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M Rietjens

Publications and source records attributed to M Rietjens.

28 records · Page 2Linked to original sources
PubMed1994

Can breast reconstruction with gel-filled silicone implants increase the risk of death and second primary cancer in patients treated by mastectomy for breast cancer?

An increased risk of cancer and autoimmune disease associated with gel-filled silicone implants has been suggested recently, but these possible detrimental effects have not been adequately studied in patients with breast cancer. In order to evaluate these effects, we have studied 146 patients with breast cancer treated by mastectomy at the Gustave Roussy Cancer Institute between 1965 and 1983 and who received a gel-filled silicone implant for immediate or delayed breast reconstruction between 1976 and 1984. These patients were compared with 146 matched controls with breast cancer who were treated in the same center by mastectomy without breast reconstruction and were matched for age at diagnosis (within 10 years), year of diagnosis (within 3 years), stage, histologic type of the tumor, histopathologic grade, and nodal status. The relative risks of death, relapse, and second primary cancer were estimated by means of the Cox proportional hazards model stratified on age at diagnosis. The risks of distant metastasis and death due to breast cancer were significantly lower in the breast reconstruction group than in the control group. The risks of local recurrence, second breast cancer, and second primary cancer in another site than the breast were not significantly different between the two groups of patients. Our results do not support the hypothesis of a detrimental effect of gel-filled silicone implants either in the course of breast cancer or in the risk of death due to other diseases.

Breast Neoplasms↗
PubMed1994

Locally advanced breast cancer: contrast-enhanced subtraction MR imaging of response to preoperative chemotherapy.

PURPOSE: To determine the value of contrast material-enhanced subtraction magnetic resonance (MR) imaging in assessment of response to chemotherapy in locally advanced breast cancer. MATERIALS AND METHODS: Eighteen women treated with chemotherapy because of locally advanced breast cancer underwent preoperative MR examination including both routine and dynamic MR sequences after injection of gadolinium tetraazacyclododecanetetraacetic acid. Any early contrast enhancement, concomitant with early vascular enhancement during the dynamic MR study, was considered pathologic. RESULTS: Dynamic MR studies showed early contrast enhancement in all women with residual tumor except one with nodular residual tumor. Histopathologic analysis and dynamic MR images of contrast-enhanced lesions correlated well, but in one patient, intraductal extension was not seen on MR images, and in another, additional isolated tumor cells were seen in the histologic specimen. Subtraction images always facilitated visualization of vascular and pathologic contrast enhancement. CONCLUSION: Dynamic MR contrast-enhanced subtraction studies are useful in assessment of residual tumor after chemotherapy.

Adult↗
PubMed1992

Risk factors for failure of immediate breast reconstruction with prosthesis after total mastectomy for breast cancer.

BACKGROUND: Immediate breast reconstruction (IBR) after mastectomy represents a clear improvement in the quality of life of patients with breast cancer, but prosthesis removal is relatively frequent. Therefore, it is important to identify risk factors related to this removal. METHODS: A series of 142 patients treated with mastectomy and IBR at the Institut Gustave-Roussy between January 1976 and December 1988 were studied. Forty-seven had an in situ carcinoma, 93 an infiltrating carcinoma, and 2 a fibrosarcoma. IBR failures were defined as removal of the prosthesis, and early failures as removal during the first 7 weeks after IBR. RESULTS: The early failure rate was significantly higher in patients with invasive carcinomas or fibrosarcomas than patients with in situ carcinomas (12% versus 0%, P = 0.04). The risk of late IBR failure was significantly higher in patients who had received postoperative radiation therapy than patients who did not (P = 0.0002). However, this increased risk applied only to women in whom the chest wall was exposed to radiation because of a high risk of recurrence. CONCLUSION: It might be preferable to postpone breast reconstruction for patients with infiltrating breast carcinoma because early complications are not infrequent and could delay adjuvant chemotherapy. Late complications associated with chest wall irradiation could be avoided with the use of alternative techniques such as the transverse rectus abdominis myocutaneous (TRAM) flap procedure.

Breast↗
PubMed1992

[Immediate breast reconstruction by musculocutaneous flap].

Immediate breast reconstruction (IBR) after mastectomy is now quite frequent. To achieve this, an implant, in a complete muscular pocket, or a myocutaneous flap (latissimus dorsi, TRAM flap) can be chosen. Since 1983, 49 immediate breast reconstructions (11% of IBR) were performed with a myocutaneous flap in the Gustave Roussy Institute. In our experience, these techniques were principally performed because of the failure of conservative treatment (70%). Immediate complications were more frequently observed after immediate breast reconstructions with a TRAM flap (partial or minimal flap necrosis: 33%, infection: 13.5%). Late complications were more frequent in reconstructions with a latissimus dorsi flap: the prostheses were the main reasons (contracture III/IV: 25%, infection: 18%, deflation of the implant: 12%). The best long term results were described with the TRAM flap, and we now prefer this technique for immediate reconstruction with a flap.

Adult↗
PubMed1992

[Immediate mammary reconstruction in the radical treatment of cancer of the breast].

Based on a series of 516 patients operated between 1976 and 1991, the authors present their experience of the various aspects of immediate breast reconstruction (IBR). A prosthesis was used in the majority of cases (80%) and the essential technical aspect was the creation of a complete muscular compartment, possibly by combining pectoralis major and serratus anterior, latissimus dorsi (5%) and by using an expander (8%) or even a musculocutaneous flap. The rectus abdominis musculocutaneous flap (TRAM, 10%) had the advantage of allowing IBR without a prosthesis. The mastectomy scar plays a major role in determining the final shape of the breast: the skin resection must be modulated according to the site of the tumour. The complications observed (40%), which required removal of the prosthesis in 12% of cases, were either immediate complications (20%), some of which (infections, necrosis, dehiscence) tended to delay adjuvant therapy, or secondary complications, principally grade III-IV contracture (20%). Evaluation of the cosmetic results of IBR in comparison with a population undergoing secondary reconstruction over the same period, did not reveal any significant difference between the two approaches. The authors discuss in detail the oncological and technical arguments for and against IBR and conclude on the psychological advantages of IBR for mastectomised patients.

Adult↗
PubMed1992

[Esthetic results of breast reconstruction after amputation for cancer. 323 cases].

323 reconstructions of the breast were carried out at the Gustave-Roussy Institute and were analysed in order to assess the aesthetic results and the sequelae of these reconstruction operations. The majority of the patients were operated on between 1984 and 1989 with a median follow-up of 3.5 years (1 to 9 years). Three types of reconstruction were carried out: simple prosthesis behind the muscle (P, 69% of this population), latissimus dorsi flap (G.D., 11%), or transverse rectus abdominis flap (TRAM, 20%). These reconstructions were either carried out immediately (RMI, 23.5%) or later (RMD, 76.5%). The unanimous enthusiasm of the patients for reconstruction was the greatest encouragement for us to continue in this way. From the aesthetic point of view the transverse rectus abdominis flap (TRAM) proved to be superior to the others. Scar and functional sequelae of the latissimus dorsi flap (GD) were by no means nil in this series (table 9) in contrast with other studies that have been carried out. All the same the majority of these sequelae were larger scars. The functional poor sequelae were minor. TRAM sequelae were less frequent and usually mainly in the abdominal wall. A more accurate technique should lower the incidence. As far as the timing of surgery is concerned, immediate reconstruction did not alter the quality of results which were better (but not significantly statistically). This has already been published. On the other hand patients were more satisfied with RMD (p less than 10(-4)). The analysis of this unexpected result show the great significance of psychological factors in interpreting these results.(ABSTRACT TRUNCATED AT 250 WORDS)

Academies and Institutes↗
PubMed1989

[Long-term results following breast reconstruction].

A ten-year experience of breast reconstruction (BR) at the Gustave-Roussy Institute (Paris) provides material for a long-term analysis of carcinologic and cosmetic results. Carcinologic results have been studied in a group of 120 breast reconstructions which was matched to a group of 120 mastectomies without BR. No statistical difference was observed both for the overall survival and the disease-free survival in both groups. The percentage of local recurrences in the reconstructed breast was inferior, but not statistically, to the percentage observed in the controls providing a good argument in favour of the BR inocuity. Cosmetic results were analyzed on photographs according to a previously defined scale. They show a 55% percentage of satisfactory results when all the techniques of BR are mixed. A comparison between the cosmetic results according to the technique of BR demonstrates the superiority of the rectus abdominis flap which provides a higher rate of satisfactory results (63%) as compared to the results observed after simple reconstruction (53%) or latissimus dorsi (44%). A psychologic study of 150 BR shows that every patient underwent a specific psychological process called mourning work. The degree of satisfaction is not linked to objective results. Overall, 93% of the groups were satisfied, would do it again and would advise it for others; 7% were dissatisfied for surgical or emotional reasons.

Breast↗
PubMedDate not supplied

Does long-term exposure to gel-filled silicone implants increase the risk of relapse after breast cancer?

BACKGROUND: An increased risk of cancer and autoimmune diseases associated with gel-filled silicone implants, debated by FDA experts since 1991, has given rise to a profusion of literature on the subject. However, such effects have not been adequately investigated in patients with breast cancer. In a previous report we compared 146 breast cancer patients with gel-filled silicone implants for breast reconstruction to 146 control patients in whom no reconstruction had been performed. The observed results were reassuring, as the evolution of the disease after 10 years was better in the reconstruction group than in the control group. We now report the end results of this study with a median follow-up of 13 years after the breast reconstruction (range, 10-20 years). METHOD: The relative risks of detrimental events were estimated with Cox's Proportional Hazards Model, with stratification according to age at diagnosis. RESULTS: The risks of locoregional recurrences and distant metastasis were significantly lower in the BR group than in the control group. The risks of death, of a second breast cancer and of a second primary cancer at a site other than the breast were not significantly different between the two groups of patients. CONCLUSION: Long-term follow-up of patients exposed to gel-filled silicone implants confirms the absence of detrimental effects after breast cancer. The power of our study is, however, below that required to detect a very slight increase in the risks studied.

Adult↗