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Palmesano M, Lisa A, Storti G, Bottoni M, Gottardi A, Colombo G, Barbieri B, Garusi C, Sala P, Lo Iacono G, Spaggiari L, De Lorenzi F, Cervelli V, Rietjens M. Resection to restoration: Assessing the synergy of polypropylene mesh (Marlex®) combined with methyl-methacrylate and latissimus dorsi flap for primary chest wall sarcomas. J Plast Reconstr Aesthet Surg 2024; 93:157-162. [PMID: 38691953 DOI: 10.1016/j.bjps.2024.04.022] [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: 11/15/2023] [Revised: 02/13/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Chest-wall sarcomas are treated with extensive resections and complex defect reconstruction to restore chest-wall integrity. It is a difficult surgical procedure that incorporates a multidisciplinary approach for the best outcome, preventing paradoxical chest movement issues and reducing complications. OBJECTIVE We aimed to describe our experience of chest-wall reconstruction using polypropylene mesh (Marlex® Mesh) combined with methyl-methacrylate and soft-tissue coverage with a latissimus dorsi flap following sarcoma resection. PATIENTS AND METHODS Among the 53 patients treated for primary chest-wall sarcomas at the European Institute of Oncology (IEO) in Milan, Italy, from 1998 to 2020, 14 cases underwent chest-wall resection and reconstruction using polypropylene mesh, methyl-methacrylate and the latissimus dorsi flap. Patients with locally advanced breast cancers, locally advanced lung cancers, squamous cell carcinomas, and other secondary chest-wall malignancies were excluded from the study, as were the patients with different types of chest-wall reconstruction. RESULTS In this study, 14 patients (6 men and 8 women) with various primary chest-wall sarcomas were enrolled. On an average, 2 ribs (range: 1-5) were removed during the surgeries, and the chest-wall defects ranged from 20 to 150 cm2 with an average size of 73 cm2. The mean follow-up period for these patients was approximately 63.80 months CONCLUSION: The combination of Marlex® mesh filled with methyl-methacrylate and covered using latissimus dorsi myocutaneous flap provides safe, low-cost and effective single-stage chest-wall reconstruction after surgery for primary sarcomas.
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Affiliation(s)
- Marco Palmesano
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Andrea Lisa
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy; Humanitas University Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20090, Italy; PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Sciences, University of Rome "Tor Vergata," Viale Oxford 81, 00133 Rome, Italy
| | - Gabriele Storti
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Manuela Bottoni
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Alessandra Gottardi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giulia Colombo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Benedetta Barbieri
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Cristina Garusi
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Pietro Sala
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
| | - Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Valerio Cervelli
- Department of Plastic Surgery, University of Rome "Tor Vergata," Viale Oxford 81, Rome, Italy
| | - Mario Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy
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Garusi C, De Antoni E, Fiori S, Vanazzi A, Pileri SA. A Rare Case of BIA-ALCL Mass Associated with Mastectomy Skin Flap Erythema After Immunization with COVID-19. Aesthetic Plast Surg 2023; 47:116-121. [PMID: 36380099 PMCID: PMC9666973 DOI: 10.1007/s00266-022-03174-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The immune response to breast implants after COVID-19 disease or COVID-19 vaccine administration includes acute inflammatory manifestations, capsular contracture and seroma. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare tumor in which numerous up-regulated pro-inflammatory immunological pathways activate a T cell lymphoproliferative disorder. METHODS The first reported case of a BIA-ALCL hidden mass clinically manifesting with inflammatory signs after SARS-CoV-2 infection and vaccinations is here described. RESULTS Complete capsulectomy and adjuvant chemotherapy were performed and immediately after the surgical procedure local inflammatory signs disappeared; no evidence of disease was present 1 year later. CONCLUSIONS Immunological stimulation by COVID-19 disease and vaccines may highlight some rare clinical manifestations of BIA-ALCL; persistent inflammatory symptomatology over breast implants should be investigated using second-level imaging. 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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Affiliation(s)
- Cristina Garusi
- grid.15667.330000 0004 1757 0843Department of Plastic and Reconstructive Surgery, IEO European Institute of Oncology, Milan, Italy
| | - Eleonora De Antoni
- Department of Plastic and Reconstructive Surgery, AOVR Verona University Hospital, Piazzale Stefani 1, 37126, Verona, Italy.
| | - Stefano Fiori
- grid.15667.330000 0004 1757 0843Haematopathology Division, IEO European Institute of Oncology, Milan, Italy
| | - Anna Vanazzi
- grid.15667.330000 0004 1757 0843Clinical Haemato-Oncology, IEO European Institute of Oncology, Milan, Italy
| | - Stefano A. Pileri
- grid.15667.330000 0004 1757 0843Haematopathology Division, IEO European Institute of Oncology, Milan, Italy
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Zeeshan S, Vohra LM, Shamsi US, Zahid N, Ali D, Khan N, Garusi C. A single centre experience of local perforator flaps in oncoplastic breast surgery; a cross-sectional study. Ann Med Surg (Lond) 2022; 84:104916. [DOI: 10.1016/j.amsu.2022.104916] [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] [Received: 08/12/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
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Petrella F, Lo Iacono G, Casiraghi M, Gherzi L, Prisciandaro E, Garusi C, Spaggiari L. Chest wall resection and reconstruction by composite prosthesis for locally recurrent breast carcinoma. J Thorac Dis 2020; 12:39-41. [PMID: 32055423 DOI: 10.21037/jtd.2019.07.92] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Giorgio Lo Iacono
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Monica Casiraghi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Lorenzo Gherzi
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Elena Prisciandaro
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Cristina Garusi
- Department of Plastic and Reconstructive Surgery, IRCCS European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Petit JY, Veronesi U, Orecchia R, Rey P, Didier F, Giraldo A, Luini A, De Lorenzi F, Rietjens M, Garusi C, Intra M, Yamaguchi S, Martella S. The Nipple-Sparing Mastectomy: Early Results of a Feasibility Study of a New Application of Perioperative Radiotherapy (Eliot) in the Treatment of Breast Cancer When Mastectomy is Indicated. Tumori 2018; 89:288-91. [PMID: 12908785 DOI: 10.1177/030089160308900311] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [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: 11/16/2022]
Abstract
Background Breast cancer surgery has become less and less mutilating, however a mastectomy is required in the case of multicentric, large tumors or recurrences after conservative treatment. The removal of the nipple areola complex during the mastectomy dramatically increases the feeling of mutilation. To reduce this negative psychological impact, in cancers located outside of the central area of the breast, we propose a new type of nipple-sparing mastectomy associated with intraoperative electron beam radiotherapy (ELIOT) delivered on the region of the areola. The nipple-sparing mastectomy is performed leaving 5 mm of glandular tissue behind the nipple areola complex to preserve its blood supply. The reconstruction is immediately performed with a prosthesis or an autologous flap. Patients and Methods Twenty-five patients were included in the study; two of them had a bilateral nipple-sparing mastectomy. Results Pathological examinations demonstrated the presence of 19 infiltrating carcinomas and 8 ductal carcinoma in situ. Two patients had a superficial skin areolar slough followed by spontaneous healing. One necrosis of the areola occurred due to extensive retroareolar dissection. In the early follow-up, the color of the areola was preserved. All patients except one expressed their satisfaction of having kept their areola. Conclusions These preliminary results are encouraging but they require further studies to evaluate the long-term results, the local recurrence rate and the psychological impact.
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Affiliation(s)
- Jean Yves Petit
- Plastic Surgery Division, European Institute of Oncology, Milan, Italy.
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Nevola Teixeira LF, Sandrin F, Garusi C, Rietjens M, Galimberti V, Bassi F, Manconi A, Gandini S, Simoncini MC, Veronesi P. Winged scapula in breast cancer patients after sentinel lymph node biopsy: A longitudinal cohort study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10085] [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] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Fabio Bassi
- European Institute of Oncology, Milan, Italy
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Garusi C, Manconi A, Lanni G, Lomeo G, Loschi P, Simoncini MC, Santoro L, Rietjens M, Petit JY. Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study - Combining DASH score and objective evaluation. Breast 2016; 27:78-86. [PMID: 27054752 DOI: 10.1016/j.breast.2016.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/25/2015] [Revised: 02/11/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. MATERIALS AND METHODS We retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011. RESULTS The majority of patients showed a joint recovery superior to 80% in all joint movements examined. Disabilities of the Arm, Shoulder and Hand questionnaire revealed minimal disability similar to normal range and furthermore it appears to decrease in all sports and in particular in those who practice with LD involvement. CONCLUSION Focusing this data, a growing, "disability-free" percentage changes depending on whether or not the patients have practiced sport could be appreciate.
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Affiliation(s)
- C Garusi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - A Manconi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - G Lanni
- Division of Physical Therapist, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - G Lomeo
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - P Loschi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - M C Simoncini
- Division of Physical Therapist, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - L Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - M Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - J Y Petit
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Tocco-Tussardi I, Presman B, Cherubino M, Garusi C, Bassetto F. Microsurgery "without borders": new limits for reconstruction of post-burn sequelae in the humanitarian setting. Ann Burns Fire Disasters 2016; 29:66-70. [PMID: 27857655 PMCID: PMC5108232] [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] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/10/2015] [Indexed: 06/06/2023]
Abstract
Post-burn contractures account for up to 50% of the workload of a plastic surgery team volunteering in developing nations. Best possible outcome most likely requires extensive surgery. However, extensive approaches such as microsurgery are generally discouraged in these settings. We report two successful cases of severe hand contractures reconstructed with free flaps on a surgical mission in Kenya. Microsurgery can be safely performed in the humanitarian setting by an integration of: personal skills; technical means; education of local personnel; follow-up services; and an effective network for communication.
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Affiliation(s)
- I. Tocco-Tussardi
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - B. Presman
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - M. Cherubino
- Plastic Surgery Unit, Department of Biotechnologies and Sciences of Life, University of Insubria/Varese, Varese, Italy
| | - C. Garusi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
| | - F. Bassetto
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
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Masia J, Olivares L, Koshima I, Teo TC, Suominen S, Van Landuyt K, Demirtas Y, Becker C, Pons G, Garusi C, Mitsunaga N. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg 2013; 30:53-8. [PMID: 24037459 DOI: 10.1055/s-0033-1354742] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The popularity of supermicrosurgery has increased dramatically over the past few years, but the lack of agreement regarding the name of the technique and its applications has caused misunderstandings among microsurgeons when trying to communicate and compare surgical procedures. We report the consensus reached on the name used to refer to supermicrosurgery techniques following the First European Conference on Supramicrosurgery held in Barcelona (Spain) on March 4-5, 2010. Present applications, advantages, and disadvantages of supermicrosurgery are discussed. It was agreed that supermicrosurgery was the most accurate name to reflect the essence of this extremely delicate technique. According to Koshima, supermicrosurgery is a technique of microneurovascular anastomosis for vessels of 0.3 to 0.8 mm and single nerve fascicles. The range of applications for this technique has increased rapidly and now includes lymphedema treatment, nerve reconstruction, replantation and reconstruction of amputated fingertips, microsurgical flap salvage, and new possibilities for free tissue transfer. Supermicrosurgery is a remarkably useful reconstructive tool that involves a great deal of skill and has a steep learning curve for the microsurgeon to master. Although it is currently performed by only a minority of microsurgeons, we consider it will be incorporated into conventional microsurgery in the near future.
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Affiliation(s)
- J Masia
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - L Olivares
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - I Koshima
- Department of Plastic Surgery, Tokyo University Hospital, Tokyo, Japan
| | - T C Teo
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - S Suominen
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinky, Finland
| | - K Van Landuyt
- Department of Plastic Surgery, Gent Universitu Hospital, Gent, Belgium
| | - Y Demirtas
- Department of Plastic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey
| | - C Becker
- Department of Plastic surgery, Hospital Europeen Georges Pompidou of Paris, Paris, France
| | - G Pons
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C Garusi
- Department of Plastic Surgery, European Institute of Oncology Milano, Milano, Italy
| | - N Mitsunaga
- Department of Plastic Surgery, Tokyo University Hospital, Tokyo, Japan
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Nevola Teixeira LF, Lohsiriwat V, Veronesi P, Rietjens M, Teixeira LC, Garusi C, Luini A, Simoncini MC, Sandrin F, Zanatta Sarian LO, Gandini S, Casales Schorr M, Sasse AD. Predictive factors for winged scapula in breast cancer patients after immediate axillary dissection. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e20634] [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: 11/20/2022] Open
Abstract
e20634 Background: Axillary lymph node dissection is an inevitable part of breast cancer surgery in certain cases. Definitive data regarding the incidence of postoperative winged scapula remains inconsistent. Ignorance of its diagnosis may lead to under-treatment and result in physical morbidity. Methods: All breast cancer patients who underwent axillary lymph node dissection procedures were recruited. In the early postoperative period, within 24 hours after surgery, the physiotherapy staff performed physical examinations to evaluate and identify the physical signs of long thoracic nerve injury by means of two specific orthopedic evaluation tests. The factors that may relate to winged scapula were recorded and analyzed. Results: From July to October 2012, 51 out of 187 patients were diagnosed with winged scapula (27.2%). The median age was 49.0 years old. 130 patients had undergone mastectomy and 100 cases had immediate breast reconstruction. Age, BMI, history of shoulder joint morbidity and previous breast surgery were not significantly associated with winged scapula. Administration of neoadjuvant treatment, mastectomy or breast conservative surgery, immediate reconstruction and its type, tumor size and nodal involvement also did not show any correlation. Conclusions: The winged scapula is not an infrequent sequela after axillary lymph node dissection in the breast cancer patient. It is usually underestimated and overlooked. There is no association between age, BMI, neoadjuvant treatment, type of breast surgery, tumor size or nodal stage. As breast reconstruction plats an ever-increasing role in current breast surgery practice it is interesting to note that reconstruction with prosthesis, even with serratus muscle dissection does not increase the incidence of winged scapula. Post reconstruction morbidity could interfere with the physical evaluation and outcome, but the result of our subgroup analysis showed no significant correlation among them. In our clinical experience, this sequela is not irreversible, being a transitory problem. Our series show only immediate 24 hr result that lack of long term follow-up and still need physical therapy proctocols to evaluate the recovery.
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Petit JY, Rietjens M, Botteri E, Rotmensz N, Bertolini F, Curigliano G, Rey P, Garusi C, De Lorenzi F, Martella S, Manconi A, Barbieri B, Veronesi P, Intra M, Brambullo T, Gottardi A, Sommario M, Lomeo G, Iera M, Giovinazzo V, Lohsiriwat V. Evaluation of fat grafting safety in patients with intraepithelial neoplasia: a matched-cohort study. Ann Oncol 2013; 24:1479-84. [PMID: 23393126 DOI: 10.1093/annonc/mds660] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Fat grafting is widely carried out in breast cancer patients to improve quality in breast reconstruction. Recently, in vitro and animal studies have questioned the role of adipose tissues in cancer development. DESIGNS Matched-cohort study. We analysed: (i) 59 intraepithelial neoplasia patients who had undergone lipofilling, with no recurrence between primary surgery and lipofilling. (ii) A control group of 118 matched patients (two controls per lipofilling patient) with the corresponding recurrence-free intervals. Both groups were also matched for main cancer criteria. A local event (LE) was the primary end point, with follow-up starting from the baseline. RESULTS Median follow-up was 63 and 66 months from surgery, and 38 and 42 from baseline, for the lipofilling and control groups, respectively; the 5-year cumulative incidence of LE was 18% and 3% (P = 0.02). Ki-67 was the significant factor in univariate survival analysis. A subgroup analysis showed that lipofilling increased the risk of LE in women <50 years, with high grade neoplasia, Ki-67 ≥ 14 or who had undergone quadrantectomy. CONCLUSION Higher risk of LE was observed in intraepithelial neoplasia patients following lipofilling. Although further studies are required to validate our conclusions, patients belonging to this subgroup should be informed of these results and the potential risks.
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Affiliation(s)
- J Y Petit
- Department of Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
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Lohsiriwat V, Rotmensz N, Botteri E, Intra M, Veronesi P, Martella S, Garusi C, De Lorenzi F, Manconi A, Lomeo G, Rietjens M, Schorr M, Kneubil MC, Petit JY. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy? Ann Surg Oncol 2012; 20:990-6. [PMID: 23070785 DOI: 10.1245/s10434-012-2677-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The selections of nipple-sparing mastectomy (NSM) are principally depending on oncologic indication and oncologic safety. The main complication of NSM is nipple areolar complex (NAC) necrosis, and it is usually related to surgical technique. However, the patients' clinicopathological factors should be also considered. METHOD We retrospectively reviewed 934 consecutive NSM patients during 2002-2007 at the European Institute of Oncology, Milan, Italy. We identified a group of patient who had NAC excision because of NAC necrosis and compared this group with those who had successful NAC conservation. We analyzed the association between the risk of NAC necrosis and the clinicopathological features of the patients. RESULTS Among 934 NSM, 772 were invasive cancers and 162 were in situ cancers. Of the 934, 40 NAC (4.2%) were removed during the postoperative period because of necrosis. When we considered age, BMI, menopausal status, smoking status, tumor size, axillary lymph node status, in situ or invasive cancer histology, presence of extensive situ component, grading, estrogen receptor, progesterone receptor, HER2/neu overexpression, Ki-67 proliferative index, and peritumoral vascular invasion, no association was observed between patients' clinicopathological features and NAC necrosis incidence. CONCLUSIONS In our study, clinicopathological features have no significant impact on necrosis complication in therapeutic NSMs. Positive retroareolar margin is the risk of necrosis. Further studies are required to avoid bias due to the different cancer treatments such as different reconstruction techniques and intraoperative radiation protocols. The correlation between breast morphology and NAC necrosis should also be investigated in the future.
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Affiliation(s)
- Visnu Lohsiriwat
- Division of Plastic Surgery, European Institute of Oncology, Milan, Italy.
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Petit JY, Rietjens M, Lohsiriwat V, Rey P, Garusi C, De Lorenzi F, Martella S, Manconi A, Barbieri B, Clough KB. Update on breast reconstruction techniques and indications. World J Surg 2012; 36:1486-97. [PMID: 22395342 DOI: 10.1007/s00268-012-1486-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. Implants or expanders are the most frequent techniques used for the reconstructions. Expander provides usually a better symmetry. A contralateral mastoplasty often is required to improve the symmetry. The nipple areola complex, which can be preserved in certain conditions, is usually removed and can be reconstructed in a second stage under local anesthesia. In case of radical mastectomy and/or radiotherapy, a musculocutaneous flap, such as rectus abdominis or latissimus dorsi autologous flaps, is required. When microsurgical facilities are available, free or perforator flaps respecting the muscle are preferred to decrease the donor site complications. In situ carcinomas or prophylactic mastectomy can be reconstructed immediately as well as invasive carcinoma according to the recent literature. Locally advanced breast cancer can be reconstructed after complete oncologic treatment. Radiotherapy of the thoracic wall is proposed in case of lymph node metastases, raising the discussion about the technique choice and the timing of the reconstruction. Plastic surgery procedures can improve the cosmetic results of the conservative surgery, also extending its indications and reducing both mastectomy and reexcision rates. Oncoplasty techniques are becoming more and more sophisticated, requiring the skill of trained plastic surgeons. Numerous publications confirm the psychosocial benefit resulting from the breast reconstruction.
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Affiliation(s)
- Jean-Yves Petit
- European Institute of Oncology-EIO, Plastic and Reconstructive Surgery Unit, Via Ripamonti, 435, 20.141, Milan, Italy.
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De Lorenzi F, Lohsiriwat V, Barbieri B, Rodriguez Perez S, Garusi C, Petit JY, Galimberti V, Rietjens M. Immediate breast reconstruction with prostheses after conservative treatment plus intraoperative radiotherapy. Long term esthetic and oncological outcomes. Breast 2012; 21:374-9. [DOI: 10.1016/j.breast.2012.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/13/2012] [Accepted: 03/18/2012] [Indexed: 11/26/2022] Open
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Petit JY, Botteri E, Lohsiriwat V, Rietjens M, De Lorenzi F, Garusi C, Rossetto F, Martella S, Manconi A, Bertolini F, Curigliano G, Veronesi P, Santillo B, Rotmensz N. Locoregional recurrence risk after lipofilling in breast cancer patients. Ann Oncol 2012; 23:582-588. [PMID: 21610155 DOI: 10.1093/annonc/mdr158] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [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: 11/12/2022] Open
Abstract
BACKGROUND Lipofilling has been indicated for postmastectomy and postlumpectomy breast reconstruction. The clinical literatures underline its technical efficacy but experimental studies raise important questions about the potential detrimental effect of adipocytes on the stimulation of cancer growth and reappearance. DESIGN We collected 321 consecutive patients operated for a primary breast cancer between 1997 and 2008 who subsequently underwent lipofilling for reconstructive purpose. For each patient, we selected two matched patients with similar characteristics who did not undergo a lipofilling. RESULTS Eighty-nine percent of the tumors were invasive. Median follow-up was 56 months from the primary surgery and 26 months from the lipofilling. Eight and 19 patients had a local event in the lipofilling and control group, respectively, leading to comparable cumulative incidence curves [P = 0.792; Hazard Ratio(Lipo vs No lipo) = 1.11 (95% confidence interval 0.47-2.64)]. These results were confirmed when patients undergoing quadrantectomy and mastectomy were analyzed separately and when the analysis was limited to invasive tumors. Based on 37 cases, the lipofilling group resulted at higher risk of local events when the analysis was limited to intraepithelial neoplasia. CONCLUSIONS Lipofilling seems to be a safe procedure in breast cancer patients. Longer follow-up and further experiences from oncological series are urgently required to confirm these findings.
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Affiliation(s)
| | - E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - V Lohsiriwat
- Division of Plastic Surgery; Department of Surgery, Mahidol University, Siriraj Hospital, Bangkok, Thailand
| | | | | | | | | | | | | | | | - G Curigliano
- Division of Medical Oncology, Department of Medicine
| | - P Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan; University of Milan, Milan, Italy
| | - B Santillo
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - N Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
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Lohsiriwat V, Martella S, Rietjens M, Botteri E, Rotmensz N, Mastropasqua MG, Garusi C, De Lorenzi F, Manconi A, Sommario M, Barbieri B, Cassilha M, Minotti I, Petit JY. Paget’s Disease as a Local Recurrence after Nipple-Sparing Mastectomy: Clinical Presentation, Treatment, Outcome, and Risk Factor Analysis. Ann Surg Oncol 2012; 19:1850-5. [DOI: 10.1245/s10434-012-2226-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Indexed: 11/18/2022]
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17
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Calabrese L, Saito A, Navach V, Bruschini R, Saito N, Zurlo V, Ostuni A, Garusi C. Tongue reconstruction with the gracilis myocutaneous free flap. Microsurgery 2011; 31:355-9. [DOI: 10.1002/micr.20885] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/23/2010] [Indexed: 11/08/2022]
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18
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Leonardi MC, Garusi C, Santoro L, Dell'Acqua V, Rossetto F, Didier F, Vischioni B, De Lorenzi F, Lohsiriwat V, Yves Petit J, Orecchia R. Impact of medical discipline and observer gender on cosmetic outcome evaluation in breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap and radiotherapy. J Plast Reconstr Aesthet Surg 2010; 63:2091-7. [DOI: 10.1016/j.bjps.2010.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 01/28/2010] [Accepted: 02/07/2010] [Indexed: 10/19/2022]
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19
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Garusi C, Lohsiriwat V, de Lorenzi F, Manconi A, de Fiori E, Bellomi M. A subfascial variant of the deep inferior epigastric artery demonstrated by preoperative multidetector computed tomographic angiography: A case report. Microsurgery 2009; 30:156-8. [DOI: 10.1002/micr.20710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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20
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Petit JY, Veronesi U, Orecchia R, Rey P, Martella S, Didier F, Viale G, Veronesi P, Luini A, Galimberti V, Bedolis R, Rietjens M, Garusi C, De Lorenzi F, Bosco R, Manconi A, Ivaldi GB, Youssef O. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat 2009; 117:333-8. [PMID: 19152026 DOI: 10.1007/s10549-008-0304-y] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/31/2008] [Indexed: 02/04/2023]
Abstract
In order to reduce mutilation, nipple-areola complex (NAC) conservation can be proposed for the treatment of breast cancer when mastectomy is indicated. To reduce the risk of retro areolar recurrence, a novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy (ELIOT) is proposed. One thousand and one nipple sparing mastectomies (NSM) were performed from March 2002 to November 2007 at the European institute of oncology (EIO), for invasive carcinoma in 82% of the patients and in situ carcinoma in 18%. Clinical complications, aesthetic results, oncological and psychological results were recorded. A comparison was performed between the 800 patients who received ELIOT and the 201 who underwent delayed one-shot radiotherapy on the days following the operation. The median follow up time was 20 months (range 1-69) for a follow up performed in 83% of the patients. The NAC necrosed totally in 35 cases (3.5%) and partially in 55 (5.5%) and was removed in 50 (5%). Twenty infections (2%) were observed and 43 (4.3%) prostheses removed. The median rate of the patients for global cosmetic result on a scale ranging from 0 (worst) to 10 (excellent) was 8. Evaluation by the surgeon in charge of the follow-up gave a similar result. Only 15% of the patients reported a partial sensitivity of the NAC. Of the fourteen (1.4%) local recurrences, ten occurred close to the tumour site, all far from the NAC corresponding to the field of radiation. No recurrences were observed in the NAC. In a group of patients characterized by a very close free margin under the areola, no local recurrence was observed. Overall, 36 cases of metastases and 4 deaths were observed. No significant outcome difference was observed between the 800 patients receiving intraoperative radiotherapy (ELIOT) and the 201 patients receiving delayed irradiation.
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Affiliation(s)
- J Y Petit
- Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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21
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Brenelli F, Hernades S, Castro P, Garusi C, Petit J. Latissimus dorsi flap for total or partial breast reconstruction – the experience of the European Institute of Oncology. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)70858-9] [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: 11/26/2022] Open
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22
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Petit JY, Veronesi U, Rey P, Rotmensz N, Botteri E, Rietjens M, Garusi C, De Lorenzi F, Martella S, Bosco R, Manconi A, Luini A, Galimberti V, Veronesi P, Ivaldi GB, Orecchia R. Nipple-sparing mastectomy: risk of nipple-areolar recurrences in a series of 579 cases. Breast Cancer Res Treat 2008; 114:97-101. [PMID: 18360773 DOI: 10.1007/s10549-008-9968-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 03/05/2008] [Indexed: 11/12/2022]
Abstract
BACKGROUND When the conservative treatment is not recommended, Nipple Sparing Mastectomy (NSM) is proposed more and more frequently for the surgical treatment of breast cancer. The risk of local recurrence behind the nipple areolar complex (NAC) is the main limiting factor of the NSM procedure. To minimize such risk, we proposed in 2002 a intraoperative radiotherapy of the preserved NAC. PATIENTS AND METHODS From March 2002 to November 2006, 579 cases (in 570 patients) of NSM were performed for carcinoma. The median follow up time was 19 months (Range: 1-60). The subcutaneous mastectomy was performed through an incision removing a portion of the skin overlying the tumour. An extemporaneous histological examination was performed on the retroareolar glandular tissue. If the histology was positive the patient was not considered eligible. Then an intraoperative radiotherapy with electrons (ELIOT) of 16 Gy in one shot was delivered on the NAC area. An immediate breast reconstruction was done using implants in most cases and in several cases a musculocutaneous flaps, usually in large breast. The number of local recurrences was recorded and the correlation between their occurrence and the clinical and histological criteria were analysed using the Gray test statistical method in a competing framework. RESULTS In 516 cases the negative retroareolar frozen section biopsy was confirmed by the final histology, while in 63 cases, the final histology showed foci of carcinoma. Seven out of these 63 cases underwent a secondary NAC removal. In the 56 cases which preserved areolas we did not observe any local recurrence after 19 months follow up. The probability of retro areola positive histology increases with the tumour size. and was not related to the nodal status. The rate of local relapses was 0.9% per year. We didn't find any significant difference in the local relapse rate according to different patient's and tumour's features. Most relapses were located close to the tumour bed but never in the NAC area. CONCLUSION Our study confirms that the local recurrence rate in the NSM completed with local radiotherapy on the NAC is not higher than the usual rate observed in the literature and the preservation of the NAC does not increase the risk. The absence of local recurrence in the region where a portion of glandular tissue has been purposely preserved is a good argument in favour of ELIOT.
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Affiliation(s)
- J Y Petit
- Department of Plastic Surgery, European Institute of Oncology, Via Ripamonti 435, Milan, 20 141, Italy.
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23
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Petit JY, Gentilini O, Rotmensz N, Rey P, Rietjens M, Garusi C, Botteri E, De Lorenzi F, Martella S, Bosco R, Khuthaila DK, Luini A. Oncological results of immediate breast reconstruction: long term follow-up of a large series at a single institution. Breast Cancer Res Treat 2008; 112:545-9. [DOI: 10.1007/s10549-008-9891-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 01/02/2008] [Indexed: 10/22/2022]
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24
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Rietjens M, Urban CA, Rey PC, Mazzarol G, Maisonneuve P, Garusi C, Intra M, Yamaguchi S, Kaur N, De Lorenzi F, Matthes AGZ, Zurrida S, Petit JY. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 2007; 16:387-95. [PMID: 17376687 DOI: 10.1016/j.breast.2007.01.008] [Citation(s) in RCA: 162] [Impact Index Per Article: 9.5] [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: 07/28/2006] [Revised: 11/09/2006] [Accepted: 01/24/2007] [Indexed: 11/20/2022] Open
Abstract
Oncoplastic surgery combining breast conservative treatment (BCT) and plastic surgery techniques may allow more extensive breast resections and improve aesthetic outcomes, but no long-term oncological results have been published. Long-term oncologic results of 148 consecutive BCT with concomitant bilateral plastic surgery have been analysed and were compared to historical data of BCT trials. Median follow-up was 74 months. Complete excision was obtained in 135 patients (91%); focally involved margins in 8 (5%); and close (<2 mm) margins in 5 (3%). Five patients developed ipsilateral recurrence (3%), 19 (13%) developed distant metastasis and 11 patients died (7.53%). Patients with tumours larger than 2 cm were at greater risk of local recurrences and distant metastasis. Long-term oncologic results of BCT with oncoplastic surgery are comparable with the results of BCT randomized trials.
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Affiliation(s)
- M Rietjens
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy
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25
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Petit JY, De Lorenzi F, Rietjens M, Intra M, Martella S, Garusi C, Rey PC, Matthes AGZ. Technical tricks to improve the cosmetic results of breast-conserving treatment. Breast 2007; 16:13-6. [PMID: 17070051 DOI: 10.1016/j.breast.2006.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 05/16/2006] [Revised: 08/29/2006] [Accepted: 08/29/2006] [Indexed: 10/24/2022] Open
Abstract
The paper describes different manoeuvres and surgical details that may help the general surgeon to improve the aesthetic outcomes after breast-conserving treatment for cancer. Among them, the pre-operative planning, the position of the patient in the operative room, the mobilisation of the glandular tissue when the tumour has been removed. All these manoeuvres contribute to achieving better symmetry with the healthy breast and to improve the final aesthetic result, minimising the surgical conflict between large resections and defects for optimal control of local disease and the consequent breast deformities.
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Affiliation(s)
- Jean Yves Petit
- European Institute of Oncology, Department of Plastic and Reconstructive Surgery, Milan, Italy
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26
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Calabrese L, Garusi C, Giugliano G, Ansarin M, Bruschini R, Chiesa F. Composite reconstruction in advanced cancer of the mouth floor: autogenous frozen-thawed mandibular bone and free flaps. Microsurgery 2007; 27:21-6. [PMID: 17205573 DOI: 10.1002/micr.20301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Mandibular symphyseal resection requires composite reconstructions, often with unsatisfactory morphofunctional results. Seven patients with advanced squamous cell carcinoma of the floor of the mouth underwent block resection with immediate reconstruction, using the removed mandible treated with liquid nitrogen and covered with a free forearm flap. In all cases, the resection was radical and no major postoperative complications occurred. Two patients died in 6 months for distant metastases and regional recurrence. In the other 5 patients, no local recurrence occurred at a mean follow-up of 52 months (36-70). Immediate cosmetic and functional results were good. Of the 5 patients, 4 had late complications requiring further surgery. This technique of bone reimplantation produces no donor site morbidity, perfect immediate morphological result, and is of low cost. The free forearm flap is effective in sealing the oral cavity, though further clinical and experimental studies are necessary to reduce late local complications.
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Affiliation(s)
- Luca Calabrese
- Division of Head and Neck Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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27
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Petit JY, Veronesi U, Luini A, Orecchia R, Rey PC, Martella S, Didier F, De Lorenzi F, Rietjens M, Garusi C, Sonzogni A, Galimberti V, Leida E, Lazzari R, Giraldo A. When mastectomy becomes inevitable: The nipple-sparing approach. Breast 2005; 14:527-31. [PMID: 16226028 DOI: 10.1016/j.breast.2005.08.028] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [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: 10/25/2022] Open
Abstract
The preservation of the nipple areola complex (NAC) could improve the quality of life in cases of mastectomy. A novel radiosurgical treatment combining subcutaneous mastectomy with intraoperative radiotherapy is proposed. Three hundred nipple-sparing mastectomies (NSM) were performed. Invasive (58%) and in situ (42%) carcinomas were included. Clinical complications, aesthetic results, oncological and psychological results were recorded. The NAC necrosed totally in 10 cases and partially in 29 and it was removed in 12. Nine infections (3%) were observed and 10 prostheses removed. Good results were rated by 82.3% of the patients and by 84.8% of the surgeons. In 7.5% a radiodystrophy was observed. The sensitivity of the NAC recovered partially in 48%. Two local recurrences occurred outside the radiated field. Overall, we observed three metastases and no deaths. Sixty-eight of the patients were satisfied with their reconstructed breast and 85.5% were satisfied having preserved the NAC.
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Affiliation(s)
- J Y Petit
- Plastic Surgery Department, European Institute of Oncology, Via Ripamonti 435, 20 141 Milan, Italy.
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28
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Petit JY, Veronesi U, Orecchia R, Luini A, Rey P, Intra M, Didier F, Martella S, Rietjens M, Garusi C, DeLorenzi F, Gatti G, Leon ME, Casadio C. Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): A new type of mastectomy for breast cancer treatment. Breast Cancer Res Treat 2005; 96:47-51. [PMID: 16261402 DOI: 10.1007/s10549-005-9033-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [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: 12/16/2004] [Accepted: 07/19/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast-conserving surgery has become the standard approach for about 80% of patients treated for primary breast cancer in most centres. However, mastectomy is still required in case of multicentric and/or large tumours or where recurrences occur after conservative treatment. When a total mastectomy is performed, the removal of the nipple areola complex (NAC) is a strongly debated issue. In fact, although removal of the NAC greatly increases the patient's sensation of mutilation, and the risk of tumor involvement of the areola is reported as a very variable percentage, NAC excision still remains the standard treatment. PATIENTS AND METHODS From March 2002 to September 2003, 106 nipple sparing mastectomies (NSM) were peformed in 102 patients, 63% of whom had invasive carcinoma and 37% of whom had in situ carcinoma. Four patients underwent bilateral surgery. In all cases, a large or multicentric tumour and/or diffuse microcalcifications, clinically distant from the NAC, were present. During surgery, the tissue under the areola was routinely sampled to exclude the presence of tumor. If disease-free at the frozen sections, the NAC was spared and a NSM was performed. Additionally, a total dose of 16 Gy of radiotherapy (ELIOT) was delivered intraoperatively in the region of the NAC. All the patients underwent an immediate plastic breast reconstruction. RESULTS In eleven patients (10.4%), the breast tissue under the areola resulted infiltrated at the definitive histological examination: in 10 cases a single or multiple foci of in situ carcinoma and in one case an invasive component were present. Eleven patients (10.4%) developed a superficial skin areolar slough followed by spontaneous healing, and 5 patients (4.7%) lost their NAC due to total necrosis. Among these, one patient had a poor cosmetic result on the NAC with asymmetrical location and required further surgical removal and reconstruction with tattoo and local flap in a better position. When rating the results from 0 (bad) to 10 (excellent), on average, the colour of the areola was rated 9/10, the sensitivity of nipple 3/10, the overall aesthetic result was rated 8/10 by both the surgeon and the patients. Early radiodystrophy (pigmentation) was observed in eight cases (7.5%). After an average follow up of 13 months, one local recurrence, located under the clavicula, far from the NAC, was observed. The preliminary results of the psychological study show a very high satisfaction with the preservation of the nipple (97.6 %), with younger women expressing a higher satisfaction than older counterparts. CONCLUSIONS In selected cases, NSM with ELIOT of NAC has so far permitted good local control of the disease and satisfactory cosmetic results. Wider surgical experience is required to minimise the risk of leaving tumor cells in the region of the spared NAC and a longer follow up is necessary to evaluate the long term tumor recurrence rate at the NAC.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma in Situ/pathology
- Carcinoma in Situ/radiotherapy
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/radiotherapy
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/radiotherapy
- Carcinoma, Lobular/surgery
- Female
- Humans
- Mammaplasty
- Mastectomy/methods
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Nipples/pathology
- Nipples/surgery
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Affiliation(s)
- Jean Yves Petit
- Division of Plastic Surgery, European Institute of Oncology, Milan, Italy.
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Abstract
BACKGROUND Immediate breast reconstruction (IBR) is considered as a safe procedure nowadays, and it can be proposed in the majority of patients requiring a mastectomy. In fact, recent studies have demonstrated that immediate breast reconstruction is not detrimental also to patients with locally advanced breast cancers. However, IBR should be reevaluated in case of locally advanced breast cancer requiring high-dose chemotherapy (HDCT). The aim of this study is to evaluate both the risk of chemotherapy delay due to surgical complications and the risk of late surgical complications related to the association with HDCT. We considered 3 series of 23, 67, and 15 patients requiring a mastectomy at the European Institute of Oncology in Milan. After mastectomy, these groups respectively received an IBR and HDCT, an IBR and conventional chemotherapy, and only HDCT with no IBR. METHODS Files of 105 patients who were admitted to our department from October 1999 to January 2002 were reviewed. Twenty-three patients underwent a mastectomy, followed by IBR and HDCT; 67 underwent a mastectomy plus IBR plus conventional CT; and, finally, 15 underwent a mastectomy alone followed by HDCT. The reconstructive techniques performed were 72 permanent prosthesis and 18 temporary expanders. We excluded all patients with IBR by flap (latissimus dorsi or pedicled rectus abdominis) to improve the homogeneity of the sample. RESULTS All patients who underwent IBR started high-dose chemotherapy without any delay; the time elapsed between surgery and HDCT is not significantly different for patients with and without IBR (54 versus 60 days, P = 0.13). The early complication rate (before CT) was 2.9% (2 patients with infection). The late complication rate (after CT) was higher for the group that underwent IBR followed by HDCT (39% versus 20%). CONCLUSION We did not observe any delay for the administration of high-dose chemotherapy after mastectomy with IBR surgery. The complication rate before HDCT is similar to the complication rates published in the literature. On the contrary, we observed a higher rate of infections (13% versus 0%, P = 0,014) after HDCT than after conventional CT, which can be related to the association with high-dose chemotherapy, inducing a decrease of the immune defenses. These results seems to demonstrate that the association of IBR with HDCT is not detrimental to patients from the oncological point of view, but the impact of HDCT on the reconstruction is more negative. Further studies are needed to verify if this risk exists, although lower, in the association with conventional CT. However, a careful evaluation of the risk of infections should be considered preoperatively, and perioperative contaminations should be carefully prevented.
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Affiliation(s)
- P Rey
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
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30
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De Lorenzi F, Yamaguchi S, Petit JY, Rietjens M, Garusi C, Martella S, Rey PC, Gennari R. Evaluation of skin perfusion after nipple-sparing mastectomy by indocyanine green dye. Preliminary results. J Exp Clin Cancer Res 2005; 24:347-54. [PMID: 16270520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The aim of the study was to investigate the blood supply of the normal nipple areola complex (NAC) and the spared areola complex after a nipple-sparing mastectomy using the analysis of the fluorescence from the indocianine green dye (ICG) injection. Between December 2002 and July 2003 we performed the ICG analysis in 10 cases of healthy breasts and in 9 patients after a nipple-sparing mastectomy and one patient after subcutaneous mastectomy. In all cases, the resulting fluorescence was measured in three different zones: nipple, areola, surrounding mammary skin. Three parameters of the fluorescence curve (slope, maximum intensity, time to achieve a maximum level) were recorded. On the healthy breast, the nipple showed a very high perfusion as compared to the other zones. On the contrary, after the mastectomy the fluorescent pattern was completely altered, being the perfusion of the nipple very low. In conclusion, these preliminary results confirm the applicability and the importance of the ICG technique for evaluating the perfusion of the healthy and spared areola after surgery. Because of the small number of patients further studies are needed.
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Affiliation(s)
- F De Lorenzi
- Dept. of Plastic and Reconstructive Surgery, European Institute of Oncology, Milano, Italy.
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Yamaguchi S, De Lorenzi F, Petit JY, Rietjens M, Garusi C, Giraldo A, Rey PC, Urban C, Martella S, Bosco R. The "perfusion map" of the unipedicled TRAM flap to reduce postoperative partial necrosis. Ann Plast Surg 2004; 53:205-9. [PMID: 15480004 DOI: 10.1097/01.sap.0000116284.51679.ea] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [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: 11/26/2022]
Abstract
The unipedicled transverse rectus abdominis musculocutaneous (TRAM) flap is a well-known technique for breast reconstruction. However, it is clinically difficult to evaluate the blood perfusion of the flap in the operating room. A new technique of blood supply evaluation, employing indocyanine green dye (ICG) fluorescence videoangiography has been performed in 10 cases of unipedicled TRAM flap breast reconstruction. In our series, the ICG measurement was demonstrated to be a safe, quick, and accurate technique of flap perfusion analysis. We confirmed the presence of individual pattern ("perfusion map") of the flap perfusion, zone II sometimes not being as well perfused as zone III. In this paper, we present our descriptive findings, and the ICG analysis seems to have a predictive value of unipedicled TRAM flap viability.
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Affiliation(s)
- Satoru Yamaguchi
- Plastic and Reconstructive Division, European Institute of Oncology, Milan, Italy.
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Petit JY, Rietjens M, Garusi C, Giraldo A, De Lorenzi F, Rey P, Millen EC, Pace da Silva B, Bosco R, Youssef O. Abdominal complications and sequelae after breast reconstruction with pedicled TRAM flap: is there still an indication for pedicled TRAM in the year 2003? Plast Reconstr Surg 2003; 112:1063-5. [PMID: 12973225 DOI: 10.1097/01.prs.0000076194.51830.65] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jean Y Petit
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy.
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Petit JY, Garusi C, Greuse M, Rietiens M, Youssef O, Luini A, De Lorenzi F. One hundred and eleven cases of breast conservation treatment with simultaneous reconstruction at the European Institute of Oncology (Milan). Tumori 2002; 88:41-7. [PMID: 12004849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
AIMS AND BACKGROUND Breast conserving treatment (BCT) should provide similar quality of local control as mastectomy and avoid psychological distress due to mutilation. Randomized trials have demonstrated the value of conservative surgery for small tumors. Several publications have indicated the possibility of improving the cosmetic result when quadrantectomy is combined with plastic surgery. These papers focused on two techniques involving reduction mammaplasty and latissimus dorsi flap procedures. At the European Institute of Oncology (EIO) we use various plastic procedures to reshape the breast and to improve symmetry. The choice of these techniques depends on tumor size and location, as well as on breast volume. METHODS AND STUDY DESIGN In two years (1995 and 1996) 111 patients were treated at the EIO with quadrantectomy and concomitant plastic surgery. Preoperative tumor staging was as follows: T1 57.5%, T2 29%, T3 4.5%, Tis 8%, and sarcoma 1%. The tumor locations were upper quadrant 50%, lower quadrant 40%, and central quadrant 10%. The plastic surgery techniques used included local glandular flaps, areola transposition, mastopexy or classical reduction mastoplasty procedures, the round block technique, prosthesis insertion, and distal musculocutaneous flaps. Cosmetic evaluation on the basis of predefined cosmetic criteria was carried out on photographs after a mean follow-up of 21 months. In 48 cases the patients' own rating of breast cosmesis was asked. RESULTS The global results were good in 77.5%, fair in 17%, and poor in 5.5% of the patients. No statistical difference was observed between different tumor locations, although the percentage of good cosmetic results, which was similar in the upper and lower quadrantectomy groups, was slightly lower for centrally located tumors. With regard to the different techniques, we obtained 100% good results with the round block technique and the Grisotti flap, 87% good results with the inferior pedicle, 74% good results with the Lejour and superior pedicle techniques, 67% good results with the latissimus dorsi flap, and 58% good results with prosthetic implants. The outcome was less satisfactory when no contralateral mastoplasty was performed (14 of the 111 cases): 72% good, 14% fair, and 14% poor results. These differences were not statistically significant. The median weight of the specimens was 157 g, which is almost three-fold the usual weight in regular tumorectomies. Six carcinomas were found in contralateral breasts (4 DCIS and 2 infiltrating). CONCLUSIONS The double-team approach (plastic surgeons and oncologists) to BCT may improve the final cosmetic result following large tumor excisions. It can also extend the indications for breast preserving surgery. Moreover, it allows surgical and histological exploration of the contralateral breast when a surgical procedure for symmetry is required.
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Affiliation(s)
- Jean Yves Petit
- Department of Plastic Surgery, European Institute of Oncology, Milan, Italy.
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Garusi C, Calabrese L, Giugliano G, Mazzarol G, Podrecca S, Chiesa F, Fassati R. Mandible reconstruction and autogenous frozen bone graft: experimental study on rats. Microsurgery 2001; 21:131-4. [PMID: 11494378 DOI: 10.1002/micr.1024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/05/2022]
Abstract
The aim of this study was to evaluate the biological behaviour of a frozen bone graft in orthotopic and heterotopic sites in the rat. The previous experimental study on this subject was published 25 years ago without sufficient detail about the histology and comparison between the orthotopic and ectopic sites. Therefore, being very important for future clinical application, we decided to evaluate the frozen bone graft using rats. The procedure was performed on two groups of five rats each (Charles River). After wide dissection of the inferior border of the mandible from the surrounding muscle, an inferior segmental resection 4 mm in length was performed, taking care not to fracture the superior part and to maintain mucosal integrity. This segment was placed in liquid nitrogen for two periods of 10 minutes each with a third period to allow it to reach room temperature. In the first group (A), the frozen segment was placed ectopically in a gluteal muscle pocket, and in the second group (B), the frozen bone was fixed in the same position in the same mandible. After 1 month of follow-up, the animals were killed, the bone graft was removed, and histology was performed. Results were consistent in both groups. In group A, the segment was surrounded by strong inflammatory reaction, with no vital cells or bone cells, but some vascular penetration. We concluded that there was no bone deposition and no bone rehabitation. In group B, the initial segment was strongly fixed to the remaining mandible, there was an increase of the macroscopic dimension that paralleled the increase in the dimension of the remaining mandible and the growth of the animal. The cortical part had thinned down, the medullary part presented signs of bone deposition as well as bone resorption and vascular penetration. The periosteum from the adjacent normal mandible was growing and covering the frozen bone graft, offering additional stimulus to the bone deposition. In conclusion, the frozen bone graft acts as a normal bone graft. It needs to be placed in contact with vascularised bone and surrounded by well vascularised soft tissue to allow deposition of new bone. If the frozen graft is placed ectopically, it will be surrounded by chronic inflammatory reaction with no bone deposition.
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Affiliation(s)
- C Garusi
- Plastic Surgery Unit, European Istitute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Petit J, Rey P, De Lorenzi F, Rietjens M, Garusi C, Giraldo A, Gatti G, Luini A. Cosmetic and reconstructive surgery and risk of breast cancer. Breast 2001. [DOI: 10.1016/s0960-9776(16)30003-0] [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: 11/30/2022] Open
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Petit J, Rietjens M, Garusi C. Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks? Crit Rev Oncol Hematol 2001; 38:231-9. [PMID: 11369256 DOI: 10.1016/s1040-8428(00)00137-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [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: 02/06/2023] Open
Abstract
Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. The techniques available today, allow reconstruction of the breast even in almost all the cases even in poor local conditions. In 60-70% of the cases, the reconstruction can be performed with an implant inserted behind the pectoralis muscle. Special implants called expanders, are inflatable progressively in the postoperative course thanks to a reservoir located subcutaneously. They provide a progressive distention of the teguments and a more natural shape after substitution of the expander with a definitive implant. The symmetry is usually obtained thanks to a contralateral plastic surgery, which allows at the same time histological check up of the glandular tissue of the opposite breast. The nipple areolar complex is usually reconstructed in a second stage under local anesthesia, using local flaps for the nipple and a tattoo for the colour of the areola. In 30% of the cases, especially after radiotherapy when a salvage mastectomy is required, a flap reconstruction is preferred. The autologous tissue reconstruction with the rectus myocutaneous flap gives excellent cosmetic results and the most natural shape for the breast. But it is a more demanding technique requiring a good experience. In some occasions, the reconstruction with the latissimus flap can also be autologous but usually requires the addition of prosthesis. In most cases, the reconstruction can be performed immediately. The delayed reconstruction is usually preferred when the adjuvant chemotherapy should be delivered as soon as possible after the mastectomy. Complications of the reconstruction such as local necrosis or infections, leading to implant removal or revision of the flap could be detrimental to the patient in delaying the start of the chemotherapy. It is not recommended to reconstruct the breast immediately in case of locally advanced breast cancer. Partial breast reconstruction using plastic surgery procedures can also be performed in case of quadrantectomy in order to obtain a better cosmetic result. Local glandular flaps, as well as specific incisions according to the location of the tumor in the breast allow the reshaping of the breast even in case of large resection and, therefore, provide an opportunity to increase the number of conservative treatment indications, especially in case of in-situ carcinomas.
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Affiliation(s)
- J Petit
- European Institute of Oncology-EIO, Plastic and Reconstructive Surgery Unit, Via Ripamonti, 435, 20.141, Milan, Italy.
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Petit JY, Rietjens M, Garusi C, Greuze M, Perry C. Integration of plastic surgery in the course of breast-conserving surgery for cancer to improve cosmetic results and radicality of tumor excision. Recent Results Cancer Res 1999; 152:202-11. [PMID: 9928559 DOI: 10.1007/978-3-642-45769-2_19] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [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: 01/10/2023]
Abstract
Integration of plastic surgery is currently widely practiced in cases of mastectomy. Immediate breast reconstruction with an implant or autologous tissue procedures is frequently proposed to the patient before the mastectomy. However, breast conserving surgery (BCS) is recognized as the treatment of choice in most cancers: breast conservation is proposed in more than 70% of the patients with primary cancer treated at the European Institute of Oncology in Milan. This high percentage of preservation has been made possible by the integration of plastic surgery at the time of primary surgery. The size of the tumorectomy remains a matter of discussion. Based on the Milan II trial and Holland's pathological studies, Veronesi recommended so-called "local radical surgery." For a tumor 1 cm in size, a free margin of 2 cm produces a final specimen at least 5-6 cm in diameter. In small or medium-sized breasts, such a resection results in a wide glandular defect and poor esthetic results if direct closure is carried out. Plastic surgery derived from reduction mammaplasty procedures allows much better final cosmetic results, which is the goal of conservative treatment. In 25% of our patients treated with BCS, the plastic surgeon is called upon by the general surgeon to close the glandular defect. However, such glandular remodeling changes the size and position of the breast. Therefore, in 15% of these cases a symmetry procedure is performed on the opposite breast. The reduction procedure in the opposite breast should be taken as a good opportunity to check the glandular tissue. Special attention should therefore be given to the contralateral mammogram in order to focus the glandular resection on the most dubious areas. Occult carcinomas, half of them infiltrating, were found in 4% of a series of 350 symmetry procedures performed during breast reconstruction at the Gustave Roussy Cancer Institute. In conclusion, close collaboration between oncologists and plastic surgeons is required not only to obtain the best cosmetic results but also to allow improved radicality of the tumor resection and a histological check-up of the contralateral breast.
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Affiliation(s)
- J Y Petit
- European Institute of Oncology, Milan, Italy
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Garusi C, Petit JY, Rietjens M, Cassano E. Silicone granulomas: 30 years after injection of fluid silicone for breast and inner thigh augmentation – a possible case of human adjuvant disease improved after massive siliconomas removal. E J Plastic Surg 1998. [DOI: 10.1007/s002380050053] [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: 10/28/2022]
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Garusi C, Petit JY, Rietjens M, Lanfrey E. [Role of plastic surgery in the conservative treatment of breast cancer]. ANN CHIR PLAST ESTH 1997; 42:168-76. [PMID: 9768152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Conservative surgery (CS) is widely accepted today as the treatment of choice for 60 to 80% of the primary breast cancer. Esthetic results of CS are not good in all the cases and improvement can be obtained thanks to the remodelling of the breast after tumorectomy. The scar should be selected according to the location of the tumor; the glandular tissue should be reshaped using local glandular flaps or following the principles of the reduction mammaplasties. Tumorectomy located in the upper part of the gland can be reshaped with an inferior pedicle type of mammoplasty. Defect located in the inferior part of the gland can be reconstructed with a superior pedicle mammoplasty. These sophisticated tumorectomies are providing good esthetic results on the reconstructed breast but require commonly a symmetry procedure on the contralateral breast. Such contralateral reduction allows a better exploration of the opposite breast and histological examination of the reduction specimen. In a series of 76 CS performed at the European Institute of Oncology (IEO), which were associated with some kind of plastic procedure to lower the risk of bad cosmetic results (representing 25% of the CS associated with plastic surgery), we confirmed the value of the mixed oncologic and plastic approach. The esthetic results observed in this series are better than those observed in another series previously published at the Gustave-Roussy Institute (IGR)--good results: 72% (IEO) vs 50% (IGR), and bad results: 6% (IEO) vs 20% (IGR). Statistically such comparison can be criticised, specially because of the short follow-up of the Milan series. However, the difference is rather important if we consider that the series of Milan was a selection of cases with poor esthetic expectation (25% of all the CS performed during the same period), while the series of Paris did not select the patients in what concerns the risk of poor esthetic result.
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Affiliation(s)
- C Garusi
- European Institute of Oncology, Milan, Italie
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Rietjens M, Garusi C, Lanfrey E, Petit JY. [Cutaneous suspension: immediate breast reconstruction with abdominal cutaneous advancement using a non-resorptive mesh. Preliminary results and report of 28 cases]. ANN CHIR PLAST ESTH 1997; 42:177-82. [PMID: 9768153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The immediate breast reconstruction with a definitive prosthesis (IBRDP) is the most useful technique in our experience. We proposed a technique to allow the use of IBRDP also in cases of mastectomy with large skin excision and also to permit a better definition of the inframammary fold. The prosthesis pocket is prepared as usually with the pectoralis major and serratus anterior muscles and then, a skin flap is undermined about 6-8 cm below the inframammary fold to prepare an upper abdominal skin flap. The innovation point is the use of a triangular non absorbable mersilene mesh to pull up and maintain the flap. The mesh is initially sutured at the future inframammary fold projection 4 to 6 cm lower than the previous inframammary fold and sutured under tension to the third and fourth costal cartilages. The prosthesis is located in front of the mesh and behind the muscles. Twenty nine patients had a mastectomy with IBRDP with the "Cskin suspension" technique at European Institute if Oncology (IEO) from june 1995 to september 1996. Only one case (3.4%) had a prosthesis loss 3 months after the surgery, probably by a prosthetic material rejection. This technique permits an IBRDF for the patients with a good abdominal skin laxity and also avoids the use of a more complicate or a more expensive technique (myocutaneous flaps or skin expanders). The small post-operative complications rate must be confirmed by a larger follow-up to evaluate the capsular contracture rates and the final cosmetic results.
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Affiliation(s)
- M Rietjens
- Unità di Chirurgia Plastica Ricostruttiva, Istituto Europeo di Oncologia, Milano, Italia
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Lanfrey E, Rietjens M, Garusi C, Petit JY. [Mammoplasty for symmetry of the contralateral breast and its oncologic value]. ANN CHIR PLAST ESTH 1997; 42:160-7. [PMID: 9768151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Controlateral occult carcinomas are observed in 3 to 5% of the reduction mammaplasty of the controlateral breast at the time of the breast reconstruction. The symmetry procedure allows a good check up of the glandular tissue of the controlateral breast, especially when there is no evidence of tumor. The different techniques of breast reduction provide specific possibilities for such exploration and should be chosen according to the area which should be explored. The superior pedicle technique gives us the best exposure and an easier modelling. It gives a good aesthetic results in 80% of cases. The central pedicle and dermoglandular pedicle technique give a good exposure and permits us to fill the defect with glandular flap. The drawback of the inferior pedicle technique is the lack of control of the central and inferior quadrant.
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Affiliation(s)
- E Lanfrey
- Unità di Chirurgia Plastica Ricostruttiva, Istituto Europeo di Oncologia (IEO), Milano, Italia
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Petit JY, Rietjens M, Garusi C, Capko D. Primary and secondary breast reconstruction with special emphasis on the use of prostheses. Recent Results Cancer Res 1996; 140:169-75. [PMID: 8787059 DOI: 10.1007/978-3-642-79278-6_19] [Citation(s) in RCA: 3] [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] [Indexed: 02/02/2023]
Affiliation(s)
- J Y Petit
- European Institute of Oncology, Milan, Italy
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