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Longo B, D'Orsi G, Farcomeni A, Pistoia A, Giacalone M, Gagliano E, Vannucchi L, Vanni G, Buonomo CO, Cervelli V. The FALD-V: A predictive formula for preoperative volume assessment of adipose tissue transplantation in FALD flap. J Plast Reconstr Aesthet Surg 2024; 90:25-34. [PMID: 38340688 DOI: 10.1016/j.bjps.2024.01.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/08/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The fat-augmented latissimus dorsi (FALD) flap is an evolution of the traditional latissimus dorsi (LD) flap, which allows to obtain a total autologous breast reconstruction (BR) avoiding the use of breast implants. The aim of this study was to develop a predictive preoperative formula in order to estimate and optimize the amount of fat to be transferred during FALD flap BR, using only anthropometric measurements. METHODS We conducted a prospective clinical study between September 2020 and April 2023. All patients underwent back pre-operative ultrasound scan to assess the subcutaneous skin paddle thickness (SPT) and a regression analysis was performed to evaluate which anthropometric variable had a better correlation with this thickness. RESULTS Data from 66 FALD flaps were collected. The mean SPT was 11.95 mm (SD 4.56). A significant correlation between SPT and body mass index (BMI) was found (r = 0.640, p < 0.0001). Using the fat-to-capacity ratio (113%), the following formula (the FALD-V) was developed to predict the needed fat transfer into FALD flap: [-509 + 12.32 × BMI + 11.71 × skin paddle width + 17.43 × skin paddle height] × 1.13. The considered variables (BMI, skin paddle width and skin paddle height) were statistically significant (p < 0.001, p = 0.0483, p = 0.0154, respectively). The cross-validation confirmed the accuracy of the formula (r = 0.810). CONCLUSION The FALD-V can be used as an innovative complimentary device in the planning of FALD flap one-stage total autologous BR. To enhance its application, a 3.0 WebApp at www.braflap.com (and www.breast-v.com) is available free of charge for both iOS and Android devices. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Benedetto Longo
- Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy.
| | - Gennaro D'Orsi
- PhD School of Applied Medical-Surgical Sciences,University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Alessio Farcomeni
- Department of Economics & Finance, Tor Vergata University of Rome, Rome, Italy
| | - Angelica Pistoia
- Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Martina Giacalone
- Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Elettra Gagliano
- Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Lisa Vannucchi
- Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Claudio Oreste Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Valerio Cervelli
- Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
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Longo B, D'Orsi G, Vanni G, Gagliano E, Buonomo CO, Cervelli V. Fat-Augmented Latissimus Dorsi Flap for Secondary Breast Reconstruction in Small to Medium-Sized Irradiated Breasts. Plast Reconstr Surg 2023; 152:1165-1173. [PMID: 36995214 DOI: 10.1097/prs.0000000000010480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 03/31/2023]
Abstract
BACKGROUND Secondary breast reconstruction (BR) is recognized as a challenging procedure, particularly when radiotherapy (RT) has previously been performed. The aim of this study was to compare operative data and aesthetic outcomes between secondary irradiated and immediate BR using the fat-augmented latissimus dorsi (FALD) flap. METHODS The authors conducted a prospective clinical study between September of 2020 and September of 2021. Patients were divided into two groups: group A included secondary BR using the FALD flap in previously irradiated breasts, and group B included immediate BR with the FALD flap. Demographics and surgical data were compared, and an aesthetic analysis was performed. Chi-square and t tests were performed for categorical and continuous variables, respectively. RESULTS Twenty cases of FALD flap-based BR for each group were included. The two groups were found to be homogeneous for the demographic variables. The difference in mean operative time (263.1 minutes versus 265.1 minutes; P = 0.467) and complications ( P = 0.633) between the two groups were not significant. There was statistically significant difference in term of immediate fat grafting volume in favor of group A (218.2 cc versus 133.0 cc; P < 0.0001). Regarding aesthetic outcomes, the mean global score evaluation showed no statistically significant differences between groups (17.86 versus 18.21; P = 0.209). CONCLUSIONS The authors' study states that the FALD flap can be considered a reliable procedure for secondary reconstruction in previously irradiated breasts, although it is not indicated for patients with larger breasts. This surgical technique allowed us to achieve a totally autologous BR with good aesthetic results and low complication rates, even in secondary irradiated cases. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Benedetto Longo
- From the Department of Surgical Sciences, School of Medicine and Surgery
| | - Gennaro D'Orsi
- Department of Surgical Sciences, School of Medicine and Surgery, PhD Program in Medical-Surgical Applied Sciences
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome
| | - Elettra Gagliano
- From the Department of Surgical Sciences, School of Medicine and Surgery
| | - Claudio Oreste Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome
| | - Valerio Cervelli
- From the Department of Surgical Sciences, School of Medicine and Surgery
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Longo B, D'Orsi G, La Padula S, Atzeni M, Vanni G, Buonomo CO, Cervelli V. Narrow inferior-central septum-based pedicle: A safe technique to improve aesthetic outcomes in breast reduction. J Plast Reconstr Aesthet Surg 2023; 85:226-234. [PMID: 37524035 DOI: 10.1016/j.bjps.2023.07.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Inferior-central pedicle has some aesthetic drawbacks, including hypertrophic scar along the inframammary fold (IMF), squaring of the breast contours, and propensity to develop long-term 'bottoming-out.' This study aimed to verify if the narrow inferior-central (NIC) septum-based pedicle can allow the surgeon to improve aesthetic outcomes compared with the traditional inferior-central pedicle approach. METHODS Forty breasts underwent NIC-based breast reduction (group A), and 37 underwent traditional inferior-central pedicles (group B). The NIC pedicle was drawn with a width of 3.5-4.5 cm. The recorded measurements were sternal notch to nipple distance (S-N) and nipple to IMF distance (N-IMF) at the time of preoperative markings and follow-up 1, 6, and 18 months after the procedure. RESULTS The two groups were homogeneous regarding demographics, operative data, and preoperative S-N and N-IMF distances. Both groups showed no total or partial nipple-areola necrosis. At the 18-month follow-up, S-N (p < 0.00001) and N-IMF (p = 0.00039) distances were statistically different between the two groups, in favour of NIC group A. Changes in N-IMF distances between the 1- and 18-month visits were statistically different among groups (p < 0.0001), with a length variation of + 17.51% and + 28.46%, respectively. Patient satisfaction rate regarding "breast shape" (p = 0.021), "lower pole appearance" (p = 0.00017), and "scar" (p = 0.047) were higher in group A. CONCLUSION NIC-based pedicle proved to be a safe procedure and allowed us to overcome limitations that typically characterise the inferior pedicle, i.e., 'bottoming-out' deformity, hypertrophic scar of the lower pole, and squaring of the breast contours. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Benedetto Longo
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy.
| | - Gennaro D'Orsi
- Department of Surgical Sciences, School of Medicine and Surgery, Ph.D. Program in Medical-Surgical Applied Sciences, Tor Vergata University of Rome, Italy
| | - Simone La Padula
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Matteo Atzeni
- Faculty of Medicine and Surgery, Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit, University of Cagliari, University Hospital Duilio Casula, Cagliari, Italy
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
| | - Claudio Oreste Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
| | - Valerio Cervelli
- Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
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Longo B, D’Orsi G, Giacalone M, Pistoia A, Vanni G, Buonomo CO, Farcomeni A, Cervelli V. The Ergonomic FALD Flap for One-stage Total Breast Reconstruction. Plast Reconstr Surg Glob Open 2023; 11:e5262. [PMID: 37731730 PMCID: PMC10508455 DOI: 10.1097/gox.0000000000005262] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 09/22/2023]
Abstract
Background The fat-augmented latissimus dorsi (FALD) flap combines this pedicled flap with immediate intraoperative fat transfer. Very little is described concerning its inset at the mammary site. Our efforts have concentrated on seeking the best flap orientation and skin-adipose paddle shaping, to improve the aesthetic outcome and to obtain a complete breast reconstruction (BR) in one stage. Methods A prospective clinical study was performed in patients who underwent BR with FALD flaps, between December 2020 and March 2022. Patients were randomly enrolled into two groups: ergonomic inset of the FALD flap with vertical orientation of the skin-adipose paddle (group A) and FALD flap with traditional horizontal paddle orientation (group B). The study's endpoints were the evaluation of the aesthetic outcomes (from patients' and surgeon's perspectives) and complications. Results Thirty-two FALD flaps (23 patients) were performed for group A, and 31 FALD flaps (25 patients) for group B. The two groups were homogeneous in terms of demographic and surgical data (P > 0.05). The overall complication rate was homogeneous among the groups, without statistically significant differences (P = 1.00). The surgeon's assessments showed a statistically significant superior aesthetic outcome in group A regarding volume, symmetry, and shape (P < 0.05). Higher satisfaction was observed in group A patients, in terms of breast size (P < 0.00001), shape (P = 0.0049), and overall satisfaction (P = 0.00061). Conclusions The ergonomic vertical FALD flap technique enables surgeons to perform one-stage total BR, with excellent breast projection and upper pole fullness. These refinements in flap shaping and molding reduced the need for further autologous fat transfer, obtaining a brilliant totally autologous BR without the need for microsurgical experience.
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Affiliation(s)
- Benedetto Longo
- From the Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Gennaro D’Orsi
- PhD Program in Medical-Surgical Applied Sciences, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Martina Giacalone
- From the Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Angelica Pistoia
- From the Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Gianluca Vanni
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Claudio Oreste Buonomo
- Division of Breast Unit, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Alessio Farcomeni
- Department of Economics and Finance, Tor Vergata University of Rome, Rome, Italy
| | - Valerio Cervelli
- From the Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy
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Scimeca M, Antonacci C, Toschi N, Giannini E, Bonfiglio R, Buonomo CO, Pistolese CA, Tarantino U, Bonanno E. Breast Osteoblast-like Cells: A Reliable Early Marker for Bone Metastases From Breast Cancer. Clin Breast Cancer 2017; 18:e659-e669. [PMID: 29306659 DOI: 10.1016/j.clbc.2017.11.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 04/03/2017] [Revised: 10/29/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The development of bone metastasis from breast cancer results from a functional interaction between tumor cells and osteoclasts or osteoblasts. The main aim of this study was therefore to test the hypothesis that the appearance of breast osteoblast-like cells (BOLCs) in primary mammary lesions is a precursor (and hence an early predictor) of the formation of breast cancer metastases to bone. PATIENTS AND METHODS In this study, we collected 64 breast infiltrating carcinomas, 50 breast benignant lesions, and 10 biopsies of bone metastasis selected from patients with infiltrated carcinoma. Immunohistochemical, western blot, and ultrastructural analysis allowed us to investigate the presence of BOLCs in breast cancer lesions and metastatic sites. RESULTS We established the presence of a high amount of breast cancer cells that underwent mesenchymal transformation in infiltrating carcinomas. In addition, our results demonstrated that the microenvironment of breast cancer is very similar to the microenvironment of bone. We noted a significantly higher expression of BMP-2/4 and PTX3 in breast-infiltrating carcinomas compared with benign lesions. Moreover, we also identified numerous BOLCs positive to RANKL and Vitamin D receptor. Thanks to ultrastructural analysis, we also revealed the presence of BOLCs at the metastatic site. CONCLUSIONS The identification of breast cancer cells with high affinity for a bone environment opens new perspectives on prevention and therapy of bone metastases from breast.
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Affiliation(s)
- Manuel Scimeca
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy; OrchideaLab S.r.l., Morlupo, Rome, Italy; IRCCS San Raffaele Pisana, Rome, Italy
| | - Chiara Antonacci
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Martinos Center for Biomedical Imaging, Boston, MA; Harvard Medical School, Boston, MA
| | - Elena Giannini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Rita Bonfiglio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Umberto Tarantino
- Department of Orthopedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Elena Bonanno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy; TMALab s.r.l., Spin-off of University of Rome Tor Vergata, Rome, Italy.
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