Nipple Reconstruction Using the “Arrow Flap” Technique: Outcomes and Patients Satisfaction

Introduction: Skin-sparing mastectomy (SSM) entails complete removal of the breast tissue and the nipple and areola complex (NAC) with preservation of as much of the overlying skin as possible. The preservation of the natural skin envelope during SSM improves the aesthetic outcome of immediate breast reconstruction, but the lack of NAC determines that the reconstructed breast remains anatomically incomplete with not always satisfactory final results. For this purpose, the aim of the present study was to investigate and evaluate the impact of nipple reconstruction after skin sparing and skin reducing mastectomy on the patients' perception and intimate life. Materials and method: This was a comparative single-center prospective study that involved 42 patients underwent NAC reconstruction after SSM. A pre- and postoperative quality-of-life and psychological questionnaires Breast-Q questionnaire (Breast Conserving therapy module) were given to all the patients before the surgery and 6 months after. The statistical analysis with chi-square test was performed. Results: After 6 months a prevalence of patients reported to be very satisfied in regard to shape, appearance, naturalness, projection, position and symmetry. The study shows an overall improvement in all the psychological items analyzed with statistically significant difference regarding: "patient's satisfaction," "self-confidence," "appearance of the breast." Conclusion: The authors believe that the NAC reconstruction has useful functional and aesthetic results particularly appreciated by patients who feel demoralized after breast demolition surgery

Training di microchirurgia: valutazione degli effetti in chirurgia robotica

La microchirurgia oggigiorno trova applicazione in molti campi della medicina, tra cui la chirurgia plastica, l’oftalmologia, la chirurgia ortopedica e la chirurgia generale. Lo sviluppo delle tecniche microchirurgiche ha reso possibile l’esecuzione di: trasferimento di tessuti liberi, reimpianti e trapianti. In Italia, per approcciarsi al mondo della microchirurgia esistono dei corsi standardizzati dalla Società Italiana di Microchirurgia (S.I.M.): il corso base e il corso avanzato. Lo scopo di questo lavoro di tesi è di dimostrare come le abilità acquisite durante il corso base di microchirurgia portino ad avere delle prestazioni migliori in chirurgia robotica, usando come test valutativi due esercizi svolti sul DaVinci Skills Simulator (dVSS, Intuitive Surgical), e di mettere in evidenza quanto i movimenti nello spazio di lavoro, la postura, la posizione delle braccia e il lavoro con i polsi siano molto simili tra le due tecniche