Alfred D Fitoussi

French National Centre for Scientific Research | CNRS · surgery

Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature r...

Background The aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction. Patients and methods We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 20...

: The role of nipple-sparing mastectomy for breast cancer is controversial, as there is concern regarding its oncologic safety and complication rate. The authors reviewed the literature to quantify the incidence of occult nipple malignancy in breast cancer, identify the factors influencing occult nipple malignancy, quantify locoregional recurrence...

In March of 2010, French authorities suspended the use of breast implants made by the company Poly Implant Prothèse. Institut Curie is a large cancer center, and Poly Implant Prothèse was one major silicone-filled breast implant brand used. This report describes the impact of the fraudulent implants worldwide and more specifically on patient care a...

Aim To identify predictors for infiltrating carcinoma and lymph node involvement, before immediate breast reconstructive surgery, in patients with an initial diagnosis of extensive pure ductal carcinoma in situ of the breast (DCIS). Patients and methods Between January 2000 and December 2009, 241 patients with pure extensive DCIS in preoperative b...

Cette étude évalue la faisabilité de la détection du ganglion sentinelle (GS) par technique isotopique seule chez les patientes ayant un cancer invasif du sein ainsi que la capacité des chirurgiens à s’adapter face à un changement de procédure chirurgicale.

Background To evaluate whether predictive factors of axillary lymph node metastasis in female breast cancer (BC) are similar in male BC.Patients and methodsFrom January 1994 to May 2011, we recorded 80 non-metastatic male BC treated at Institut Curie (IC). We analysed the calibration and discrimination performance of two nomograms [IC, Memorian Slo...

Description of the various modalities of breast and ovarian cancer risk management, patient choices and their outcome in a single-center cohort of 158 unaffected women carrying a BRCA1 or BRCA2 germline mutation. Between 1998 and 2009, 158 unaffected women carrying a BRCA1 or BRCA2 gene mutation were prospectively followed. The following variables...

Complications of implant-based breast reconstruction are rare but mastectomy flap necrosis and peri-implant infection are the most frequent and remain an important cause of early implant failure. This study aimed to compare the results of three different management strategies employed to deal with these complications at our institution. A consecuti...

Aim:The aim of our study was to examine the treatment and outcome of 165 patients with phyllodes tumours and to review the options for surgical management. Patients and Methods: This is a retrospective study of 165 patients who presented to the Institut Curie between January 1994 and November 2008 for benign, borderline or malignant phyllodes tumou...

Introduction: The aim of our study was to identify predictive factors of infiltrating carcinoma and lymph node involvement in patients with an initial diagnosis of extended pure ductal carcinoma in situ (DCIS) of the breast. Material and Methods: 241 patients diagnosed with extended pure ductal carcinoma in situ (DCIS) underwent treatment at the In...

Phyllodes tumors are a rare distinctive fibroepithelial tumors of the breast and their management continues to be questioned. The aim of our study was to examine the treatment and outcome of 165 patients with phyllodes tumors and to review the options for surgical management. This is a retrospective study of 165 patients who presented to the Instit...

Management of operable breast cancer requires more and more the use of oncoplatic techniques. The concept of “anticipation“ is as the prediction of response in medical oncology a key point of the surgical management. Historically the first technique was the bilateral reduction mammoplasty, a classical platic surgery technique, for the lower quadran...

Suboptimal aesthetic outcomes after conservative therapy for breast cancer are not uncommon, with reported rates up to 30 percent, of which 5 percent may be considered severe. With radiotherapy being an essential component of breast-conserving therapy, surgical correction of deformities is challenging, and guidance as to reparative technique select...

Synchronous plastic and oncological surgery is undertaken to improve the security of excision margins and yield high-quality aesthetic outcomes when conventional breast-conserving therapy either anticipates poor results or is not possible. A total of 540 consecutive patients underwent primary oncoplastic breast surgery for cancer with high tumor-to...

La cirugía oncoplástica ocupa un lugar de pleno derecho entre los posibles tratamientos quirúrgicos de los cánceres de mama, tanto si se trata de tumores palpables como de lesiones radiológicas infraclínicas. Permite disminuir el número de mastectomías y obtener un mejor control local del cáncer de mama gracias a exéresis amplias que proporcionan m...

Up to 60 per cent of cancers develop laterally in the breast and breast-conserving surgery frequently produces superolateral nipple-areolar complex (NAC) distortion aggravated by postoperative irradiation. Correction is technically demanding and the outcomes are variable. Lateral mammaplasty may allow wider excision margins and prevent such deformi...

Lipofilling is usually performed in breast surgery for treatment of aesthetics sequelae after breast conserving surgery or correction after breast reconstruction by prothesis or musculocutaenous flaps. We present a case of a patient where exclusive lipofilling breast reconstruction has been succesfully performed. Aesthetic result is assessed by the...

Oncoplastic breast surgery (OBS) is relatively new, but has made rapid progress from its tentative steps of infancy in the 1990s. The recent Milanese Consensus Conference on Breast Conservation concluded that, firstly, oncoplastic techniques are warranted to allow wide excision and clear margins without compromising cosmesis. Secondly, such surgery...

Lipofilling is usually performed in breast surgery for treatment of aesthetics sequelae after breast conserving surgery or correction after breast reconstruction by prothesis or musculocutaneous flaps. We present a case of a patient where exclusive lipofilling breast reconstruction has been successfully performed. Aesthetic result is assessed by th...

CTRC-AACR San Antonio Breast Cancer Symposium: 2008 Abstracts Abstract #5158 Introduction : 65% of breast cancers develop in the lateral pole, particularly superiorly. Following conservative treatment, , tumourectomy may produce a typical deformity of superolateral nipple-areolar complex (NAC) deviation. This unaesthetic deformity, is exaggerate...

The mammary gland is situated on the anterior thorax and is by definition bilateral and symmetrical. Its form, volume and contents vary with age, making precise characterisation impossible. Glorified by artists throughout the ages, the breast occupies an important place in the image of women in our culture, and in its beauty rests a fundamental ele...

Breast cancer is a growing public health problem in many countries: in France, 42,000 new cases were diagnosed in 2006, which corresponds to an incidence of one in ten women. Fortunately, this cancer can be diagnosed at an increasingly early stage. In 1980, 15% of cancers were diagnosed at stage T0—1. This rate has since increased to more than 50%,...

Reconstruction of the nipple—areola complex (NAC) is an essential part of the quality of a breast reconstruction. It should be possible to do this under local anaesthesia in order to both reduce the number of general anaesthetics and increase its acceptability. Numerous techniques have been described in the literature (Amarante et al. 1994; Klatsky...

This chapter is concerned with “simple” tumourectomies; that is, those with a tumour-to-breast volume proportion and location that permit wide excision in a conservative fashion without the need for an oncoplastic technique.

The use of the greater omentum in breast cancer surgery was first described by Kiricuta in 1963. The advantages of the greater omentum have been long recognised in numerous situations, including salvage of “at risk” intestinal anastomoses, tamponade of diffuse haemorrhage, particularly from the liver, and perineal defect restoration. It can also be...

Centrally located tumours have long been considered to be more serious, multifocal and more likely to recur. In fact, this is not the case; the only real problem is ensuring that the breast is preserved with a “normal” form following breast-conserving surgery and adjuvant radiotherapy. As with more peripheral tumours, central tumours may also benef...

'Oncoplastic and Reconstructive Surgery for Breast Cancer describes the reconstructive techniques that have been refined over the past decade by surgeons in a very high volume unit. It provides clear descriptions of all the available techniques. With proven experience in the procedures described and detailed scientific evaluation, it furthermore pr...

Nipple and areola reconstruction is very important in the evaluation of the quality of breast reconstruction. It can be done during the primary or secondary breast reconstruction or later. We have performed the techniques of nipple reconstruction routinely since 1992. Under local anesthesia during a second operative time or general anesthesia durin...

Nipple and areola reconstruction is very important in the evaluation of the quality of breast reconstruction. It can be done during the primary or secondary breast reconstruction or later. We have performed the techniques of nipple reconstruction routinely since 1992. Under local anesthesia during a second operative time or general anesthesia durin...

En cas de cancer du sein, 60 à 75 % des patientes ont un traitement conservateur. Celui-ci peut laisser des séquelles esthétiques qui amènent la patiente à demander une reconstruction du sein traité. Ces demandes de reconstruction partielle sont de plus en plus fréquentes et constituent un problème difficile pour le chirurgien plasticien. Nous avon...

Breast cancer surgery has long consisted in the sole use of mastectomy. Then, it was proved that, in terms of global survival, conservative treatments associated with radiotherapies could give the same results. But breast deformations due to classic conservative treatments led some authors to use plastic surgery procedures: breast plastic surgery....

Since more than twenty years, methods of breast reconstruction using implants have continued to evolve in order to improve their aesthetic results. Shapes and materials of these implants have also evolved to obtain contours similar to that of the natural opposite breast. Therefore it can be considered that the use of asymmetric implants is the last...

Since more than 30 years, the quality of breast implants has continued to evolve in order to improve the aesthetic results of prosthetic augmentation. Shapes and materials of these implants have also evolved to obtain stronger and more reliable prostheses almost similar to the natural breast. Therefore it can be considered that the use of asymmetri...

The long cosmetic outcome of breast implant reconstruction is unknown. The morbidity and cosmetic outcome of 360 patients who underwent immediate breast reconstruction with various types of implant has been prospectively analysed over a 10-year period. 334 patients who completed their reconstruction were suitable for evaluation of their cosmetic ou...

The long cosmetic outcome of breast implant reconstruction is unknown. The morbidity and cosmetic outcome of 360 patients who underwent immediate breast reconstruction with various types of implant has been prospectively analysed over a 10-year period. 334 patients who completed their reconstruction were suitable for evaluation of their cosmetic ou...

Patients with suboptimal results following breast conservative therapy are presenting more frequently to plastic surgeons as a difficult management problem. A three-type "cosmetic sequelae classification" is proposed to evaluate and manage these patients. From February of 1991 to November of 2001, 85 patients were treated for cosmetic sequelae of b...

Since the law of 4 March 2002, that confirms the right of each person to dispose of his own body with respect for his own dignity, cosmetic surgery becomes the most regulated medical discipline. The establishment of regional commissions for conciliation and indemnification, which could within the framework of their mission of conciliation delegate...

To assess the oncologic and cosmetic outcomes in women with breast carcinoma who were treated with breast-conserving therapy using oncoplastic techniques with concomitant symmetrization of the contralateral breast. Although breast-conserving therapy is the standard form of treatment for invasive breast tumors up to 4 cm, in patients with large, ill...

The indications for autologous reconstruction are increasing. The standard procedure is the transverse rectus abdominis muscle flap; however, this flap has contraindications and drawbacks. The latissimus dorsi muscle flap is simple and reliable. Hokin et al. demonstrated in 1983 that this flap can be extended and used for breast reconstruction with...

The long-term cosmetic outcome of breast implant reconstruction is unknown. The morbidity and cosmetic outcome of 360 patients who underwent immediate postmastectomy breast reconstruction with various types of implants have been analyzed prospectively over a 9-year period. Of these patients, 334 who completed their reconstruction were suitable for...

Although it is thought that transverse rectus abdominis muscle (TRAM) flap breast reconstruction produces excellent cosmetic results that are maintained over the long term, there is little objective evidence in the literature to support this. One hundred seventy-one consecutive patients who underwent TRAM flap reconstruction were prospectively anal...

The gold standard technique for autologous breast reconstruction is the transverse rectus abdominis flap (TRAM). Recently, techniques of harvesting a latissimus dorsi flap have been modified in such a way as to increase the flap and allow breast reconstruction without an associated implant. The aim of this study was to evaluate aesthetic results ob...

The number of breast cancer patients treated with breast conservation is expanding. However, when proposing breast conserving therapy, one should be sure to leave a normal appearing breast; secondary reconstruction of breast deformities is possible, but at the cost of further operations, sophisticated surgery, and unpredictable final results. By in...

This series analyses the results of conservative surgery for large lower pole breast cancers by lumpectomy associated with a bilateral remodelling mammoplasty, in order to avoid residual deformities. This retrospective study concerns 50 patients with a lower pole breast cancer treated between 1986 and 1996 by lumpectomy, mammoplasty and irradiation...

After conservative treatment for breast cancer, 20% to 30% of patients have a residual deformity that sometimes requires surgical correction. Thirty-five of these patients were operated between 1990 and 1995 at the Institut Curie. The authors classify these sequelae into three types: type I, asymmetrical breasts with no deformity of the treated bre...

The need for a systematic axillary clearance in breast cancer is presently under question. Alternative methods include the omission of node biopsy in very small tumours and lymphadenectomy limited to the sentinel node. This article discusses the current procedures in axillary surgery in 1998, with information concerning the relationships between th...

The need for a systematic axillary clearance in breast cancer is presently under question. Alternative methods include the omission of node biopsy in very small tumours and lymphadenectomy limited to the sentinel node. This article discusses the current procedures in axillary surgery in 1998, with information concerning the relationships between th...

Breast reconstruction with transverse rectus abdominis muscle (TRAM) flap raises two contradictory questions: the vascular safety of the flap and the late abdominal wall sequellae. In order to analyse these sequellae, 71 patients with TRAM flap breast reconstruction at the Institut Curie had a late postoperative evaluation by both a physiotherapist...

Having carried out four cases of vaginal caesarean section the authors describe the technique they used. The advantages of the operation are: it is simple and can be carried out quickly, future obstetric behaviour is not compromised. It is important to avoid two complications of the operation: haemorrhage and injury to the bladder. These are reduce...

Renal transplantation has changed completely the fertility of women who had been dialysed. Our study is on 10 pregnancies which we followed up in 7 women who had had renal transplants in the University Hospital of Pitié Salpêtrière (Professor Y. Darbois) between 1979 and 1985. All patients were treated by the same technique and the same methods of...

65 cases of premature rupture of the membranes before the 28th week of amenorrhoea occurred during the 5 years between 1983 and 1987 in two maternity units in Paris. A retrospective study was carried out on 42 of these cases where conservative measures had been decided on. In two-thirds of the cases, of which 42% had had bleeding and 40% vaginal in...

Suboptimal aesthetic outcomes following conservative treatment for breast cancer are common. The literature reports an incidence between 15 and 30%, of which 3 to 5% are severe. With 42,000 breast cancers treated annu- ally in France, one could expect up to 5-10,000 cases annually. These sequelae are highly variable and their management varies acco...

We report our experience of the management of thoracic wall radio necrosis in breast and other tumours at the Institute Curie. We propose a four-stage classification. It is based on the clinical aspects of the lesions and de- termines the management strategy. It is of prime importance to ensure that there is no tumour recurrence. The initial stage...