update on one stage immediate breast reconstruction with definitive prosthesis after sparing mastectomies

Abstract Immediate breast reconstruction after skin and nipple-sparing mastectomies is commonly performed as a two-stage procedure; to overcome the paradox of traditional two-stage tissue expander/implant reconstruction used to create a tight muscular pocket that needs expansion to produce lower pole fullness, while losing the laxity of the mastectomy skin flaps, the authors conceived a subpectoral-subfascial pocket by elevating the major pectoral muscle in continuity with the superficial pectoralis fascia up to the inframammary fold. This alteration allowed for the immediate insertion of the definitive implant. The authors present their experience in 220 cases of immediate one-stage breast reconstructions with definitive prostheses in sparing mastectomies. Immediate and long-term local complications were evaluated. Immediate breast reconstruction with definitive anatomical silicone-filled implants can produce excellent cosmetic results (78.6%) with a low rate of complications (17.7%); these results allow for agreement between oncologic, aesthetic and economic purposes

Mastectomy with immediate breast reconstruction during "phase 1" COVID-19 emergency: An Italian experience.

n/

Primary systemic treatment and concomitant low dose radiotherapy for breast cancer: final results of a prospective phase II study.

Abstract Background To evaluate the efficacy of preoperative low dose fractionated radiotherapy (LD-FRT) and chemotherapy in breast cancer. Materials and methods Patients with stage IIA–IIIA breast cancer, received LD-FRT (0.40 Gy bid, on day 1 and 2, for 6 cycles) to primary tumor volume and concurrent chemotherapy with non-pegylated liposomal anthracycline and docetaxel. Pathological response was assessed by Mandard Tumor Regression Grade (TRG). We evaluated the pathological major response rate (PMRR) as TRG1 and TRG2. The expected outcome was a PMRR of 60%. The accrual was determined by the single proportion powered analysis ( α = 0.05, power = 0.8). Results Twentyone patients were enrolled. No grade 2–4 acute skin and hematological toxicity was observed. TRG1 was obtained in 3 patients (14.3%), TRG2 in 4 patients (19%). The PMRR was 33.3%; it does not concur with the expected result, but is similar to that of chemotherapy alone. According to molecular subtype, 2/11 luminal A patients and 4/6 luminal B patients obtained a PMRR to preoperative treatment (35.3%); 1/4 basal like patients reported TRG1 (25%). Conclusions LD-FRT concomitant with primary systemic treatment has a good toxicity profile. The response rate is consistent with that of chemotherapy alone, and suggests different interactions between low dose radiotherapy and molecular subtypes. Additional investigations are planned

olympiad trial moving to a next level of treatment for patients with brca mutation and her2 negative metastatic breast cancer

n/

Management of BRCA mutation carriers

Pathogenic mutations in two autosomal dominant genes, BRCA1 and BRCA2 , with high penetrance are supposed to be the cause for an approximated 5–7% risk of all breast cancer (BC) and ovarian cancer (OC). Compared to sporadic BC, BRCA mutated ( BRCAmut ) BC differs for lifetime risk of onset and sensitivity to systemic therapies. A hereditary BC syndrome should be taken into account when there are numerous relatives with BC early-onset (typically before menopause). Moreover, BRCAmut carriers showed a lifetime possibility of manifesting OC. When a BC diagnosis is made in young patients or in suspicious personal relatives' anamnesis, be aware of being carriers of a BRCA mutation may influence the decision making-process about surgical procedure and prevention strategies. In this review, we examined surgical treatment choice for BRCAmut BC, risk of ipsilateral breast recurrence (IBR) and contralateral breast cancer (CBC). We examined the role of breast-conserving therapy (BCT), risk-reducing mastectomy (RRM) and preventive risk-reducing salpingo-oophorectomy (RRSO) with a special consideration about advantage in terms of mortality reduction for both conservative and prophylactic measures. We also reviewed the sensitivity of mutated BC to platinum-based antineoplastic drugs and poly (ADP-ribose) polymerase inhibitors (PARPi) by emphasizing the results of clinical trials recently published

Early onset lactating adenoma and the role of breast MRI: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lactating adenoma is a benign condition, representing the most prevalent breast lesion in pregnant women and during puerperium; in this paper, a case of a woman with lactating adenoma occurring during the first trimester of pregnancy is reported. There have been no reports in the literature, according to our search, focusing on magnetic resonance imaging findings in cases of lactating adenomas. Also the early onset of the lesion during the first trimester of pregnancy is quite unusual and possibly unique.</p> <p>Case presentation</p> <p>We report the case of a primiparous 30-year-old Caucasian woman, who noted an asymptomatic lump within her left breast during the 9^thweek of gestation, slightly increasing in size over the next few weeks. Ultrasound demonstrated a hypoecoic solid mass, hypervascularized and measuring 4 cm. On magnetic resonance imaging, performed in the first month after delivery, the lesion appeared as an ovoidal homogeneous mass, with regular margins and a significant contrast enhancement indicative of a giant adenoma.</p> <p>Conclusion</p> <p>Magnetic resonance imaging could play an important role in the differential diagnosis of pregnancy-related breast lumps, particularly during puerperium, thus avoiding unnecessary surgical biopsies.</p

MACROECOLOGIA, BIOGEOGRAFIA E ÁREAS PRIORITÁRIAS PARA CONSERVAÇÃO NO CERRADO

revista vol 13 nº 3.indd Há consenso entre os cientistas de que a há atualmente uma “crise da biodiversidade”, resultado da constante e intensa perda de habitat natural causada pela expansão da ocupação. Como a biologia da conservação tem sido muitas vezes reconhecida como uma ciência da crise, ela deve fornecer informações capazes de mediar, de forma mais científica possível, as tomadas de decisão que são necessárias. Dentre estas, uma das mais importantes é indicar regiões prioritárias para a conservação, já que por motivos óbvios não é possível preservar todos os ecossistemas por inteiro. Nesse contexto, recentemente sugeriu-se que a aplicação de princípios, teorias e análises provenientes da biogeografia e da macroecologia seriam importantes na Biologia da Conservação, formalizando uma abordagem que tem sido denominada “Biogeografia da Conservação”. Assim, o objetivo deste artigo é discutir e revisar esses componentes da biogeografia da conservação, utilizando uma abordagem macroecológica para desenvolver e aplicar métodos de planejamento sistemático em conservação, utilizando o bioma Cerrado como um modelo de estudo. Foram discutidos inicialmente os padrões de riqueza e diversidade beta e, em um segundo momento, como esses padrões podem ser correlacionados à ocupação humana do Bioma. Essa relação é fundamental para subsidiar a aplicação de modelos de planejamento sistemático de conservação em escala regional (análises de insubstituibilidade, complementaridade e de lacunas). É preciso considerar também que há sérias falhas de conhecimento sobre os padrões de biodiversidade na região e que a escolha de grupos indicadores pode ser importante para minimizar problemas gerados pela falta de conhecimento. Assim, essa abordagem é interessante em um cenário de grandes incertezas (ausência de dados detalhados) e de rápida transformação da paisagem, possibilitando a otimização de estudos em grandes escalas e depois transferir os resultados para escalas espaciais mais locais e realmente relevantes para a conservação. Nessas regiões, podem ser realizados, em um segundo momento, estudos mais detalhados a fim de avaliar padrões de viabilidade populacional, fragmentação de habitat e regiões potenciais de manutenção da diversidade genética

Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience

: Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC

Impact on survival of primary tumor resection in patients with metastatic breast cancer: preliminary results of a retrospective analisys

Background: Treatment of de novo metastatic breast cancer is usually centered around systemic therapy, with local therapy (surgery and radiation therapy) largely reserved for palliation in patients with significant symptoms from primary tumour. The efficacy of locoregional treatment like surgery and/or radiotherapy is still controversial and the debate about surgical resection of primary tumor (PT) in de novo metastatic breast cancer (MBC) patients persists. Methods: All patients with de novo MBC undergone surgical treatment between January 2015 and January 2020 at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome were included in this study. The primary endpoint was overall survival (OS) after PT resection, the secondary endpoint was progression free survival (PFS). The survival analyses were done using Kaplan-Meier method. Patients and tumour characteristics were analyzed in an exploratory modality in order to identify prognostic factor. Results: 45 patients received resection of the primary breast cancer (26 mastectomy and 19 breast conserving surgery). Median age of diagnosis was 53 years old (range 25-75 years old). Median follow-up was 25.67 months. The median OS was not reached with 75% of patients alive over 2 years from PT resection. The median PFS was not reached with 64% of patients alive over 2 years from PT resection. For both PFS and OS only the triple negative (TN) immunophenotype appears to be a prognostically unfavorable factor in multivariate analysis. Conclusions: In view of the low number of disease progression events and deaths, although our results are preliminary, surgical treatment of primary breast cancer in metastatic setting seems to be an option after systemic therapies in luminal and HER2 positive breast cancer. Randomized prospective trials in for each immunophenotype are necessary order to confirm this evidence

Ancient Appia Landscapes: paesaggi antichi e risorse attuali. Alcuni casi di studio dal territorio di Beneventum

Ancient Appia Landscapes: ancient landscapes, present resources. This paper discusses briefly some reflections related to the "Ancient Appia Landscapes" Archaeological project, carried out by the University of Salerno, in collaboration with the Soprintendenza Archeologia, Belle Arti e Paesaggio per le province di Caserta e Benevento. The project aims at the reconstruction of the Benevento territory in its anthropic and environmental elements, from a historical and archaeological point of view. The identification of ancient relics of the landscape has been made through the use of cartography in the broadest sense of the word, from the most recent supports to the historical cartography, geophysical surveys, geomorphological and archaeological maps. Cartography is therefore intended as a means of representing a reality structured on multiple time scales, readable through a regressive approach which is able to seize the stratification of anthropic and environmental processes. The idea is that the identification of ancient agrarian assets through surface surveys and cartographic analysis can highlight historical and cultural values of landscapes, translating them into a resource for the community. In this sense, the ancient Via Appia between Beneventum and Aeclanum represents the leitmotiv of a highly conservative landscape. The reconstruction of this ancient path could become particularly relevant in light of recent approaches to the enhancement of historical roads, which have been recognized as fundamental elements in the structuring of communities and territorial dynamics over time. The Via Appia could become a cultural resource with which it is possible to recover, develop and enhance vocations, geographical and productive specificities, aiming at planning in agreement with local authorities and communities. In this way, an open approach to the integration of territorial resources can transform cultural heritage in a catalyst for a socio-economic sustainable development