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M C Missana

Publications and source records attributed to M C Missana.

8 recordsLinked to original sources
PubMed2003

Endoscopic muscular latissimus dorsi flap harvesting for immediate breast reconstruction after skin sparing mastectomy.

AIM: Immediate breast reconstruction after mastectomy using the latissimus dorsi musculo-cutaneous flap is well recognized. It allows for satisfactory aesthetic results. To minimize scanning in skin sparing mastectomy patients, we used a surgical technique consisting of an endoscopic harvesting of the latissimus dorsi pure muscular flap with a virtual cavity created by CO(2) gas distention. METHOD: Between 9 April 2001 and 30 September 2001, 8 patients underwent latissimus dorsi endoscopic harvesting for an immediate breast reconstruction after skin sparing mastectomy. RESULT: The mean operating endoscopic time was 112 minutes. No open surgical conversion was necessary. The mean lymphatic drainage was 2720 ml with removal of the drainage on post operative day 15. CONCLUSION: The endoscopic harvesting of the latissimus dorsi muscular flap, using a mixed technique of dissection guided by the lighted cleaver forceps and a closed technique by CO(2) insufflation using an endoscope is feasible, reproducible and has acceptable morbidity. This technique brings encouraging aesthetic results after skin sparing mastectomy.

Adult↗
PubMed2002

[Endoscopic harvesting of the latissimus dorsi flap in breast reconstructive surgery. Feasibility study and review of the literature].

STUDY AIM: Breast reconstructive surgery with latissimus dorsi flap is routinely performed with a long dorsal scar ransom. To reduce the scar the authors propose an endoscopic technique to harvest the pure latissimus dorsal flap. We evaluate our first experience. PATIENTS AND METHODS: Between April 2001 and december 2001, 13 patients were operate using an endoscopic pure muscular latissimus dorsal flap for breast reconstruction surgery. RESULTS: Mean operative time is 116 min. No open conversion was necessary. One patient was transfused. The average lymphatic drainage was of 2520 ml with removal of the drainage on postoperative day 15. CONCLUSION: The endoscopic harvesting of the latissimus dorsi pure muscular flap, brings less scar than the open surgery.

Adult↗
PubMed2000

[Radiotherpay and immediate breast reconstruction with myocutaneous flap in breast cancer of reserved prognosis].

In France, immediate breast reconstruction (IBR) for infiltrating carcinoma remains controversial. Many teams advocate the possible event of a post mastectomy radiotherapy and its negative effect on IBR. In our Institute we do not exclude infiltrating breast cancer patient from IBR. In the poor prognostic patients who wish IBR, we recommend autologous IBR to obtain the best aesthetic result with minimum revision procedures and best tolerance to adjuvant radiotherapy. From January 1993 to December 1997, we performed 687 IBR with myocutaneous flap for infiltrating carcinomas. In this group only 68 patients needed postoperative chest wall radiotherapy (45 Gy): 27 TRAM flap, 41 latissimus flap. Only one of the TRAM but 39 of latissimus flaps were associated with a prosthesis. The mean follow-up was 24 months. Fourteen patients developed metastatic disease, and ten were dead at the time of the chart revue. The autogenous TRAM flap tolerate radiation quite well and remain soft and mobile. The latissimus flap associated with a prosthesis developed capsular contracture (BAKER II or III) in 71% of cases. In all cases the cosmetic impairment was not important and the result after capsulectomy remained soft. We concluded that IBR could be offered to motivated patients in all stages of the disease regardless of the subsequent chest wall radiotherapy, and we recommend its use for possible autologous reconstruction.

Adult↗
PubMed1997

[Rectus abdominis myocutaneous flaps].

The free transverse rectus abdominis myocutaneous (TRAM) flap is vascularized by the inferior epigastric pedicle. There are many techniques according to the indication. We describe the technique for breast reconstruction after mastectomy for cancer. The rectus muscle is taken between the umbilicus and the arcuate line. The skin paddle, was taken transversely like an abdominoplasty. The incision extends from 1 cm above the umbilicus to include the perforators around it. The mean length of the vascular epigastric pedicle is 6 cm. This study was performed from one hundred dissections.

Breast Neoplasms↗
PubMed1997

[Breast reconstruction using free rectus abdominis myocutaneous flap].

More than 50% of patients who have breast cancer do not need a mastectomy. Since 1976, reconstruction of the breast is suitable. From 1976 to 1995, we have performed 220 breast reconstructions with a pediculed latissimus dorsi and 510 reconstructions with a pediculed transverse rectus abdominis myocutaneous flap (TRAM). So, in all, 1100 immediate breast reconstruction with either a prosthesis or a pediculed flap were performed. The specialised teams aim is to use the TRAM free transplant for immediate breast reconstruction. Between 1990 to 1995 we have performed 5 free TRAM for breast reconstruction for cancer and 6 TURBOTRAM. It is important for the woman to have an abdominal adiposity, to be able to give an excellent breast. Four out of five of the free TRAM reconstructions were successful and one give partial necrosis (4 x 4 cm). All the 6 TURBOTRAM operations were uneventful. There are many advantages with this technique: the free TRAM allows a large resection of the thoracic skin and gives a natural form to the breast, without any prosthesis. The taking of the free TRAM gives only few abdominal hernia and realize an abdominoplasty. Our aim is to perform immediate breast reconstruction with free TRAM flap.

Adult↗
PubMed1994

[Closure of the abdominal wall after removal of a mucocutaneous flap from the transverse rectus abdominis for breast reconstruction. Apropos of 48 cases. Review of the literature].

In view of the good results of breast reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap, we used this method in 48 patients, but we observed abdominal complications, which are difficult to accept for cosmetic surgery. Hartrampf, one of pioneers of this technique, reports a very low complication, rate by closing the abdominal wall without the use of prosthetic mesh. However his results are not reproducible as numerous authors, following his technique, have reported abdominal hernias and now use prosthetic reinforcement. In the light of our experience, we analyse these complications, not only hernias, but also abdominal weakness, indicating a new operation in some cases (6/9). The quality and duration of the follow-up (52 months) accounts for the fairly high complication rate. A review of literature examines the various means of abdominal wall closure and their results. The functional injury of muscular harvesting must also be considered, especially in sports women.

Abdominal Muscles↗
PubMed1994

[Apropos of 49 transverse rectus abdominis muscle flap (TRAM) in carcinologic and reconstructive surgery].

The C.A.C. de Nice reconstructive surgery unit presents their experience of TRAM pedicled flap (41 cases) or free flap (8 cases). The technical details, complications and sequelae are analysed for the entire series of flaps with particular attention to the problems of the abdominal wall and the respective advantages of the two techniques. The applications of TRAM essentially concern breast reconstruction (41 cases) in women with large breasts and not desiring an implant or a contralateral procedure. TRAM is compared to other procedures (latissimus dorsi, implant, greater omentum) which the authors consider to be valid alternatives. The other indications are reconstructive, either for the chest wall (5 cases) or inguinoperineal (3 cases) for defects in an irradiated region.

Adult↗