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Bordoni D, Cadenelli P, Ornelli M, Falco G, Accurso A, Gloria A, Maietta S, Rocco N, Magalotti C. The axillary flap in oncoplastic resection of breast cancers located in the upper-outer quadrants: a new surgical technique. BMC Surg 2019; 18:21. [PMID: 31074383 PMCID: PMC7402579 DOI: 10.1186/s12893-018-0467-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background The combination of breast conserving surgery (BCS) with plastic surgery techniques has provided a useful surgical tool matching the radicality of the oncological excision with the preservation of breast cosmesis. Even though BCS represents a good option for surgical treatment of tumors located in these quadrants, wide excisions often necessitate breast reshaping in order to avoid nipple areola complex (NAC) displacement and skin retraction. We present a new surgical technique to repair upper-outer quadrants’ defects following breast cancer excision using dermo-glandular flaps and an axillary adipo-fascial flap. Methods During the period from January 2014 to December 2015, 168 patients with an upper-outer quadrant’s breast cancer have been treated in our Department. 83 women have been treated with the described oncoplastic technique and immediate contra-lateral symmetrisation and 85 women underwent standard BCS. We present surgical, oncological and cosmetic outcomes comparing our results with standard BCS. Results At a mean follow-up of 27 months loco-regional recurrences in the two groups were comparable. Short-term complication rates were comparable between the two groups. Re-intervention rates for positive margins were significantly higher in the standard BCS group. The overall satisfaction with cosmetic outcome both assessed by the patient and the surgeon was significantly higher in the oncoplastic group. Conclusions The proposed oncoplastic technique represents a safe and effective solution for reshaping that follows upper-outer breast cancer wide excision, achieving comparable complication rates, lower re-intervention rates for positive margins and better cosmetic results when compared with standard BCS.
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Affiliation(s)
- Daniele Bordoni
- Department of Senology, Ospedale Santa Maria della Misericordia Urbino, Asur marche Area Vasta 1, Urbino, Italy
| | | | - Matteo Ornelli
- Department of Plastic Surgery, Marche Politechnic University, Ancona, Italy
| | - Giuseppe Falco
- Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Antonello Accurso
- Department of Surgery, Breast Unit, University of Naples Federico II, Naples, Italy
| | - Antonio Gloria
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Viale J.F. Kennedy 54, Mostra d'Oltremare Pad. 20, 80125, Naples, Italy
| | - Saverio Maietta
- Department of Industrial Engineering, Fraunhofer JL IDEAS, University of Naples Federico II, P.le Tecchio 80, 80125, Naples, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini, 5, 80131, Naples, Italy.
| | - Cesare Magalotti
- Department of Senology, Ospedale Santa Maria della Misericordia Urbino, Asur marche Area Vasta 1, Urbino, Italy
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Bordoni D, Cadenelli P, Rocco N, Tessone A, Falco G, Magalotti C. Serratus Anterior Fascia Flap Versus Muscular Flap for Expander Coverage in Two-stage Breast Reconstruction Following Mastectomy: Early Post-operative Outcomes. Aesthetic Plast Surg 2017; 41:26-30. [PMID: 28032155 DOI: 10.1007/s00266-016-0770-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The demand for reconstructive breast surgery after mastectomy is increasing among women and the two-stage option remains the most commonly performed technique. We conducted a self-controlled prospective clinical trial comparing the use of the serratus anterior fascia with the serratus anterior detached fibers to cover the inferolateral aspect of the expander in immediate two-stage breast reconstruction following conservative mastectomies as oncological or risk-reducing procedures. PATIENTS AND METHODS We analyzed the surgical outcome of 29 bilateral mastectomies and immediate reconstruction with the positioning of a tissue expander in a pocket beneath the pectoralis major and serratus anterior muscle on one side and in a pocket beneath the pectoralis major and a serratus anterior fascia flap on the other side. We considered all complications presenting in the first month after surgery and patient-reported early post-operative pain. RESULTS Complication rates in the two groups did not significantly differ (p = 0.237). The total amount of drainage and the time of drainage permanence were significantly lower for the subfascial group (p < 0.05). Patient-reported early post-operative pain was significantly different between the two groups both at 24 h (p < 0.05) and at 5 days (p < 0.05) with significantly lower pain scores reported by the patients in the subfascial group. DISCUSSION Our self-controlled prospective trial demonstrated an advantage in performing an implant-based two-stage breast reconstruction using a serratus anterior fascia flap when compared with the serratus muscle fibers use for inferolateral implant coverage following mastectomy. The use of the anterior serratus fascia flap for inferolateral implant coverage in two-stage breast reconstructions following mastectomy could be considered as a safe and effective technique, presenting lower morbidity for the patient when compared with the serratus muscle fibers use and lower costs when compared with biological and synthetic meshes use, achieving good outcomes in terms of post-operative complications and women's quality of life and satisfaction levels. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Falco G, Foroni M, Castagnetti F, Marano L, Bordoni D, Rocco N, Marchesi V, Iotti V, Vacondio R, Ferrari G. Ultrasound-Guided Percutaneous Catheter Drainage of Large Breast Abscesses in Lactating Women: How to Preserve Breastfeeding Safely. Breastfeed Med 2016; 11:555-556. [PMID: 27726424 DOI: 10.1089/bfm.2016.0121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Management of breast abscess in lactating women remains controversial. During pregnancy, women may develop different kinds of benign breast lesions that could require a surgical incision performed under general anesthesia with consequent breastfeeding interruption. The purpose of this study was to prospectively evaluate the management of large breast abscesses with ultrasound-assisted drainage aiming at breastfeeding preservation. MATERIALS AND METHODS 34 lactating women with a diagnosis of unilateral breast abscess have been treated with an ultrasound (US)-assisted drainage of the abscess. A pigtail catheter was inserted into the fluid collection using the Seldinger technique under US guide and connected to a three stop way to allow drainage and irrigation of the cavity until its resolution. RESULTS All procedures have been found safe and well tolerated. No recurrence was observed and breastfeeding was never interrupted. CONCLUSIONS The described technique allows to avoid surgery and to preserve breastfeeding in well-selected patients with a safe, well-tolerated and cost-effective procedure.
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Affiliation(s)
- Giuseppe Falco
- 1 Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
| | - Monica Foroni
- 1 Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
| | - Fabio Castagnetti
- 1 Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
| | - Luigi Marano
- 2 General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital-ASL Umbria 2 , Spoleto, Italy
| | - Daniele Bordoni
- 3 Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia , Urbino, Italy
| | - Nicola Rocco
- 4 Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples , Italy
| | - Vanessa Marchesi
- 5 Diagnostic Imaging Department, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
| | - Valentina Iotti
- 5 Diagnostic Imaging Department, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
| | - Rita Vacondio
- 5 Diagnostic Imaging Department, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
| | - Guglielmo Ferrari
- 1 Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova , Reggio Emilia, Italy
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Bordoni D, Cadenelli P, Falco G, Rocco N, Manna P, Tessone A, Ornelli M, Magalotti C. Extreme oncoplastic breast surgery: A case report. Int J Surg Case Rep 2016; 28:182-187. [PMID: 27718437 PMCID: PMC5061119 DOI: 10.1016/j.ijscr.2016.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/24/2016] [Accepted: 09/25/2016] [Indexed: 11/17/2022] Open
Abstract
Many oncoplastic approaches have been proposed for breast cancer surgery but few have been described for multicentric cancers. “Extreme oncoplastic surgery” allows successful breast conservation in selected patients with multicentric tumors. We present an application of oncoplastic breast surgery in a case of multicentric breast cancer with optimal outcomes.
Introduction So called “extreme oncoplastic surgery” is emerging as a new promising concept in breast cancer surgery allowing successful breast conservation in selected patients with multicentric tumors. Presentation of case We report the case of a 48-year-old woman presenting with a multicentric breast cancer and successfully treated with an oncoplastic technique consisting in three radical lumpectomies followed by breast reshaping and simultaneous contralateral symmetrization. Discussion According to our experience, oncoplastic conserving breast surgery could represent a better option than the combination of mastectomy, reconstruction and radiation therapy, in terms of quality of life for selected patients affected by multicentric breast cancer. Conclusion The surgical treatment for multicentric breast cancers remains controversial even though emerging evidences show good oncological and aesthetic outcomes following oncoplastic conserving breast surgery.
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Affiliation(s)
- Daniele Bordoni
- Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy
| | | | - Giuseppe Falco
- Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery. University of Naples "Federico II", Naples, Italy.
| | - Paola Manna
- Department of Radiology, Asur Marche Area Vasta 1, Santa Maria della Misericordia Hospital, Via Comandino 70, Urbino, Italy
| | - Ariel Tessone
- Department of Plastic and Reconstructive Surgery, The Talpiot Medical Leadership Program, Sheba Medical Center, Israel
| | - Matteo Ornelli
- Department of Plastic Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Cesare Magalotti
- Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy
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Cadenelli P, Bordoni D, Ornelli M, Radaelli S. Reconstruction of a large upper arm defect with muscle sparing latissimus dorsi. BMJ Case Rep 2016; 2016:bcr-2016-216684. [PMID: 27555043 DOI: 10.1136/bcr-2016-216684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Reconstruction of large soft tissue defects in the upper arm represents a challenge for the reconstructive surgeon. The latissimus dorsi flap is widely used and preferred for this latter type of reconstruction due to its reliability and versatility, although sacrificing the entire muscle can lead to higher incidences of postoperative seroma and functional disability. The recent introduction of the perforator-based flap concept has led to an evolution in upper extremity reconstruction by significantly reducing donor-site morbidity and simultaneously ensuring optimal soft tissues coverage. We report a case of a large soft tissue defect of the posterolateral part of the upper arm, consequent to a sarcoma resection, in which a muscle-sparing latissimus dorsi technique was used to obtain total soft tissue coverage. A 2-year follow-up showed a satisfactory functional result and no evidence of recurrence.
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Affiliation(s)
| | | | | | - Stefano Radaelli
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy
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Abstract
Basal cell carcinomas (BCCs) are one of the most frequent cutaneous malignancies. The majority of BCCs are reported to occur on the auricular helix and periauricular region due to ultraviolet light exposure. Despite the frequency of BCCs, those that develop within scar tissue are rare, and the phenomenon of keloid BCCs has rarely been reported in the literature. Keloid collagen within BCCs is associated with morphoeiform characteristics, ulceration, or necrosis. Extensive keloid collagen is often seen in BCCs of the ear region, a site prone to keloid scarring. This article presents a rare case of a secondary tumor (BCC) which arose on top of a primary tumor (keloid scar) on the right auricle region in a healthy 23-year-old female after an ear piercing 2 years prior. To our knowledge, the tumor described in this case, in contrast to keloidal BCCs, has never been reported in the literature.
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Affiliation(s)
- Maya Goder
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Rachel Kornhaber
- School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia
| | - Daniele Bordoni
- Department of Senology, Ospedale Santa Maria della Misericordia Urbino, Urbino, Italy
| | - Eyal Winkler
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Josef Haik
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Ariel Tessone
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel
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Falco G, Rocco N, Bordoni D, Marano L, Accurso A, Buccelli C, Di Lorenzo P, Capasso E, Policino F, Niola M, Ferrari G. Contralateral risk reducing mastectomy in Non-BRCA-Mutated patients. Open Med (Wars) 2016; 11:238-241. [PMID: 28352801 PMCID: PMC5329834 DOI: 10.1515/med-2016-0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/18/2016] [Indexed: 01/02/2023] Open
Abstract
The use of contralateral risk reducing mastectomy (CRRM) is indicated in women affected by breast cancer, who are at high risk of developing a contralateral breast cancer, particularly women with genetic mutation of BRCA1, BRCA2 and P53. However we should consider that the genes described above account for only 20-30% of the excess familiar risk. What is contralaterally indicated when genetic assessment results negative for mutation in a young patient with unilateral breast cancer? Is it ethically correct to remove a contralateral "healthy" breast? CRRM rates continue to rise all over the world although CRRM seems not to improve overall survival in women with unilateral sporadic breast cancer. The decision to pursue CRRM as part of treatment in women who have a low-to-moderate risk of developing a secondary cancer in the contralateral breast should consider both breast cancer individual-features and patients preferences, but should be not supported by the surgeon and avoided as first approach with the exception of women highly worried about cancer. Prospective studies are needed to identify cohorts of patients most likely to benefit from CRRM.
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Affiliation(s)
- Giuseppe Falco
- Breast Surgery Unit Arcispedale-IRCCS Santa Maria Nuova, Reggio Emilia, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Napoli, Italy
| | - Daniele Bordoni
- Department of Senology, “Santa Maria della Mi-sericordia” Hospital, Urbino, Italy
| | - Luigi Marano
- Robotic Surgery Unit, “San Matteo degli Infermi” Hospital - ASL Umbria 2, 06049, Spoleto (PG), Italy
| | - Antonello Accurso
- Department of Gastroenterology, Endocrinology and Surgery, Breast Unit, AOU “Federico II”, Naples, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, Naples, Italy, University “Federico II” of Naples, via S. Pan-sini,5, 80131 Naples, Italy
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, Naples, Italy, University “Federico II” of Naples, via S. Pan-sini,5, 80131 Naples, Italy
| | - Emanuele Capasso
- Department of Advanced Biomedical Sciences, Naples, Italy, University “Federico II” of Naples, via S. Pan-sini,5, 80131 Naples, Italy
| | - Fabio Policino
- Department of Advanced Biomedical Sciences, Naples, Italy, University “Federico II” of Naples, via S. Pan-sini,5, 80131 Naples, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, Naples, Italy, University “Federico II” of Naples, via S. Pan-sini,5, 80131 Naples, Italy
| | - Guglielmo Ferrari
- Breast Surgery Unit Arcispedale-IRCCS Santa Maria Nuova, Reggio Emilia, Italy
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Abstract
Primary angiosarcoma (AS) of the breast is a rare neoplasia that is not related to radiation exposure. It represents less than 0.05% of all malignant breast tumors. This lesion is characterized by aggressive patterns and poor prognosis and by the absence of typical features at radiologic examination. Currently there are not evidence-based guidelines regarding surgical and adjuvant treatment for this tumor even though wide surgical resection followed by chemo- radiotherapy appears to improve both disease free survival and overall survival. The aim of this study was to analyze the available series of AS patients suggesting the most reliable treatment options for this rare neoplasia.
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Affiliation(s)
- Daniele Bordoni
- Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy.
| | - Elisa Bolletta
- Department of Plastic and Reconstructive Surgery, University of Ancona, Via Conca 71, Ancona, Italy.
| | - Giuseppe Falco
- Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy.
| | - Pierfrancesco Cadenelli
- Department of Plastic Surgery, Hand Surgery and Microsurgery, San Gerardo Hospital, Monza, Milano, Italy.
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery. University of Naples "Federico II", Naples, Italy.
| | - Ariel Tessone
- Department of Plastic and Reconstructive Surgery, The Talpiot Medical Leadership Program, Sheba Medical Center, Israel.
| | - Stefania Guarino
- Department of Oncology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy.
| | - Antonello Accurso
- Department of Gastroenterology, Endocrinology and Surgery, AO "Federico II", Naples, Italy.
| | - Bruno Amato
- Department of Clinical Medicine and Surgery. University of Naples "Federico II", Naples, Italy.
| | - Cesare Magalotti
- Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy.
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Cadenelli P, Bordoni D, Radaelli S, Marchesi A. Proximally Based Anterolateral-Thigh (ALT) Flap for Knee Reconstruction: An Advancement Propeller Perforator Flap. Aesthetic Plast Surg 2015. [PMID: 26195130 DOI: 10.1007/s00266-015-0536-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adequate coverage of the knee region is often challenging for plastic and orthopedic surgeons. In the last decade, among several reconstructive techniques, local perforator flaps have become useful reconstructive units. After a wide resection for soft-tissue sarcoma, the knee vascular web may be reasonably damaged and, consequently, perforator flaps based on a local pedicle [such as the distally based anterolateral thigh (ALT) flap] are not reliable. Thus, we harvested a proximally based ALT for knee coverage. METHODS A 52-year-old man underwent local radiation therapy and a wide resection of a soft-tissue sarcoma on the anterior-lateral aspect of the left knee, which resulted in a 15 × 10 cm defect. The defect was covered with a proximally based ALT, through an advancement and propeller relocation of its skin paddle. RESULTS All margins were tumor free. After 5 days, the donor site was closed primarily because of edema. Neither necrosis of the flap nor dehiscence of the wound was detected. No local relapses were detected at 6-month follow-up. CONCLUSIONS In case of soft-tissue defects of the knee region, with likely involvement of the local vascular web, a local perforator solution is the advancement and propeller proximally based ALT flap. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Nava MB, Rocco N, Catanuto G, Falco G, Capalbo E, Marano L, Bordoni D, Spano A, Scaperrotta G. Impact of contra-lateral breast reshaping on mammographic surveillance in women undergoing breast reconstruction following mastectomy for breast cancer. Breast 2015; 24:434-9. [PMID: 25866351 DOI: 10.1016/j.breast.2015.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/09/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The ultimate goal of breast reconstruction is to achieve symmetry with the contra-lateral breast. Contra-lateral procedures with wide parenchymal rearrangements are suspected to impair mammographic surveillance. This study aims to evaluate the impact on mammographic detection of mastopexies and breast reductions for contralateral adjustment in breast reconstruction. PATIENTS AND METHODS We retrospectively evaluated 105 women affected by uni-lateral breast cancer who underwent mastectomy and immediate two-stage reconstruction between 2002 and 2007. We considered three groups according to the contra-lateral reshaping technique: mastopexy or breast reduction with inferior dermoglandular flap (group 1); mastopexy or breast reduction without inferior dermoglandular flap (group 2); no contra-lateral reshaping (group 3). We assessed qualitative mammographic variations and breast density in the three groups. RESULTS Statistically significant differences have been found when comparing reshaped groups with non reshaped groups regarding parenchymal distortions, skin thickening and stromal edema, but these differences did not affect cancer surveillance. The surveillance mammography diagnostic accuracy in contra-lateral cancer detection was not significantly different between the three groups (p = 0.56), such as the need for MRI for equivocal findings at mammographic contra-lateral breast (p = 0.77) and the need for core-biopsies to confirm mammographic suspect of contra-lateral breast cancer (p = 0.90). CONCLUSIONS This study confirms previous reports regarding the safety of mastopexies and breast reductions when performed in the setting of contra-lateral breast reshaping after breast reconstruction. Mammographic accuracy, sensitivity and specificity are not affected by the glandular re-arrangement. These results provide a further validation of the safety of current reconstructive paradigms.
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Affiliation(s)
- Maurizio B Nava
- Department of Surgery, Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori Milano, Via Venezian 1, 20133 Milano, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy.
| | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
| | - Giuseppe Falco
- Breast Unit, IRCCS Arcispedale S.M.N, Via Risorgimento 80, 42120 Reggio Emilia, Italy
| | | | - Luigi Marano
- 8th General and Gastrointestinal Surgery, Second University of Naples, Italy
| | - Daniele Bordoni
- Department of Senology Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino, 70 Urbino, Italy
| | - Andrea Spano
- Department of Surgery, Plastic and Reconstructive Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori Milano, Via Venezian 1, 20133 Milano, Italy
| | - Gianfranco Scaperrotta
- Department of Diagnostic Radiology 1, Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan, Italy
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Masia J, Bordoni D, Pons G, Liuzza C, Castagnetti F, Falco G. Oncological safety of breast cancer patients undergoing free-flap reconstruction and lipofilling. Eur J Surg Oncol 2015; 41:612-6. [PMID: 25800344 DOI: 10.1016/j.ejso.2015.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/19/2015] [Accepted: 02/28/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Autologous fat grafting is a widely accepted approach for breast reconstruction after mastectomy but its oncological safety has not been established. This study aimed to compare recurrence in patients who underwent fat-grafting procedures after autologous breast reconstruction and those who did not. PATIENTS AND METHODS We retrospectively reviewed 207 consecutive patients, who underwent mastectomy and reconstruction using free flap surgery. We divide them in two groups: a study group of patients who underwent fat grafting procedure and a control group of patients who did not. Outcome regarding local and regional recurrence was compared between the two groups. Particularly, we studied recurrences from primary surgery to baseline (first lipofilling) and from baseline to most recent follow-up. RESULTS Median follow-up was 60 months from surgery to baseline and 29 months from baseline to most recent follow-up. The overall observational period after mastectomy in the control group was 120 months. Local recurrence was observed in 6 patients from the study group, respectively 3 in the first observational period and 3 after the fat grafting procedure. The control group, as the study one, presented a total of 6 recurrences (p = 0.555; Hazard Ratio free flap and lipo vs only free flap: = 0.66; 95% CI 0.16-2.66). CONCLUSIONS We found no significant differences in recurrence between patients who underwent fat grafting and those who did not. These encouraging findings support previous results but larger series of patients are required to confirm long-term oncological safety in these procedures.
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Affiliation(s)
- J Masia
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - D Bordoni
- Department of Plastic and Reconstructive Surgery, University School of Medicine, Ancona, Italy
| | - G Pons
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - C Liuzza
- Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - F Castagnetti
- Breast Surgery Unit, Arcispedale SMN-IRCCS, Reggio Emilia, Italy
| | - G Falco
- Breast Surgery Unit, Arcispedale SMN-IRCCS, Reggio Emilia, Italy.
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Falco G, Rocco N, Procaccini E, Sommella MG, Bordoni D, Cenini E, Castagnetti F, Sabatino V, Compagna R, Della Corte GA, Accurso A, Amato B, Ferrari G. Breast conserving treatment for ductal carcinoma in situ in the elderly: Can radiation therapy be avoided? Our experience. Int J Surg 2014; 12 Suppl 2:S47-S49. [DOI: 10.1016/j.ijsu.2014.08.382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/23/2014] [Accepted: 06/15/2014] [Indexed: 01/04/2023]
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13
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Riggio E, Bordoni D. The anatomy of the pectoral nerves and its significance in reconstruction and augmentation of the breast. J Plast Reconstr Aesthet Surg 2013; 66:870-1. [DOI: 10.1016/j.bjps.2012.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 11/26/2012] [Accepted: 11/30/2012] [Indexed: 10/27/2022]
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