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Acea Nebril B, García Novoa A, García Jiménez L, Díaz Carballada C, Bouzón Alejandro A, Conde Iglesias C. Immediate breast reconstruction by prepectoral polyurethane implant: Preliminary results of the prospective study PreQ-20. Cir Esp 2023; 101:187-197. [PMID: 36108952 DOI: 10.1016/j.cireng.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/13/2021] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In recent years, mastectomy and reconstruction techniques have evolved towards less aggressive procedures, improving the satisfaction and quality of life of women. For this reason, mastectomy has become a valid option for both women with breast cancer and high-risk women. The objective of this study is to analyze the safety of mastectomy and immediate prepectoral reconstruction with polyurethane implant in women with breast cancer and risk reduction. METHOD Observational prospective study to evaluate the feasibility and safety of immediate reconstruction using prepectoral polyurethane implant. All women (with breast cancer or high risk for breast cancer) who underwent skin-sparing or skin-and-nipple-sparing mastectomy with immediate reconstruction with a prepectoral polyurethane implant were included. Women with breast sarcomas, disease progression during primary systemic therapy (PST), delayed, autologous or retropectoral reconstruction, and those who did not wish to participate in the study were excluded. Surgical procedures were performed by both senior and junior surgeons. All patients received the corresponding complementary treatments. All adverse events that occurred during follow-up and the risk factors for developing them were analyzed. RESULTS 159 reconstructions were performed in 102 women, 80.4% due to breast carcinoma. Fourteen patients developed complications, the most frequent being seroma and wound dehiscence. Eight women required a reoperation (5.0%), seven of them due to implant exposure. Four reconstructions (2.5%) resulted in loss of the implant. Three patients progressed from their oncological process: a local relapse in the mastectomy flap, an axillary progression and a systemic progression. CONCLUSIONS Prepectoral reconstruction with a polyurethane implant is a procedure with a low incidence of postoperative complications (8.8%) and implant loss (2.5%). Its use is safe with perioperative cancer treatments (neoadjuvant chemotherapy and radiotherapy).
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Affiliation(s)
- Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - Lourdes García Jiménez
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Carlota Díaz Carballada
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Alberto Bouzón Alejandro
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Carmen Conde Iglesias
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
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Avellaneda Oviedo EM, García Novoa A, Palacios García P, Pacheco Compaña FJ, Acea Nebril B, Albaina Latorre L. Mastectomía ahorradora de piel tipo IV con injerto libre de areola-pezón para reconstrucción con prótesis en cirugia reductora de riesgo. Cir plást iberolatinoam 2019. [DOI: 10.4321/s0376-78922019000200006] [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: 11/11/2022] Open
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Acea Nebril B, García Novoa A, Polidorio N, Cereijo Garea C, Bouzón Alejandro A, Mosquera Oses J. Extreme oncoplasty: The last opportunity for breast conservation-Analysis of its impact on survival and quality of life. Breast J 2019; 25:535-536. [PMID: 30964211 DOI: 10.1111/tbj.13267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Natalia Polidorio
- Breast Unit, Complexo Hospitalario Universitario A Coruña, A Coruna, Spain
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García Novoa A, Acea Nebril B, Bouzón Alejandro A, Cereijo Garea C, Antolín Novoa S. Radiation-induced angiosarcoma of the breast in a Li-Fraumeni patient. Cir Esp 2018; 97:114-116. [PMID: 30001797 DOI: 10.1016/j.ciresp.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Hospital Abente y Lago, Complejo Hospitalario Universitario de A Coruña, A Coruña, España.
| | - Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Hospital Abente y Lago, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Alberto Bouzón Alejandro
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Hospital Abente y Lago, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Carmen Cereijo Garea
- Unidad de Mama, Hospital Abente y Lago, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Silvia Antolín Novoa
- Unidad de Mama, Servicio de Oncología Médica, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
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García Novoa A, Acea Nebril B. Treatment of the axila in breast cancer surgery: Systematic review of its impact on survival. Cir Esp 2017; 95:503-512. [PMID: 29033068 DOI: 10.1016/j.ciresp.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/04/2016] [Revised: 08/15/2017] [Accepted: 08/31/2017] [Indexed: 11/16/2022]
Abstract
Sentinel lymph node biopsy and ACOSOG-Z0011 criteria have modified axillary treatment in breast cancer surgery. We performed a systematic review of studies assessing the impact of axillary treatment on survival. The search showed 6891 potentially eligible items. Of them, 23 clinical trials and 12 meta-analyses published between 1980 and 2017 met the study criteria. The review revealed that axillary lymph node dissection (ALND) can be omitted in patients pN0 and pN1mic, without compromising survival. In patients pN1 it is proposed not to treat the axilla or replace ALND for axillary radiotherapy. The main limitations of this study are the inclusion of old tests that do not use therapeutic targets and lack of risk categorization of relapse. In conclusion, axillary treatment can be avoided in patients without metastatic involvement or micrometastases in the sentinel lymph node. However, there is no evidence to make a recommendation of axillary treatment in N1 patients, so individualized analysis of patient risk factors is needed.
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Affiliation(s)
- Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
| | - Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, La Coruña, España
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García Novoa A, Acea Nebril B, Díaz I, Builes Ramírez S, Varela C, Cereijo C, Mosquera Oses J, López Calviño B, Seoane Pillado MT. Axillary radiotherapy in conservative surgery for early-stage breast cancer (stage I and II). Cir Esp 2016; 94:331-8. [PMID: 27256280 DOI: 10.1016/j.ciresp.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/05/2015] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Several clinical studies analyze axillary treatment in women with early-stage breast cancer because of changes in the indication for axillary lymph node dissection. The aim of the study is to analyze the impact of axillary radiotherapy in disease-free and overall survival in women with early breast cancer treated with lumpectomy. METHODS Retrospective study in women with initial stages of breast carcinoma treated by lumpectomy. A comparative analysis of high-risk women with axillary lymph node involvement who received axillary radiotherapy with the group of women with low risk without radiotherapy was performed. Logistic regression was used to determine factors influencing survival and lymphedema onset. RESULTS A total of 541 women were included in the study: 384 patients (71%) without axillary lymph node involvement and 157 women (29%) with 1-3 axillary lymph node involvement. Patients with axillary radiotherapy had a higher number of metastatic lymph node compared to non-irradiated (1.6±0.7 vs. 1.4±0.6, P=.02). The group of women with axillary lymph node involvement and radiotherapy showed an overall and disease-free survival at 10 years similar to that obtained in patients without irradiation (89.7% and 77.2%, respectively). 3 lymph nodes involved multiplied by more than 7 times the risk of death (HR=7.20; 95% CI: 1.36 to 38.12). The multivariate analysis showed axillary lymph node dissection as the only variable associated with the development of lymphedema. CONCLUSION The incidence of axillary relapse on stage I and II breast cancer is rare. In these patients axillary radiotherapy does not improve overall survival, but contributes to regional control in those patients with risk factors.
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Affiliation(s)
- Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España.
| | - Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Inma Díaz
- Servicio de Radioterapia, Centro Oncológico de Galicia, La Coruña, España
| | - Sergio Builes Ramírez
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Cristina Varela
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Carmen Cereijo
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Joaquín Mosquera Oses
- Unidad de Mama, Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Beatriz López Calviño
- Unidad de Estadística y Epidemiología, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
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Acea Nebril B, Builes Ramírez S, García Novoa A, Varela Lamas C. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations. Cir Esp 2016; 94:372-8. [PMID: 27140865 DOI: 10.1016/j.ciresp.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/18/2016] [Revised: 03/12/2016] [Accepted: 03/18/2016] [Indexed: 11/26/2022]
Abstract
Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery.
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Affiliation(s)
- Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España.
| | - Sergio Builes Ramírez
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
| | - Cristina Varela Lamas
- Unidad de Mama, Servicio de Cirugía General, Complexo Hospitalario Universitario A Coruña, La Coruña, España
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García Novoa A, Fernández Soria N, Builes Ramírez S, Sanluis Verdes N, Gómez Gutiérrez M. Surgical alternatives in the treatment of portal vein thrombosis in liver transplantation. Cir Esp 2016; 94:412-5. [PMID: 27045611 DOI: 10.1016/j.ciresp.2016.02.010] [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: 11/10/2015] [Revised: 11/30/2015] [Accepted: 02/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandra García Novoa
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España.
| | - Nicolasa Fernández Soria
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Sergio Builes Ramírez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Namibia Sanluis Verdes
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
| | - Manuel Gómez Gutiérrez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña, La Coruña, España
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Acea Nebril B, Domenech Pina E, Díaz Carballada C, García Novoa A. [Brachial plexus lesions in breast surgery. Recommendations for prevention]. Cir Esp 2016; 94:251-3. [PMID: 26724868 DOI: 10.1016/j.ciresp.2015.10.008] [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: 07/23/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Benigno Acea Nebril
- Unidad de Mama, Complexo Hospitalario Universitario A Coruña, A Coruña, España.
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Álvarez Seoane R, García Novoa A, Gómez Gutierrez M. [Obstructive jaundice caused by a mucinous adenocarcinoma of the appendix in a patient with intestinal malrotation]. Cir Esp 2013; 92:131-3. [PMID: 24229812 DOI: 10.1016/j.ciresp.2013.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/04/2013] [Accepted: 07/10/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Rosa Álvarez Seoane
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - Alejandra García Novoa
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, La Coruña, España.
| | - Manuel Gómez Gutierrez
- Servicio de Cirugía General y del Aparato Digestivo, Complejo Hospitalario Universitario A Coruña, La Coruña, España; Sección Hepatobiliopancreática, Servicio de Trasplante Hepático, Complejo Hospitalario Universitario A Coruña, La Coruña, España
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