Plastic surgeons play a central role in the management of breast cancer, from prevention to post-treatment follow-up. Aesthetic breast surgery accounts for a significant proportion of plastic surgery in France. This practice places plastic surgeons in a privileged position for the early detection of breast cancer, enabling them to identify high-risk patients and steer them towards personalized monitoring. During multidisciplinary consultation meetings, the plastic surgeon's expertise guides the therapeutic strategy. By assessing the aesthetic and functional impact of treatments, he works with the surgical oncologist to define a surgical approach that respects oncological imperatives while limiting aesthetic and functional after-effects. Breast oncoplastic techniques have become an established part of conservative breast treatment, combining tumour removal and glandular remodelling. Breast reconstruction is an integral part of treatment, and must be systematically proposed in the event of mastectomy. Immediate reconstruction is discussed according to the histological characteristics of the cancer and the adjuvant treatments planned. During post-treatment follow-up, the plastic surgeon finalizes the breast reconstruction and manages the after-effects of conservative treatments through lipofilling or symmetrization procedures. This comprehensive approach makes the plastic surgeon a key player in modern breast oncology.

Breast imaging plays a central role in breast cancer screening, diagnosis and treatment planning. In patients undergoing oncoplastic surgery, MRI enables a detailed assessment of multifocality and improves the selection of candidates for extended conservative surgery, with a demonstrated benefit in terms of local control. Non-wire tracking devices (magnetic, radar, radiofrequency) offer a comfortable and precise alternative to wire, facilitating dissection and improving operative organization. Macrobiopsies for excision of certain borderline lesions with no atypia enable surgical de-escalation of lesions. Angiomammography represents a relevant alternative to MRI in certain indications. Finally, artificial intelligence opens up new prospects at every step of the way: improved acquisition quality, automated detection of suspicious anomalies, assisted characterization of lesions to refine diagnoses, and personalized estimation of long-term risk. The radiomics approach, by extracting quantitative biomarkers from images, could eventually enrich this personalization, although it remains limited to date by the lack of transferability of models. These advances, while promising, raise major ethical issues linked to the transparency of algorithms, shared responsibility in interpretation, and the need for rigorous clinical validation.

Immediate breast reconstruction (IBR) following total mastectomy is now an established surgical approach that combines oncological safety with aesthetic benefits. This review discusses indications, techniques, and surgical adaptations of IBR based on breast morphology and adjuvant therapy planning. At Institut Curie, experience with over 600 reconstructions has led to refined patient selection, with an overall implant removal rate of 5.8%, dropping to 4% in "low risk" patients. Prepectoral implant placement, with or without acellular dermal matrices (ADM), has emerged as a reliable alternative to subpectoral techniques. It offers less postoperative pain, eliminates animation deformity, and significantly reduces capsular contracture. For large or ptotic breasts, skin-reducing mastectomy or two-stage reconstruction enhances outcomes.

Oncoplastic breast surgery combines carcinological excision and plastic surgery techniques to reduce the iatrogenic sequelae of breast cancer treatment and extend the indications for conservative surgery. In France, conservative treatment (lumpectomy and radiotherapy) is performed in 70% of cases, with survival rates similar to those obtained with mastectomy. Nearly 20% of these patients develop aesthetic after-effects. Oncoplasty not only reduces these after-effects but also extends the possibilities of breast conservation to larger tumors. Oncoplasty is classified into two levels: (1) level I: resections<20% of breast volume with glandular transfer, without skin resection and (2) level II: resections>20%, requiring breast reduction techniques with reduction of the skin sheath. Mammoplasty techniques vary according to tumour location ("atlas quadrant by quadrant"). For resections of external and inferior tumors, perforator flaps based on intercostal perforators (LICAP, AICAP), or terminal branches of axillary vessels (LTPA, TDAP) can also be used. CONCLUSION: Oncoplasty has transformed breast cancer management, optimizing both oncological safety and patient quality of life.

Atypical fibroxanthoma is a rare, malignant skin tumor, mainly affecting elderly, photoexposed men. It accounts for less than 0.2% of skin cancers, and manifests as an erythematous or fleshy nodule, often on the head and neck. Diagnosis is based on anatomopathological analysis, requiring immunostaining to exclude its main differential diagnosis, pleomorphic dermal sarcoma. Extension workup should include ultrasound of lymph node drainage areas. Treatment is based on surgery, with two options: wide excision with 2cm margins, or Mohs micrographic surgery, which reduces recurrence. Recurrences generally occur within the first two years, requiring regular follow-up. Radiotherapy is not recommended. Despite its metastatic potential, appropriate surgical treatment usually ensures a good prognosis.

To reconstruct a lower eyelid defect involving two aesthetic cutaneous subunits, we propose the use of bilateral upper eyelid dermatochalasis. A homolateral heteropalpebral flap combined with a contralateral upper eyelid skin graft is our first-line option for cutaneous coverage. In the case of full-thickness defects, a composite tarsoconjunctival graft harvested from the three healthy eyelids provides satisfactory and functionally competent tissue reconstruction.

In the absence of evidence regarding the diagnosis and management of LAGC-AIM caused by textured breast implants, this article aims to provide recommendations based, on the one hand, on updated data from the literature, and on the other hand, on the experience gained in the management and treatment of patients within the French LAGC-AIM study group. A search was carried out in the MEDLINE and Cochrane databases, supplemented by manual searches for relevant articles in English. Studies on breast surgery and breast implant-associated lymphoma were included. The most convincing articles were integrated to synthesize recommendations and determine incidence, clinical presentation, risk factors, different therapies and surveillance. Breast implant surgeons need to be aware of the specific risks associated with these medical devices. Short-term risks must be considered as carefully as long-term risks. Modifications to a medical device, no matter how small, can lead to unexpected increased risks. In addition to the usual safety and approval procedures for the market launch of a medical device, appropriate patient monitoring and adverse event reporting are essential prerequisites for the implementation of imputability investigations and any corrective measures.

Mohs micrographic surgery is a surgical technique allowing for nearly 100% histological analysis of the margins of a removed skin tumor, unlike conventional surgery which only analyzes a small portion (around 5-6%). The most common method ("frozen section") involves excising the tumor with minimal margins, spatially orienting the specimen using dyes, then freezing it for sectioning and immediate microscopic analysis by the surgeon themselves. If tumor cells remain at the edges, the surgeon re-operates only the affected area on the same day until clear margins are achieved before reconstruction. A variation, "slow Mohs", uses analysis on paraffin-fixed tissue with a delay. Mohs surgery significantly reduces recurrence rates for carcinomas (basal cell and squamous cell) compared to standard surgery and better preserves healthy tissue. It is recommended by European and American authorities for high-risk skin cancers and is considered mandatory for dermatofibrosarcoma protuberans.

A superficial or deep mass in the limbs or body walls may be a sarcoma, even if it has been present for a long time. It warrants caution, as inappropriate surgery can worsen the prognosis. A superficial tumor should be evaluated with an ultrasound: if the tumor is not perfectly fatty and homogeneous, a percutaneous biopsy is necessary. Deep tumors require an MRI followed by a percutaneous biopsy. The final histopathological diagnosis must be awaited, which may include molecular biology in addition to immunohistochemistry. If it is a sarcoma or a desmoid tumor, the therapeutic strategy must be decided in a specialized multidisciplinary team meeting. Sarcomas require wide excision, ensuring healthy margins by staying well away from the lesion. In France, there is a network of specialized centers for the treatment of sarcomas (NETSARC).

Rare breast tumors include benign or borderline entities that are often clinically and radiologically misleading. Diagnosis relies in all cases on appropriate biopsy and cross-anatomical-radiological interpretation. Optimal management requires multidisciplinary discussion. Desmoid tumors are non-metastatic but locally aggressive, infiltrative fibroblastic lesions whose management is now based on active surveillance. Idiopathic granulomatous mastitis is a chronic inflammatory mastitis, probably of autoimmune origin, which generally responds to corticosteroid treatment. Phyllodes tumor is a rare fibro-epithelial proliferation, with variable behavior depending on its histological grade, requiring complete excision with negative margins. Radial scarring, a benign sclerosing lesion, can mimic a carcinoma, and sometimes warrants excision depending on the presence of atypia. The aim in managing all these rare tumors is to limit overtreatment, while ensuring personalized follow-up.

Primary bone tumors in children are almost exclusively represented by osteosarcomas and Ewing sarcomas. They mainly affect the limbs, particularly the lower limbs. It is estimated that there are approximately 250 new cases per year. While the initial goal is survival, the question of reconstruction quickly follows. The aim of reconstruction is to avoid amputation, ensure functional outcomes, and, if possible, support ongoing growth in these children. For a long time, free fibula transfer was the first choice, as it allowed for the use of a vascularized bone whose shape was well-suited for limb reconstruction. Later, the induced membrane technique, also known as the Masquelet technique, was introduced. New radiotherapy protocols led to a preference for this latter technique. One of the arguments was that the risk of nonunion or delayed union would be too high with fibula grafts. So much so that, in our experience, no free fibula transfers were performed between 2015 and 2020. However, the analysis of the data from our series shows quite the opposite and does not support the superiority of the Masquelet technique (quite the contrary). Moreover, the fibula remains irreplaceable in certain indications (joint reconstruction, growth plate reconstruction, bi- or trifoliate graft reconstruction, etc.). Therefore, based on the analysis of our experience, the free fibula graft does not appear to be inferior in the specific context of bone reconstruction in children following malignant tumor resection.

Over the past 30 years, since the identification of the BRCA1 and BRCA2 genes, the panorama of breast cancer predisposition tests has continued to evolve: today, ultra-high-throughput sequencing enables the study of eight predisposition genes, and indications are constantly expanding, with the new entry point being the identification of BRCA1/2 alterations in tumors, 75% of which are of constitutional origin. While these tests can be used to provide appropriate preventive treatment in cases where risk factors have been identified, many challenges remain to be met: identification of new predisposition genes, or rather validation of candidate genes such as ATM, detection of new modes of inactivation of genes already included in the diagnosis (remote deletions, epigenetic modifications), classification of variants of unknown significance as pathogenic or benign, and identification and inclusion of modifying factors, whether genetic or not, in multifactorial risk models. Patients and their relatives have played, and continue to play, a major role in the development of oncogenetics. We owe them quality tests, information, support and protection.

Ballistic injuries to the knee present a complex reconstructive challenge due to associated bone, tendon, and soft tissue loss. Early coordinated management between orthopedic and plastic surgery teams is essential to optimize functional outcomes.

Histopathological examination is a cornerstone in the diagnosis, prognostic stratification, and therapeutic planning of breast cancer. It combines morphological, immunophenotypic, and molecular data to guide clinical decision-making. This article provides a comprehensive overview of the main histological types, technical modalities, and conventional and emerging biomarkers in breast cancer pathology. Breast carcinomas are categorized into in situ (DCIS, LCIS) and invasive forms. The most frequent invasive types are invasive carcinoma of no special type (NST) and invasive lobular carcinoma (ILC). Rare histologic variants (e.g., mucinous, micropapillary, metaplastic) exhibit distinct biological and prognostic features. The diagnostic workflow includes standardized steps: sampling, formalin fixation, paraffin embedding, H&E staining, immunohistochemistry (ER, PR, HER2, Ki-67), and molecular testing when needed (FISH, PCR, NGS). Routine biomarkers help define surrogate molecular subtypes (luminal A/B, HER2-positive, triple-negative) and guide systemic therapies. The emergence of the HER2-low category exemplifies how biomarker refinement impacts clinical practice. Additional markers such as PIK3CA and ESR1 mutations, BRCA/HRD status, PD-L1 expression, and tumor-infiltrating lymphocytes (TILs), along with multigene signatures (e.g., Oncotype DX, MammaPrint), further individualize prognostic assessment and treatment selection. Innovative approaches such as liquid biopsy and next-generation sequencing (NGS) enable minimally invasive monitoring and personalized care, especially in advanced disease. Breast cancer pathology is thus a dynamic, integrative discipline central to precision oncology, driven by ongoing technological and molecular advances, and essential to multidisciplinary cancer care.

Radiotherapy is a major pillar of breast cancer treatment, aimed at reducing local recurrence and improving survival while preserving quality of life. It is often administered after conservative surgery, and in some cases post-mastectomy for high-risk patients. Techniques and indications have evolved, including approaches such as intensity-modulated conformal radiotherapy (IMRT) for greater precision and reduced side effects. (1) General: radiotherapy reduces the risk of local recurrence (35% to 19.3% after conservative surgery) and improves overall survival, particularly in patients with lymph node involvement (pN+). Modern approaches favor the reduction of axillary curage in favor of sentinel lymph node detection, limiting morbidity. (2) Specific indications: after total mastectomy, radiotherapy is recommended according to risk factors (stage, margins, age). Different irradiation protocols are available, with hypofractionated regimens becoming the standard. (3) Breast reconstruction and radiotherapy: immediate breast reconstruction combined with radiotherapy requires careful planning to minimize complications. (4) Reverse sequence: this innovative approach, involving preoperative radiotherapy prior to mastectomy, is designed to improve aesthetic results and tumor control. Although promising, it requires further study. (5) Merkel carcinoma and oligometastases: radiotherapy is essential in the treatment of Merkel carcinoma, significantly reducing the risk of recurrence. For oligometastases, stereotactic radiotherapy is emerging as an effective option for precisely targeting metastases, with good local control rates and few side effects. Radiotherapy continues to evolve, integrating advanced technologies to optimize cancer treatment while reducing the associated side effects.

In 2019, dermatologists in the Île-de-France region launched the OncoDerm tele-MTM (Multidisciplinary Team Meeting) platform to optimize the management of skin cancers operated on by private practitioners. The goal is to ensure a quality of care equivalent to that of public hospitals by facilitating the registration and collegial discussion of cases (melanomas, carcinomas). The management of these tele-MTM has since been taken over in Île-de-France by the Specialized Care Team in Dermatology and Venereology (ESSDV IDF) via Omnidoc, and in Corsica by ESSDV CorsicaDerm via Alta Strada Rofim. The text details the regulation of oncological surgery, the functioning of MTM (quorum, coordinator's role, dissemination of opinions), and specifically tele-MTM in onco-dermatology (quorum composition, indications for cancer registration, required information). It then discusses management guidelines for basal cell carcinomas, melanomas (emphasizing the importance of MTM for access to therapeutic innovations), and cutaneous squamous cell carcinomas. In conclusion, it reiterates the possibility for private practitioners to use these tele-MTM via the ESSDV, which aim to improve access to dermatological care and coordination, notably through telemedicine.

Medical treatment of breast cancer today depends on the tumor profile. For triple-negative breast cancer, the standard treatment before surgery now combines chemotherapy and immunotherapy, significantly improving the chances of cure. In the metastatic stage, new therapies such as the antibody conjugate (ADC) sacituzumab-govitécan have substantially prolonged survival. For HER2-positive tumours, the strategy is also to treat before surgery. For metastatic forms, a new-generation ADC, trastuzumab deruxtecan, has proved its immense efficacy, becoming a benchmark. Finally, for hormone-dependent (HR+) cancers at high risk, the addition of CDK4/6 inhibitors to hormone therapy after surgery reduces the risk of recurrence. In addition, ADCs are also of interest in advanced forms, particularly for tumours known as "HER2-low".

Kaposi's disease is a primarily dermatological disorder characterized histologically by a proliferation of endothelial cells of lymphatic origin, linked to the HHV-8 virus, and occurring most often in a context of reduced immunity, whether linked to age, HIV infection or immunosuppressive therapy. There are 5 epidemiological forms of Kaposi's disease, all of which are predominantly male and of advanced age, especially in the classic form. In the majority of cases, the disease is indolent, but in certain situations, it can become aggressive, either locally or through involvement of internal organs such as the lung and digestive tract. Whenever possible, treatment focuses on restoring immunity. Unfortunately, in some patients this is impossible and/or ineffective, and chemotherapy or, more recently, immunotherapy, is required.

Breast cancer accounts for approximately 24% of all new cancer cases in women worldwide and remains a major challenge for the medical community despite advances in screening and treatment. The management of axillary lymph nodes is crucial for local-regional control and tumor staging. Historically, radical mastectomy was introduced by William Halsted in the late 19th century; however, this method resulted in significant morbidity. Over time, less invasive techniques have been developed, notably sentinel lymph node biopsy (SLNB) in the 1990s, which assesses the status of axillary lymph nodes based on the sentinel node. If this node is disease-free, a complete axillary dissection can often be avoided, thereby reducing complications. SLNB is now recognized as the standard of care for patients with early-stage breast cancer without clinical nodal involvement, supported by studies such as ACOSOG Z0011 and AMAROS. However, questions remain regarding the best surgical approach for patients with specific tumor subtypes or extensive nodal involvement. This article offers an analysis of the scientific foundations of lymph node surgery, technical advancements, clinical trial outcomes, and the future prospects of increasingly personalized medicine.

Adnexal carcinomas are rare cutaneous malignancies arising from the skin's appendages. Skin biopsy is essential for making the diagnosis, and enables the carcinoma to be classified into precise groups and subgroups. Prognosis and initial extension will depend on the histological subtype of the tumor. There is no consensus on the treatment of adnexal carcinomas: large-scale surgery is the standard treatment for localized tumors. Radiotherapy and certain systemic treatments may be proposed for inoperable or metastatic lesions.