anastomosis at the bladder neck, upstream of the urinary sphincter. Average donor measurements (length (cm), diameter (mm)) were: external pudendal artery (2.5, 2.0) and vein (2.0, 3.5), internal pudendal artery (15.0, 4.0), pudendal (15.0, 3.0) and genitofemoral nerves (8.0, 2.0).Conclusions: We have described the anatomical basis for a one-stage GUVCA in trans masculine genitourinary reconstruction.& COPY; 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons.Published by Elsevier Ltd. All rights reserved.

El desarrollo de la obesidad y su tratamiento radical mediante cirugía bariátrica genera una demanda frecuente en cirugía plástica para la corrección de las secuelas de la pérdida de peso, o exceso tisular, a menudo importantes. El tratamiento se basa en la resección cutánea, con el corolario de cicatrices considerables. Son necesarias múltiples cirugías, que deben organizarse lo mejor posible, favoreciendo las localizaciones quirúrgicas agrupadas por razones prácticas y financieras, preservando al mismo tiempo la calidad del resultado y la seguridad de estos pacientes frágiles. Es la exploración física la que determinará los procedimientos quirúrgicos por localización anatómica. Teniendo en cuenta las peticiones de los pacientes, estas cirugías se agrupan en secuencias terapéuticas sucesivas según una estrategia adaptada a cada caso particular. La cirugía de las secuelas de la pérdida de peso es larga, agotadora para el paciente y el cirujano, y el postoperatorio suele estar plagado de complicaciones. Sin embargo, esta cirugía es la única solución para garantizar a estos pacientes un nivel de vida digno y favorecer así su estabilidad ponderal en el futuro.

La mastoplastica additiva è la procedura di chirurgia estetica più frequentemente eseguita nel mondo oggi. La gestione chirurgica delle pazienti che ne fanno richiesta obbedisce a una serie di principi che consentono di evitare i risultati difettosi e le complicanze. Una doppia visita, oltre ad avere un valore medicolegale, è indispensabile per valutare la necessità, eseguire un esame clinico, scegliere la tecnica più idonea e informare la paziente. L’introduzione di due protesi mammarie resta a tutt’oggi la soluzione più utilizzata. Esistono molte varianti tecniche, che costringono il chirurgo a fare scelte basate sulle preferenze personali della paziente e su criteri clinici o morfologici. Egli deve decidere quale protesi impiantare, la sua forma e il suo volume e scegliere la via d’accesso e i piani di dissecazione. Deve eventualmente proporre una procedura aggiuntiva di mastopessi che causa ulteriori cicatrici se all’ipoplasia è associata una ptosi mammaria. Il lipomodellamento estetico del seno è oggi un’alternativa perfettamente valida che consente di evitare gli inconvenienti da corpo estraneo offrendo una soluzione autologa. Le indicazioni per questa tecnica sono tuttavia limitate ed è necessario conoscere un certo numero di precauzioni. L’aumento di volume è moderato e a volte richiede due interventi chirurgici. La mastoplastica additiva composita associa le due tecniche precedenti. Questa è una soluzione che può rivelarsi saggia per alcune donne magre che desiderano un aumento significativo con un risultato più naturale.

INTRODUCTION:Little is known about the anatomical elements that allow safe and predictable performance of fronto orbital surgery for facial feminization. The primary objective of this study was to analyze the characteristics (dimensions, pneumatization rate, and anterior wall thickness) of the frontal sinus in MtF transgender patients. The secondary objective was to establish reproducible criteria for CT measurements that could guide preoperative planning of frontal impaction in feminization frontoplasty (FF). MATERIALS:Fifty preoperative facial mass scans of FF surgery patients were included. The mean age of the operated patients was 34 years. The F line represented the ideal forehead tilt in the absence of a frontal hump. RESULTS:The height, width, depth, and thickness of the anterior sinus wall were 26.6mm (±5.7), 49.5mm (±11.3), 10.9mm (±3.3), and 3mm (±0.7), respectively. The mean sinus width to skull width ratio was 0.73 (±0.12). Six percent of patients had bilateral frontal sinus agenesis. An osteotomy of the anterior wall of the frontal sinus was performed in the 64% of patients with frontal sinus projection anterior to the F-line. The emergence of the supraorbital nerves from the frontal bone was through a bony notch in 73.8% of cases. CONCLUSIONS:Knowledge of the anatomy of the frontal sinus and preoperative study of the scans of the facial mass is essential for planning the FF. These characteristics guide the surgical technique of bone remodeling as well as the procedure for releasing the supraorbital nerves.

Lo sviluppo dell’obesità e del suo trattamento radicale mediante la chirurgia bariatrica genera in chirurgia plastica una frequente richiesta di correzione di eccessi tissutali da sequele spesso rilevanti. Il trattamento si basa sulla resezione cutanea con, come corollario, un importante prezzo cicatriziale. Sono necessari molteplici interventi chirurgici che è opportuno organizzare al meglio, favorendo siti chirurgici raggruppati per ragioni pratiche ed economiche, preservando al tempo stesso la qualità del risultato e la sicurezza di questi fragili pazienti. È l’esame clinico che determinerà i gesti chirurgici da ipotizzare tramite localizzazione anatomica. Tenendo conto delle richieste del paziente, questi interventi sono raggruppati in sequenze terapeutiche successive secondo una strategia adattata a ciascun caso particolare. La chirurgia delle sequele del dimagrimento è lunga, stressante per il paziente e per il suo chirurgo, e i postumi sono spesso costellati di complicanze, ma tale chirurgia si rivela l’unica soluzione per assicurare a questi pazienti un comfort di vita decente e favorire così la loro futura stabilità ponderale.

Lymphatic dissemination is thought to be a rare event in breast sarcomas. The decision to perform axillary clearance is challenging. In our prospective cohort, we aimed to evaluate the frequency and factors determining lymph node (LN) involvement in breast sarcomas, with the aim of proposing a decision tree/algorithm for the realization of LN clearance in breast sarcomas. Patients and methods > Fourty-five women were surgically treated for breast sarcomas from 1982 to 2020. Angiosarcomas and other sarcomas were compared in terms of LN involvement, recurrence, and mortality.Results > Twenty-three patients underwent axillary lymphadenectomy. Initial LN involvement was diagnosed in one case of D2-40 positive, primary angiosarcoma for which preoperative imaging detected a suspicious LN confirmed by preoperative histology. Among the 22 patients who had no initial axillary lymphadenectomy, two patients with D2-40 positive angiosarcoma had recurrent cancer in LN (internal mammary group in 1 and homolateral axilla in 1). The average follow-up in the overall population was 6.2 years (+/- 8.3). The cohort's overall recurrence rate was 33% (15/45) and the time of recurrence after initial surgery was on average 2.4 years (+/- 3.1). For the three patients with LN metastases, time to recurrence after surgery was 3.7 years (+/- 4.5). There was no significant difference in the overall recurrence rate depending on whether or not lymphadenec-tomy was initially performed (respectively 26% vs 41% OR = 1.11, P = 0.29). Discussion/Conclusion > Systematic axillary clearance leads to overtreatment in breast sarcomas. A decision tree, including radiological examination of the axilla, histological type of sarcoma, and D2-40 positivity, could be a decision aid in the choice of axillary clearance.

Postoperative satisfaction after facial gender-affirming surgery (FGAS) has not yet been assessed using a validated questionnaire. There is currently no postoperative satisfaction questionnaire specific to transgender patients concerning facial surgery. The contributions of three-dimensional planning in fronto-orbital surgery in trans women and the use of bone cutting guides for facial feminization surgery have been demonstrated. The primary objective of this study was to evaluate postoperative satisfaction with the upper third of the face in trans women using a validated questionnaire - FACE-Q - after fronto-orbital surgery using custom-made bone cutting guides. The secondary objective was to determine predictive factors of satisfaction. Forty-two patients who underwent frontoplasty with frontal sinus impaction osteotomies using custom bone cutting guides between May 2018 and September 2020 were included. Three-dimensional preoperative computed tomography planning was performed for each patient. Evaluations were performed preoperatively and at 1 year postoperative using FACE-Q items relating to the upper third of the face (fronto-orbital area) and general questionnaire items. At 1 year, the following FACE-Q scales had improved significantly in comparison to the preoperative evaluation: overall facial appearance (33.6 ± 19.4 vs 70.1 ± 21.1; P < 0.001), forehead and eyebrow appearance (38.3 ± 19.7 vs 80.1 ± 15.9; P < 0.001), wrinkles between the eyebrows (54.1 ± 26.7 vs 82.6 ± 19.9; P = 0.001), appearance-related psychological distress (58.1 ± 18.1 vs 24.6 ± 24.5; P < 0.001). No factors predictive of postoperative satisfaction were found for the included frontal FGAS. In the absence of a validated questionnaire specific to facial feminization surgery in transgender patients, the FACE-Q questionnaire showed an improvement in patient satisfaction after FGAS of the upper third using custom-made cutting guides.

Introduction. - Scrotal rejuvenation is a real male aesthetic demand. Scrotal injection of Wrinkles; botulinum toxin makes the testicles smoother, less dangling and subjectively larger. Methods. - Intrascrotal botulinum toxin injections were performed to a 44-year-old patient for aesthetic purposes. We used the intracremasteric injection protocol. Cremaster muscle injections and dartos muscle injections were performed. Results. - The patient was satisfied. No adverse reaction to the intrascrotal botulinum toxin injection was observed. The patient wanted to repeat the procedure in the future. Conclusion. - At the moment, there is no recommendation about the aesthetic use of intrascrotal injections of botulinum toxin A and the risks are unknown. The purpose of this article is to show the feasibility, context and technical modalities of intrascrotal injection. The risk of infertility is real, but marginal for men who no longer have progeny's desire. (C) 2020 Elsevier Masson SAS. All rights reserved.

Background Unfractionated heparin has anticoagulant properties by catalyzing antithrombin III, which inactivates coagulation enzymes. Used in microsurgery, it would prevent the occurrence of thrombosis during microsurgical anastomoses. The objective of this study was to evaluate the role of intraoperative irrigation of the vascular lumen with pure sodium heparin to prevent vascular thrombosis after end-to-end microsurgical anastomoses. Methods End-to-end anastomoses were performed on rats by 21 operators. Three surgical sites were studied (cervical, femoral, and rat tail). The first vessel was irrigated with physiological salt solution (0.9%) before, during, and before the end of the anastomosis. Whenever possible, the contralateral vessel was irrigated with pure unfractionated heparin 5,000 UI/mL. The primary endpoint was the occurrence of thrombosis 60 minutes after anastomosis. Results From November 2015 to April 2018, 247 anastomoses were performed on 229 arteries and 18 veins. One hundred twenty-five anastomoses were irrigated with physiological salt solution, 122 with pure unfractionated heparin. A 60-minute thrombosis was found on 31 anastomoses (25%) irrigated with physiological salt solution compared with 16 anastomoses (13%) irrigated with heparin, that is, a decrease in the thrombosis rate of 2.6 ( p = 0.01). Conclusion The use of pure unfractionated heparin in intraoperative lumen irrigation during microsurgical end-to-end anastomoses reduces the rate of vascular 60-minute thrombosis compared with physiological salt solution irrigation. It is an effective intraoperative procedure for the prevention of microsurgical thrombosis.

Le lymphome anaplasique à grandes cellules associées aux implants mammaires (LAGC-AIM) est une pathologie récente. Le seul facteur de risque reconnu est l'implant mammaire. Une étude rétrospective a été réalisée sur les cas français de LAGC-AIM diagnostiqués par le réseau Lymphopath et déclarés à l'ANSM. Afin de compléter ces données sur l'histoire prothétique des implants nous avons envoyé aux chirurgiens référents un questionnaire. En combinant les données de l'ANSM et celles des questionnaires, nous avons pu étudier l'histoire prothétique de 32 LAGC-AIM unilatéraux et deux LAGC-AIM bilatéraux. L'âge moyen des patientes au moment du diagnostic était de 59 ans (29 ; 83). Douze LAGC-AIM étaient survenus après augmentation mammaire esthétique, 22 après mastectomie pour néoplasie, et deux après symétrisation par prothèse du sein controlatéral à une mastectomie pour néoplasie. Quinze LAGC-AIM ont été diagnostiqués sur prothèse unique, toutes macrotexturées avec une macrotexturation obtenue par projection de cristaux de sels de type biocell. Les 21 autres LAGC-AIM ont été diagnostiqués sur prothèses multiples (2 à 5) et ont tous été en contact au moins une fois avec une prothèse de type biocell. La durée moyenne d'exposition aux implants tous confondus était de 11 ans (4 ; 31). La durée moyenne d'exposition à des enveloppes macrotexturées obtenues par projection de cristaux de sel était de neuf ans (2 ; 23). Six patientes étaient exposées à une prothèse d'expansion obtenue par projection de cristaux de sel. Aucune patiente n'a été exposée uniquement à une macrotexture projetée sur prothèse d'expansion. Les implants macrotexturés projetés aux cristaux de sel et plus particulièrement de type biocell sont retrouvés dans l'histoire de tous les 36 LAGC-AIM de cette série. Breast implant-associated anaplastic large cell lymphoma is a recent pathology; the one known risk factor is breast implantation. A retrospective study was conducted on the French BIA-ALCL cases diagnosed by the Lymphopath network and reported to the National Medical Safety Agency (ANSM). Wishing to obtain supplementary data on the prosthetic history of implants, we sent the referent surgeons a questionnaire. By combining the relevant ANSM data and questionnaire data, we studied the histories of 32 unilateral cases of BIA-ALCL and 2 bilateral cases of BIA-ALCL. Mean patient age on diagnosis was 59 (29; 83). Twelve BIA-ALCL cases occurred after breast augmentation for esthetic purposes, 22 following mastectomy for neoplasia and 2 after symmetrization of the contralateral breast in reconstruction. Fifteen BIA-ALCL cases were diagnosed on single prostheses, all of them macrotextured with macrotexturing obtained by projection of biocell salt crystals, also known as the biocell "salt loss" technique. The other 21 BIA-ALCL cases were diagnosed on multiple prostheses (2 to 5), and all of them had had at least one contact with a biocell implant. Mean duration of exposure to implants was 11 years (4; 31). Mean duration of exposure to the macrotextured shell surfaces obtained by the salt loss technique was 9 years (2; 23). Six patients were exposed to a temporary macrotextured Expander implant obtained with the aforementioned salt loss technique. No patient was exposed to the macrotextured Expander implant alone. Salt loss macrotextured implants, particularly those of the biocell-type, were found in the prosthetic history of all 36 BIA-ALCL cases in this series.

Introduction. - Immediate or delayed breast reconstruction by deep inferior epigastric perforant flap (DIEP) is a frequent and widespread autologous breast reconstruction technique that presents a risk of failure inherent in its microsurgical nature. The main objective was to evaluate the interest of surgical revision in case of DIEP failure, the secondary objective was to evaluate the consequences of surgical revision on the subsequent management. Materials and methods. - This is a retrospective monocentric and single-operator analytical study of 167 unilateral DIEPs carried out from 2008 to 2016. Two groups were compared: success of DIEP without revision versus DIEP requiring a revision that resulted in success or failure. After analyzing the failure and recovery rates of DIEP, we compared the transfusion rate, total operating time, hospitalization time, and final breast reconstruction in the two groups. Results. - One hundred and sixty-seven DIEPs were performed from 2008 to 2016 in 167 women, 18 revisions were reported (10.7%), 12 revisions were successfully reported (7.2%) 6 failures were reported after revision (3.6%). Surgical revision allows the flap to be rescued in 67% of cases. Revision increases the risk of blood transfusion by a factor of 12 (OR = 12.24 [95% CI = 3.74-43.17] P < 0.05). Revision or failure doubles the total operating time (281.8 min [170-570] vs. 577.8 min [285-860] P < 0.05) and increases hospitalization time by 2.5 days compared to DIEP's initial success (5.74 days [4-9] vs. 8.33 days [5-17] P < 0.05). Fifty percent of patients choose another type of breast reconstruction after DIEP failure. Conclusion. - DIEP is a reliable microsurgical breast reconstruction technique, failure can be prevented in two thirds of cases by monitoring and early reoperation. (C) 2019 Elsevier Masson SAS. All rights reserved.

Introduction. - Breast implant-associated anaplastic large cell lymphoma is a recent pathology; the one known risk factor is breast implantation. Methods. - A retrospective study was conducted on the French BIA-ALCL cases diagnosed by the Lymphopath network and reported to the National Medical Safety Agency (ANSM). Wishing to obtain supplementary data on the prosthetic history of implants, we sent the referent surgeons a questionnaire. Results. - By combining the relevant ANSM data and questionnaire data, we studied the histories of 32 unilateral cases of BIA-ALCL and 2 bilateral cases of BIA-ALCL. Mean patient age on diagnosis was 59 (29; 83). Twelve BIA-ALCL cases occurred after breast augmentation for esthetic purposes, 22 following mastectomy for neoplasia and 2 after symmetrization of the contralateral breast in reconstruction. Fifteen BIA-ALCL cases were diagnosed on single prostheses, all of them macrotextured with macrotexturing obtained by projection of biocell salt crystals, also known as the biocell "salt loss" technique. The other 21 BIA-ALCL cases were diagnosed on multiple prostheses (2 to 5), and all of them had had at least one contact with a biocell implant. Mean duration of exposure to implants was 11 years (4; 31). Mean duration of exposure to the macrotextured shell surfaces obtained by the salt loss technique was 9 years (2; 23). Six patients were exposed to a temporary macrotextured Expander implant obtained with the aforementioned salt loss technique. No patient was exposed to the macrotextured Expander implant alone. Conclusion. - Salt loss macrotextured implants, particularly those of the biocell-type, were found in the prosthetic history of all 36 BIA-ALCL cases in this series. (C) 2019 Elsevier Masson SAS. All rights reserved.