[Role of plastic surgery in the treatment of breast cancer].

The surgical treatment of breast cancer has changed dramatically since the last twenty years. Radical and super-radical mastectomy are almost no longer indicated except in certain cases of local recurrences. Breast saving procedures are the best indication for small tumors. And the psychological impact of the different treatments including radiotherapy and chemotherapy is considered as an important issue. Therefore, plastic surgeons are more and more frequently called upon to restore the breast appearance using some technique of breast reconstruction or to improve the bad results of a conservative treatment. Moreover, a good knowledge of the plastic surgery techniques allows a better exploration of the breast and large resections in case of fibrocystic diseases with extensive foci of microcalcifications. Such extensive explorations of the breast are more frequently indicated with the development of screening campaigns. When the mastectomy remains the best indication, it is mandatory to propose an immediate breast reconstruction. Insertion of a silicone implant is discussed in several countries, especially in France, although more and more studies are showing the inocuity of such material. A long experience at the Gustave-Roussy Institute of such material used for breast reconstruction showed us the inocuity of long term silicone exposure in patients treated for breast cancer. The conservative surgery should remove the tumor with a free margin of 1 to 2 or even 3 cm and the defect left is sometimes large enough to justify some local glandular mammoplasty in order to prevent from final mammary distorsion or local visible defect. Partial reconstructions could sometimes require more sophisticated techniques including musculo-cutaneous flaps or prosthesis implantation. Finally the integration of the plastic surgery in the surgical protocols of breast cancer treatment, requires a close collaboration between the plastic and the cancer teams. In certain cases, a special surgical training provides the surgeon with a double competence in oncology and in plastic surgery. With such breast surgeon competent both in oncology and plastic surgery, a patient can ask for an aesthetic operation without missing a complete cancer screening as well as she can be treated for a cancer with the best chance to obtain the best cosmetic result.