Aesthetic results following breast cancer surgery: A prospective study on 6515 cases from ten Italian Senonetwork breast centers

Breast Cancer Local Recurrence Risk in Implant-Based Breast Reconstruction with Macrotexturized and Microtexturized Prosthesis: A Multicentric Retrospective Cohort Study

Background  Nowadays, implant-based breast reconstruction is a common technique after mastectomy. The widespread use of implant employment is prompting significant concerns regarding the oncological safety of prostheses and the potential impact of surface texture on the recurrence of local breast cancer. This article examines the oncological outcomes associated with postmastectomy breast reconstructions using micro- and macrotexturized implants, focusing on the incidence and relative risk (RR). Materials and Methods  A retrospective cohort study was conducted on patients admitted to Multimedica group (IRCCS, San Giovanni Hospital, Milan) and ICH groups (Humanitas Clinical Institute, Milan) between January 2003 and September 2020. Minimum follow-up considered was of 1 year. Patients submitted to either complete or nipple-spearing mastectomy, who underwent breast reconstruction with macrotexturized or microtexturized prosthesis, were included in group A and B, respectively. Results  A total of 646 patients met the basic inclusion and exclusion criteria. Group A included 410 (63.5%) patients and group B included 236 (36.5%). Cancer recurrence absolute risk in group A was 5.6 ± 2.2% and in group B was of 2.1 ± 1.8%. RR for breast cancer recurrence in group A compared to group B was of 2.65; confidence interval 95% (1.02; 6.87). Statistical analysis identified a higher local recurrence risk in patients reconstructed with macrotexturized prosthesis ( p -value 0.036). Conclusion  This study detected a higher risk for local breast cancer recurrence associated to macrotexturized breast implants employment. Further investigations are required to verify these outcomes.

The multicenter experience in the multidisciplinary Italian breast units: a review and update

A breast unit is a multidisciplinary center specialized in the management of women with breast diseases, including breast cancer (BC). It represents a care path, passing from screening activities to diagnostic investigations, from surgery to the definition of the therapeutic strategy, from psychophysical rehabilitation to long-term checks (follow-up), and up to genetic counseling. Since 2006, following a resolution issued by the European Parliament to urge member states to activate multidisciplinary breast centers by 2016, work has been underway throughout Italy to improve the management of women with BC. In Italy, the State-Regions agreement was signed on 18 December 2014, sanctioning the establishment of breast units. These centers must adhere to specific quality criteria and requirements. In 2020, the experts of the EUSOMA group (European Society of Breast Cancer Specialists), in their latest document published, expanded the requirements of the breast units. Furthermore, Senonetwork was founded in 2012 with the aim of allowing BC to be treated in breast units that comply with European requirements to ensure equal treatment opportunities for all Italian women. Indeed, the available data indicate that the BC patient has a greater chance of better treatment in the breast units with a multidisciplinary team, thus increasing the survival rate with a better quality of life, compared to those managed in nonspecialized structures. The present review is a perspective on the current Italian reality of breast units, updated with the available literature and the most recent epidemiological data from Senonetwork and AgeNaS.

Adherence to Quality Indicators for Breast Cancer Management in a Multidisciplinary Training Program

Background: The management of early breast cancer (BC) needs supervision and skill maintenance, and should be performed by specialists working as a team in multidisciplinary breast units. This approach aims to improve the long-term survival and quality of life of patients with BC. Methods: This was a prospective observational study including patients newly diagnosed with operable BC. The study encompassed the pre-surgical phase, throughout the diagnostic and surgical workout, and included post-therapeutic master multidisciplinary team meetings (MTMs) sessions, between 2019 and 2022. Results: We enrolled 280 patients with BC from eight breast units. The Senonetwork indicators regarding diagnosis, waiting time, loco-regional treatment, and adjuvant therapy were collected for each patient discussed. Conclusions: Overall, the majority of quality indicators were respected among breast units. The most critical issue referred to timing indicators: more than 30 days from MTM to surgery, more than 42 days from diagnosis to surgery, and more than 60 days from the first screening mammogram to surgery for many patients. Some aspects of the histopathological diagnosis of intraductal BC also need to be improved. Furthermore, other critical issues in our study regarded some aesthetical indicators, demonstrating low interest in these essential quality indicators.