title: [Shift the skin paddle in an additional incision improves the result: Study of a series of 82 breast reconstructions by latissimus dorsi flap and prosthesis implantation at 10 years].
abstract: The position of the skin paddle on the breast area is a fundamental element for the breast reconstructions by latissimus dorsi flap and prosthesis implantation. Should, as Millard advocated, to recreate the initial defect and include it in the mastectomy scar or is it better in an additional incision as have others authors. This study compares the long-term morphological results of these two attitudes, with or without additional incision.
  
  
  METHODS
  Eighty-two breast reconstructions by latissimus dorsi flap and prosthesis implantation, with a mean follow-up of 9.5 years were scored from 1 to 5 by a panel of expert and non-expert. The patients scored also their own reconstruction. Various parameters of the reconstructed breast were thus evaluated. We compared the results, according to the positioning of the skin paddle: with additional incision (50 cases); without additional incision (32 cases). The characteristics of the mastectomy scar on the breast area, high or low, horizontal or oblique, defined 6 groups where the results of the 2 surgical options were compared.
  
  
  RESULTS
  Only the reconstructions with additional incision get significantly higher results than those without additional incision (P<0.05). This involves the two panels, in the case of high mastectomy scars. In the others cases the additional incision is not essential.
  
  
  CONCLUSIONS
  If the realization of an additional incision can be perceived like misfit on an area already "mutilated", we plead for this solution in selected cases. This provides a benefit stable in time, in terms of overall results, shape and even rendering scar.
authors.affiliation: Chirurgie plastique, reconstructrice et esthétique, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France. Electronic address: schiriac@chu-reims.fr.
authors.forename: S
authors.initials: S
authors.lastname: Chiriac
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Dissaux
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Bruant-Rodier
authors.affiliation: Laboratoire de pharmacologie, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
authors.forename: Z
authors.initials: Z
authors.lastname: Djerada
authors.affiliation: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Civil, hôpitaux universitaires de Strasbourg, BP 426, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Bodin
authors.affiliation: Chirurgie plastique, reconstructrice et esthétique, hôpital Maison Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France; EA 3801 université de Champagne-Ardenne, 51, rue Cognacq-Jay, 51100 Reims, France.
authors.forename: C
authors.initials: C
authors.lastname: François
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods; D008875:Middle Aged; D064827:Myocutaneous Flap; D017060:Patient Satisfaction; D012189:Retrospective Studies; D064171:Superficial Back Muscles / Q000637:transplantation; D013997:Time Factors; D016896:Treatment Outcome
keywords: Breast reconstruction; Latissimus dorsi; Long-term result; Palette cutanée; Prosthesis; Prothèse; Reconstruction mammaire; Résultat à long terme; Skin paddle