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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Invited Response on: Comment on "Reverse Expansion Following Nipple Sparing Mastectomy: A Natural, Safe and Effective Autologous Technique for Breast Reconstruction". Aesthetic Plast Surg 2023; 47:51-52. [PMID: 35641689 DOI: 10.1007/s00266-022-02936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Elena Lucattelli
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A. Franchini" Hospital, AUSL Romagna, Via Pedrignone, 3, 47822, Santarcangelo di Romagna, Italy
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Fabiocchi L, Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Semprini G, Samorani D. Reverse Expansion for Breast Reconstruction after Skin-sparing and Nipple-sparing Mastectomy: Our First 100 Cases. Plast Reconstr Surg Glob Open 2023; 11:e4915. [PMID: 37020986 PMCID: PMC10069859 DOI: 10.1097/gox.0000000000004915] [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] [Received: 10/05/2022] [Accepted: 02/02/2023] [Indexed: 04/05/2023]
Abstract
Patients with breast cancer have experienced advancements both in oncological treatment and in aesthetics as a result of developments in reconstructive techniques. We aimed to present our experience with the reverse expansion technique, summarizing the results of our first 100 cases of reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy.
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Affiliation(s)
- Luca Fabiocchi
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Elena Lucattelli
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cattin
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- From the General and Breast Surgery Department, “A. Franchini” Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Reverse Expansion Following Nipple Sparing Mastectomy: A Natural, Safe and Effective Autologous Technique for Breast Reconstruction. Aesthetic Plast Surg 2022; 46:1602-1608. [PMID: 35064338 DOI: 10.1007/s00266-021-02720-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
The majority of surgeons choose an implant-based breast reconstruction after mastectomy. Nevertheless, lipofilling is a constantly growing technique allowing a complete breast reconstruction without prosthesis. We introduce our experience using reverse expansion for breast reconstruction following a nipple-sparing mastectomy (NSM) with a subpectoral skin expander. In the period January 2010-August 2021, 106 breast reconstruction procedures were performed on 50 patients after a NSM. We harvested an amount of fat tissue using a 2.5 mm liposuction cannula, we centrifuged it 3 min at 4000 rpm and injected in the recipient site using 3 ml syringes and Coleman cannulas. At the beginning of every session, the breast expander was deflated of a saline volume similar to the one of the fat to be injected. We harvested an average of 679.2 ccs of fat per session and injected an average of 319.3 ccs per breast. The mean number of sessions has been 2.4 per breast. The average number of sessions in a radiotreated patients' subgroup has been slightly higher than a control group. The mean follow-up time was 63.5 months and we observed no complications in 105 over 106 procedures. Lipofilling has proven to be a safe and effective technique for complete breast reconstruction. Our procedure considers the use of a breast expander as a device to prepare the recipient site. Reverse expansion after a NSM allows a like-with-like reconstruction and it might be the first reconstructive choice in a selected group of patients.Level of Evidence IV 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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Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi, Largo Piero Palagi 1, 50139, Florence, FI, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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Lucattelli E, Cattin F, Cipriani F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D, Semprini G, Fabiocchi L. Invited Response on: "Reverse Expansion and Tissue-Engineering for Breast Reconstruction". Aesthetic Plast Surg 2022; 46:44-45. [PMID: 35286411 DOI: 10.1007/s00266-022-02847-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, AOU Careggi Largo Piero Palagi 1, 50139, Florence, Italy.
| | - Federico Cattin
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cipriani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Laura Dellachiesa
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Tommaso Fogacci
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, "A Franchini" Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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Cattin F, Fogacci T, Frisoni G, Semprini G, Fabiocchi L, Samorani D. Use of indocyanine green (ICG) alone as a tracer for sentinel lymph node detection after neoadjuvant chemotherapy in breast cancer patients. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fogacci T, Cattin F, Semprini G, Frisoni G, Fabiocchi L, Samorani D. The negative pressure therapy with PICO as a prevention of surgical site infection in high-risk patients undergoing breast surgery. Breast J 2019; 26:1071-1073. [PMID: 31628760 DOI: 10.1111/tbj.13659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tommaso Fogacci
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, Rimini, Italy
| | - Federico Cattin
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, Rimini, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, Rimini, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, Rimini, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, Rimini, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, Rimini, Italy
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Cattin F, Fogacci T, Frisoni G, Semprini G, Fabiocchi L, Samorani D. Reply to: Prospective evaluation of the limitations of near-infrared imaging in detecting axillary sentinel lymph nodes in primary breast cancer. Breast J 2019; 26:343-344. [PMID: 31495048 DOI: 10.1111/tbj.13607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 08/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Federico Cattin
- Santarcangelo di Romagna Hospital-General Surgery, Santarcangelo di Romagna, Rimini, Italy
| | - Tommaso Fogacci
- Santarcangelo di Romagna Hospital-General Surgery, Santarcangelo di Romagna, Rimini, Italy
| | - Gianluca Frisoni
- Santarcangelo di Romagna Hospital-General Surgery, Santarcangelo di Romagna, Rimini, Italy
| | - Gloria Semprini
- Santarcangelo di Romagna Hospital-General Surgery, Santarcangelo di Romagna, Rimini, Italy
| | - Luca Fabiocchi
- Santarcangelo di Romagna Hospital-General Surgery, Santarcangelo di Romagna, Rimini, Italy
| | - Domenico Samorani
- Santarcangelo di Romagna Hospital-General Surgery, Santarcangelo di Romagna, Rimini, Italy
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Fogacci T, Cattin F, Samorani D. The negative pressure therapy with PICO as a prevention of surgical site infection in high risk patients undergoing breast surgery. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz098.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fogacci T, Cattin F, Semprini G, Frisoni G, Fabiocchi L, Samorani D. The use of chromophore gel-assisted blue light phototherapy (Lumiheal) for the treatment of surgical site infections in breast surgery. Breast J 2018; 24:1135. [PMID: 30230127 DOI: 10.1111/tbj.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Tommaso Fogacci
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Federico Cattin
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gloria Semprini
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Gianluca Frisoni
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Luca Fabiocchi
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
| | - Domenico Samorani
- General and Breast Surgery Department, Santarcangelo di Romagna Hospital, AUSL Romagna, Santarcangelo di Romagna, Italy
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Fabiocchi L, Semprini G, Cattin F, Dellachiesa L, Fogacci T, Frisoni G, Samorani D. 'Reverse expansion': A new technique of breast reconstruction with autologous tissue. J Plast Reconstr Aesthet Surg 2017; 70:1537-1542. [PMID: 28779906 DOI: 10.1016/j.bjps.2017.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/16/2017] [Revised: 06/23/2017] [Accepted: 07/10/2017] [Indexed: 01/15/2023]
Abstract
The treatment for breast cancer is sometimes long and requires a multidisciplinary approach. In 2010, in our centre, we began to perform fat grafting for breast reconstruction using the so-called 'reverse expansion' technique. This consists of the insertion of a skin expander during mastectomy, in its expansion and then in its gradual deflation in the surgical theatre during fat grafting. We performed a complete breast reconstruction in 57 patients by reverse expansion. We harvested fat from the fat excess areas using a normal liposuction cannula. From each patient, an average of 640 ccs of was collected and then centrifuged in a 4000-rpm centrifuge for 3 min. The obtained adipocytes were then injected in the operated breast using a normal lipofilling cannula. We injected an average of 318.05 ccs of adipocytes for each patient each time. The average number of sessions per patient was 3.6. Reverse expansion can be a safe and effective technique for breast reconstruction in all the breast cancer patients.
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Affiliation(s)
- L Fabiocchi
- Breast and General Surgery Unit, "A. Franchini" Hospital, Via Pedrignone 3, Santarcangelo di Romagna, Italy
| | - G Semprini
- Breast and General Surgery Unit, "A. Franchini" Hospital, Via Pedrignone 3, Santarcangelo di Romagna, Italy.
| | - F Cattin
- Breast and General Surgery Unit, "A. Franchini" Hospital, Via Pedrignone 3, Santarcangelo di Romagna, Italy
| | - L Dellachiesa
- General Surgery Clinic, University of Ferrara School of Medicine, Via Aldo Moro 8, Ferrara, Italy
| | - T Fogacci
- Breast and General Surgery Unit, "A. Franchini" Hospital, Via Pedrignone 3, Santarcangelo di Romagna, Italy
| | - G Frisoni
- Breast and General Surgery Unit, "A. Franchini" Hospital, Via Pedrignone 3, Santarcangelo di Romagna, Italy
| | - D Samorani
- Breast and General Surgery Unit, "A. Franchini" Hospital, Via Pedrignone 3, Santarcangelo di Romagna, Italy
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Dellachiesa L, Fogacci T, Cattin F, Frisoni G, Semprini G, Fabiocchi L, Samorani D. Pseudoangiomatous stromal hyperplasia recurrence in a young lady. Chirurgia (Bucur) 2017. [DOI: 10.23736/s0394-9508.16.04607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fogacci T, Cattin F, Samorani D. The therapy with negative pressure as a valid device to treat chronic breast infections. Breast Cancer Res Treat 2015; 155:201-2. [PMID: 26608696 DOI: 10.1007/s10549-015-3650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Tommaso Fogacci
- UO General Surgery Santarcangelo Hospital, AUSL Romagna, Santarcangelo di Romagna, Rimini, Italy.
| | - Federico Cattin
- UO General Surgery Santarcangelo Hospital, AUSL Romagna, Santarcangelo di Romagna, Rimini, Italy.
| | - Domenico Samorani
- UO General Surgery Santarcangelo Hospital, AUSL Romagna, Santarcangelo di Romagna, Rimini, Italy
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Samorani D, Fogacci T, Frisoni G, Accardi F, Dellachiesa L, Fabiocchi L, Menghini L, Ricci M. 1929 Indocynine green to find sentinel node in breast surgery. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Samorani D, Fogacci T, Panzini I, Frisoni G, Accardi F, Ricci M, Fabbri E, Nicoletti S, Flenghi L, Tamburini E, Tassinari D, Gianni L. The use of indocyanine green to detect sentinel nodes in breast cancer: A prospective study. Eur J Surg Oncol 2015; 41:64-70. [DOI: 10.1016/j.ejso.2014.10.047] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/27/2022] Open
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Di Saverio S, Catena F, Santini D, Ansaloni L, Fogacci T, Mignani S, Leone A, Gazzotti F, Gagliardi S, De Cataldis A, Taffurelli M. 259 Patients with DCIS of the breast applying USC/Van Nuys prognostic index: a retrospective review with long term follow up. Breast Cancer Res Treat 2007; 109:405-16. [PMID: 17687650 DOI: 10.1007/s10549-007-9668-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Accepted: 06/26/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Van Nuys Prognostic Index (VNPI) is a simple score for predicting the risk of local recurrence (LR) in patients with Ductal Carcinoma In Situ (DCIS) conservatively treated. This score combines three independent predictors of Local Recurrence. The VNPI has recently been updated with the addition of age as a fourth parameter into the scoring system (University of Southern California/ VNPI). PATIENTS AND METHODS Our database consisted of 408 women with DCIS. Applying the USC/VNPI we reviewed retrospectively 259 patients who were treated with breast conserving surgery with or without radiotherapy (RT). Of these patients 63.5% had a low VNPI score, 32% intermediate and 4.5% a high score. In the low score group, the majority of the patients underwent Conservative Surgery (CS) without RT while in the intermediate group, almost half of the patients received RT. Eighty-three percent (83%) of the patients with high VNPI were treated with Conservative Surgery plus RT. Nodal assessment by Sentinel Lymph Node Biopsy was obtained in 32 patients since 2002. RESULTS Twenty-one Local Recurrences were observed (8%) with a mean follow up of 130 months: sixteen were invasive. No statistically significant differences in Disease Free Survival were reached in all groups of VNPI score between patients treated with Conservative Surgery or Conservative Surgery plus RT. However it was noted that the higher the VNPI score, the lower was the risk of local recurrence in the group treated additionally with RT, even though it was not statistically significant. Further analysis included those patients treated with Conservative Surgery alone and followed up. Disease-free survival (DFS) at 10 years was 94% with low VNPI and 83% in both intermediate and high score (P < 0.05). No significant differences were observed in the subgroups of VNPI. The Local Relapse rate after Conservative Surgery alone, increased with tumor size, margin width, and pathology classification (P < 0,05), while age was not found to be a significant factor. Lesions with only mammographic appearances are associated with lower DFS but it did not reach significance (P = ns), while assumption of estrogenic hormones and familial history of breast cancer are significant factors associated with a higher risk of local recurrence. After multivariate analysis including seven clinical and pathological factors, the only significant predictors of local recurrence remained margin width of surgical excision, previous therapy with estrogens (contraceptives or Hormone Replacement Therapy) and the Van Nuys pathologic classification. The overall survival breast cancer specific was 99% and no differences were observed between groups (P = ns). The comparison of patients treated with a total mastectomy and those conservatively treated showed a significantly better local relapse free survival rate obtained with mastectomy (98.2% vs. 89.7% at 10 years P = 0.02). However, the overall cause-specific survival did not prove any better outcome (98.7% in both groups). Of the 32 patients who underwent a Sentinel Lymph Node Biopsy, four were found to have micrometastases and all of them had a previous Directional Vacuum Assisted Biopsy. CONCLUSIONS Although in our series there is not a significant difference in LR rates by the parameter of age, the new USC/VNPI is still a simple and reliable scoring system for therapeutic management of DCIS. We did not find any statistically significant advantage in groups treated with the addition of RT. Obtaining wide surgical margins appears to be the strongest prognostic factor for local recurrence, regardless of other pathological factors or the addition of adjuvant radiation therapy. However, only prospective randomized studies can precisely predict the risk of LR of conservatively treated DCIS. The clinical significance of Sentinel Lymph Nodes micrometastases Immuno-Histo-Chemistry-detected found in DCIS patients remains uncertain. However, we hypothesize that the anatomical disruption after preoperative biopsy procedures increases the likelihood of epithelial cell displacement and the frequency of IHC-positive Sentinel Lymph Nodes, both of which are directly proportional to the degree of manipulation.
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Affiliation(s)
- Salomone Di Saverio
- Emergency and General Surgery, Department of Surgery, Breast Unit, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy.
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Catena F, Santini D, Di Saverio S, Laneve A, Ansaloni L, Fogacci T, Gagliardi S, Gazzotti F, Guidi G, De Cataldis A, Taffurelli M. Skin Angiosarcoma Arising in an Irradiated Breast: Case-Report and Literature Review. Dermatol Surg 2006; 32:447-55. [PMID: 16640696 DOI: 10.1111/j.1524-4725.2006.032089.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/19/2022]
Abstract
BACKGROUND Angiosarcoma (AS) is a rare, invasive malignancy originating from endothelial cells caused by many different clinical situations. AS following radiotherapy for breast cancer after conservative surgery is a rare but well-known association. OBJECTIVE The aim of this article is to describe a case of AS after breast conserving surgery and to review the literature to date. RESULTS We report the case of an 84-year-old woman who developed AS four years after she was subjected to quadrantectomy for invasive ductal cancer, followed by 30 tangent field radiotherapy sessions. She presented with a one-month history or red papular skin eruptions on the operated breast. Skin lesions were submitted for biopsy, and they were positive for AS. The patients was subjected to surgical excision of the remaining breast including all AS lesions. She is alive with no evidence of disease after 10 months follow-up. CONCLUSION Post-radiotherapy AS is rare neoplasm, but it should be considered in the case of patients with red lesions after breast conserving surgery and adjuvant radiotherapy.
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Affiliation(s)
- Fausto Catena
- St. Orsola-Malpighi University Hospital, Via Massarenti, Bologna, Italy.
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