Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review’s scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies

Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review

Nanotechnology, the art of engineering structures on a molecular level, offers the opportunity to implement new strategies for the diagnosis and management of pregnancy-related disorders. This review aims to summarize the current state of nanotechnology in obstetrics and cancer in pregnancy, focusing on existing and potential applications, and provides insights on safety and future directions. A systematic and comprehensive literature assessment was performed, querying the following databases: PubMed/Medline, Scopus, and Endbase. The databases were searched from their inception to 22 March 2022. Five independent reviewers screened the items and extracted those which were more pertinent within the scope of this review. Although nanotechnology has been on the bench for many years, most of the studies in obstetrics are preclinical. Ongoing research spans from the development of diagnostic tools, including optimized strategies to selectively confine contrast agents in the maternal bloodstream and approaches to improve diagnostics tests to be used in obstetrics, to the synthesis of innovative delivery nanosystems for therapeutic interventions. Using nanotechnology to achieve spatial and temporal control over the delivery of therapeutic agents (e.g., commonly used drugs, more recently defined formulations, or gene therapy-based approaches) offers significant advantages, including the possibility to target specific cells/tissues of interest (e.g., the maternal bloodstream, uterus wall, or fetal compartment). This characteristic of nanotechnology-driven therapy reduces side effects and the amount of therapeutic agent used. However, nanotoxicology appears to be a significant obstacle to adopting these technologies in clinical therapeutic praxis. Further research is needed in order to improve these techniques, as they have tremendous potential to improve the accuracy of the tests applied in clinical praxis. This review showed the increasing interest in nanotechnology applications in obstetrics disorders and pregnancy-related pathologies to improve the diagnostic algorithms, monitor pregnancy-related diseases, and implement new treatment strategies

Incidence and Risk Factors for Venous Thromboembolism in Female Patients Undergoing Breast Surgery

Albeit it does not have the highest venous thromboembolism (VTE) incidence compared to other neoplasms, breast cancer contributes to many VTE events because it is the most diagnosed tumor in women. We aim to analyze the occurrence and timing of VTE during the follow-up of patients who underwent breast surgery, the possible correlated factors, and the overall survival. This retrospective study included all female patients diagnosed with mammary pathology and surgically treated in our clinic between January 2002 and January 2012. Of 5039 women who underwent breast surgery, 1056 were found to have no evidence of malignancy, whereas 3983 were diagnosed with breast cancer. VTE rate resulted significantly higher in patients with invasive breast cancer than in women with benign breast disease or carcinoma in situ. Invasive cancers other than lobular or ductal were associated with a higher VTE rate. In addition, chronic hypertension, high BMI, cancer type, and evidence of metastasis turned out to be the most significant risk factors for VTE in women who underwent breast surgery. Moreover, VTE occurrence significantly impacted survival in invasive breast cancer patients. Compared to women with benign mammary pathology, VTE prevalence in women with breast cancer is significantly higher. The knowledge about the risk factors of VTE could be helpful as prognostic information, but also to eventually target preventive treatment strategies for VTE, as far as the co-existence of invasive breast cancer and VTE has a significantly negative impact on survival

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Objective: Breast-conserving surgery (BCS) experienced a significant surge during the last decades due to the increase of early breast cancer detection. Central to the discussion is margin adequacy which represents one of the most significant predictive factors for local relapse. This paper aims to shed light on the problem of margins in breast surgery. Mechanism: We performed a systematic narrative review of the literature by conducting a search using Medline/PubMed, Scopus, and Embase. The following keywords were considered: "breast-conserving surgery"AND "margins"/"margin". Findings in Brief: In the case of invasive breast cancer, "no ink on tumor"can be considered an adequate margin, while for ductal carcinoma in situ (DCIS), a distance of 2 mm from tumor should be obtained. Many novel tools have been developed based both on the latest radiological imaging techniques and on the tissue expression of certain markers, with the aim of precise navigation of tumor excision and intraoperative evaluation of cavity excision margins. Oncoplastic surgery can be considered oncologically safe while improving the cosmetic outcome and patients' quality of life. The appropriate use of adjuvant treatments in the context of a multidisciplinary and personalized management of breast cancer is the only means to omit a second intervention in some carefully selected cases. Conclusions: Debate still exists concerning the definition of adequate clear margin following BCS for DCIS. Further studies are required to better assess multimodal treatment approaches in this condition

Reduction Mammaplasty as a Treatment Option for Early Breast Cancer

Background: Although reduction mammaplasty is a well-known technique for cosmetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. Mammaplasty combined with breast conservation surgery is an effective treatment of early breast cancer, and leads to better overall results and superior quality of life in patients with previous macromastia or ptosis. Our aim is to analyze both the aesthetic and oncologic outcome of reduction mammaplasty combined with conservative breast surgery reconstruction. Patient and Methods: 25 patients with stage 1 or 2 breast cancer, with a tumor size not more than 3 cmin its greatest dimension, were operated upon by quadrantectomy, and bilateral reduction mammaplasty. Oncologic data on tumor size, location, and axillary lymph node, were assessed, and accordingly the design of the pedicle was chosen. Reconstructed breast and opposite breast reduction were evaluated. Results: Of the total 50 breast reductions techniques, 35 (70 percent) were superomedial pedicle, 4 (8 percent) were superior, 3 (6 percent) were superolateral, and 8 (16 percent) were inferior. The cosmetic result was considered to be good or very good in 18 cases, satisfactory in 6 cases, and poor in 1 case. There were no other complications as regard nipple areola ischemia, heamatoma, seroma, wound problems, fat necrosis, or recurrence in any of the cases. Conclusion: By adding breast reduction and other plastic surgery techniques to breast conservation, patients have the opportunity for an improved cosmetic outcome and overall improved quality of life. Although the combined approach between the oncologic surgeon and the plastic surgeon requires more preoperative planning and intraoperative care, the concept can reduce deformities, favor the oncologic treatment, and optimize the aesthetic outcome in most early-stage cancer patients

La chirurgia oncoplastica: l\u2019esperienza della scuola universitaria udinese

I benefici emozionali e psicologici della chirurgia conservativa mammaria sono stati ampiamente dimostrati: il successo della chirurgia conservativa mammaria \ue8 basato sull\u2019intento di garantire una completa escissione del tumore preservando la forma naturale della mammella. I dati di Letteratura riportano un tasso del 20-30% di risultati estetici scarsi e deformit\ue0 della mammella trattata in caso di BCS. Per fronteggiare tali problematiche \ue8 emerso negli anni il concetto di chirurgia oncoplastica come nuovo approccio per permettere grandi escissioni senza compromettere la naturale forma ed il contorno della ghiandola: l\u2019applicazione di tecniche ricostruttive avanzate amplia le indicazioni alla chirurgia mammaria conservativa migliorandone i risultati estetici. MATERIALI E METODI e RISULTATI Le principali opzioni ricostruttive proposte nel corso degli anni vedono l\u2019utilizzo di lembi locali, lembi a distanza e tecniche di mastoplastica riduttiva. Gli Autori, nell\u2019ambito di un approccio integrato alla patologia mammaria, presentano la casistica interna all\u2019Istituto, dal novembre 2005 al dicembre 2010, in maniera sistematica, analizzando benefici e complicanze delle principali tecniche utilizzate in base alle loro indicazioni di applicazione. CONCLUSIONI Le indicazioni variano in relazione all\u2019entit\ue0 della resezione correlata al volume mammario iniziale ed alla localizzazione del tumore. Per tale motivo, le tecniche applicabili sono numerose e non vi \ue8 concordanza tra i vari Autori sulle migliori tecniche da utilizzare e sullo sviluppo di un algoritmo comune. Nella nostra esperienza il tasso di deformit\ue0 \ue8 risultato inferiore alla percentuale riportata in Letteratura in tutti i modelli ricostruttivi. Il tasso di complicanze a breve e lungo termine si mantiene in linea con i dati della comunit\ue0 scientifica. Riteniamo che sia da incentivare l\u2019utilizzo di tecniche di chirurgia oncoplastica come valido approccio ricostruttivo dopo chirurgia mammaria conservativa