Oncoplastic Breast Surgery

:  Oncoplastic surgery is an establish approach that combines conserving treatment for breast cancer and plastic surgery techniques. It allows wide excisions and prevents breast deformities by immediate reconstruction of large resection defects. The procedures are mostly useful for resection of 20–40% of the breast – a group of patients normally treated by mastectomy in the past. Four features are integral to oncoplastic breast surgery: (i) Appropriate surgery for cancer excision. (ii) Partial reconstruction to correct wide excision defects. (iii) Immediate reconstruction with the full range of available techniques. (iv) Correction of volume and shape asymmetries relative to the contra-lateral healthy breast. There are two fundamentally different approaches: (i) volume-replacement procedures, which combine resection with immediate reconstruction by using local flaps (glandular, fasciocutaneous, and latissimus dorsi mini-flaps), and (ii) volume-displacement procedures, which combine resection with a variety of different breast reduction and reshaping techniques, according to the location of the tumor. Oncoplastic surgery increases the oncological safety of breast-conserving treatment because a much larger breast volume can be excised and wider surgical margins can be achieved. Moreover, a "surgical screening" of the contra-lateral breast allows the diagnosis of occult cancers. Among oncoplastic approaches, a very unique technique is the possibility of implant use (augmentation mammaplasty) in case of quadrantectomy and simultaneous delivery of intraoperative radiotherapy to the tumor bed

An efficient method for the correction of iatrogenic symmastia: A case series

Background: Symmastia is a medial confluence of the breasts, produced by a web of skin and fat merged across the midline, that generates the disappearance of the intermammary sulcus. Apart from the rare congenital cases, this condition is usually a result of technical complications during breast augmentation surgery.This article describes a simple and reliable method for correcting symmastia. Methods: From November 2006 to June 2015, we treated 10 patients with acquired symmastia who had previously undergone an implant-based reconstruction. We performed a crescent-shape medial capsulectomy and we then performed an adequate and resistant closure with a substitute device, consisting of a Tuohy epidural needle and polydioxanone sutures, which are easily accessible and inexpensive. The process outcome was successful and resulted in a normal cleavage between the breasts. Results: Mean follow-up was 24 months. We haven't observed any recurrence of symmastia to date in this study. One postoperative hematoma and one seroma occurred. All ten patients achieved acceptable results through the procedure. Conclusion: Our pericapsular Tuohy technique for medial closure of the pocket is a practical and efficient substitute to traditional capsulorraphy and provides reliable and reproducible results. Keywords: Symmastia, Synmastia, Implant malplacements, Capsulorrhaphy, Breast augmentation, Tuohy needl

Diurnal variations of transpiration in a vineyard at different soil water availability

Abstract: The water consumption of grapevines is one of the main factors influencing grape quality. Vineyards are discontinuous, heterogeneous canopies and they are often grown in stony soils, small fields and sloping grounds. Plant-based methods for measuring transpiration can therefore be suitable to the large range of vine-growing conditions. In this paper transpiration of vine-branches at decreasing soil moisture availability is analysed in relation to microclimate and plant vigour. A procedure is suggested to calculate transpiration of the whole plot by scaling up from sap flow measurements in a sample of vine-branches by using plant leaf area. Transpiration was monitored through sap flow measurements in an irrigated table grape vineyard, trained by the overhead system ("Tendone"), in Southern Italy, in July 1998 for six days in the interval between two irrigations. Stem heat balance gauges were installed on vine-branches of seven plants, and sap flow of one shoot per plant was measured. Leaf area supported by the shoot above the gauge was measured and plant vigour was estimated through the length and number of branches; leaf area of a sample of four vines was estimated. At decreasing soil water availability sap flow rate decreased and modified its daily pattern, anticipating the peak of maximum rate. Both the reduction of sap flow rate and the shift of the peak were related to plant vigour. The scaling up procedure, based on plant leaf area and flow rates per unit leaf area, gave reasonable estimates of plant transpiration

Lupus mastitis in male mimicking a breast lump

A 43-year-old male, with a 3-month history of a left breast lump underwent clinical evaluation in our Institute. This solid and irregular mass measured 2 2 cm and was located at the upper lateral quadrant with no skin changes. There were no inflammatory signs. However, a lymphadenopathy was presented with a mobile ipsilateral axillary node 1.5 cm in diameter. Computerized tomography demonstrated a hyperplastic lateral cervical lymph nodes reactio

immediate breast reconstruction with prostheses after conservative treatment plus intraoperative radiotherapy long term esthetic and oncological outcomes

Abstract Electron intraoperative radiotherapy (ELIOT) has been introduced for breast conservative treatment (BCT) with promising oncological outcome. Thus, immediate breast reconstruction with prosthesis after BCT became possible due to minimal radiation effect on local tissue from ELIOT. We reported oncological and esthetical results of 29 BCT patients who had immediate implant reconstruction plus 21 Gy-ELIOT as the sole radiation treatment. All patients had prosthesis in ipsilateral breast and had simultaneous contralateral augmentation for symmetrical procedure. The average age was 52.3 years. There were stage Ia thirteen cases, stage Ib seven cases, stage IIa six cases and stage IIIb one case and two cases of intraepithelial neoplasia. From 54.2 (36–88) months follow up, the capsular contracture grading in the reconstructed breast from ELIOT-side is comparable with non-irradiated contralateral side. There was one patient who developed local recurrence (LR) and later on dead with breast related event (LR = 0.76% per year). There was no primary ipsilateral carcinomas and distant metastasis

The value of latissimus dorsi flap with implant reconstruction for total mastectomy after conservative breast cancer surgery recurrence

The presence of previous RT following breast cancer conservative treatment and actual recurrence does not contraindicate breast reconstruction with implant. The use of latissimus dorsi flap together with breast implant provides a large muscle cover to the implant and ideally a low capsular contraction rate. The authors describe a large study in order to have a long follow-up in this group of patients demonstrating the very low capsular contraction rate despite the previous RT

PRENYLATED CURCUMIN ANALOGUES AS MULTIPOTENT TOOLS TO TACKLE ALZHEIMER'S DISEASE

Alzheimer's disease is likely to be caused by copathogenic factors including aggregation of A\u3b2 peptides into oligomers and fibrils, neuroinflammation and oxidative stress. To date, no effective treatments are available and because of the multifactorial nature of the disease, it emerges the need to act on different and simultaneous fronts. Despite the multiple biological activities ascribed to curcumin as neuroprotector, its poor bioavailability and toxicity limit the success in clinical outcomes. To tackle Alzheimer's disease on these aspects, the curcumin template was suitably modified and a small set of analogues was attained. In particular, derivative 1 turned out to be less toxic than curcumin. As evidenced by capillary electrophoresis and transmission electron microscopy studies, 1 proved to inhibit the formation of large toxic A\u3b2 oligomers, by shifting the equilibrium towards smaller non-toxic assemblies and to limit the formation of insoluble fibrils. These findings were supported by molecular docking and steered molecular dynamics simulations which confirmed the superior capacity of 1 to bind A\u3b2 structures of different complexity. Remarkably, 1 also showed in vitro anti-inflammatory and anti-oxidant properties. In summary, the curcumin-based analogue 1 emerged as multipotent compound worth to be further investigated and exploited in the Alzheimer's disease multi-target context

immediate breast reconstruction after mastectomy

Summary Aims There is a general agreement for immediate breast reconstruction in case of in situ tumors, while the reconstruction is often still delayed in cases of invasive cancers or not performed in the elderly cohort. Aim of this review is to investigate the safety of immediate postmastectomy reconstruction for invasive cancers and in the elderly population. Methods and results We reviewed our series and the recent literature on this topic. While there is a general consensus that advanced age is not a contraindication to immediate reconstruction and breast reconstruction can be successfully performed on well-selected elderly patients, many oncologists in Europe do not prefer immediate reconstruction for invasive carcinoma, advocating the risk of delay of the medical adjuvant treatment in case of complications due to the reconstructive procedure. Our experience and a lot of studies suggest that immediate breast reconstruction is a safe and reliable treatment option in case of invasive cancers. However, if postmastectomy irradiation is necessary on the basis of the final pathological finding, this is associated with a high rate of surgical complications and implant loss among patients who underwent immediate reconstruction with prostheses. Moreover, current evidence suggests that postmastectomy radiation therapy also adversely affects autologous tissue reconstruction. Conclusions Immediate breast reconstruction after mastectomy is an integral part of the complete management of breast cancer. Determining the risk of postmastectomy irradiation prior to definitive resection and reconstructive operations may reduce complications and improve aesthetic outcomes by guiding surgical decision making

Erratum to: Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis

n/

HtrA1 in differentiation and growth of human placental tissues

HtrA1 is a secreted multidomain protein with serine protease activity. We used immunohistochemistry, western blotting, real time PCR and ELISA techniques to analyse the role of HtrA1 in normal and pathological development of human placental villous trees. In addition, we evaluated the alterations of maternal plasma HtrA1 level in preeclampsia (PE) complicated by intrauterine growth restriction (IUGR). HtrA1 is expressed in the mesenchymal villi which are considered the basis of growth and differentiation of the villous trees and in the villous stroma directly opposed to cell islands and cell columns in first trimester placentas. In addition, the villous trophoblast, the syncytial knots and the foetal vessels are stained for HtrA1 in first as well as third trimester placentas [1]. When the placenta escapes the normal differentiation and growth control mechanisms, which are present during normal pregnancy, it may develop gestational diseases, such as trophoblastic disease as well as PE and IUGR [1,2]. The most striking finding of our investigation is the decrease of this protease in placental tissues with increasing severity of gestational diseases and the increase of HtrA1 in maternal plasma of PE complicated by IUGR [3]. Based on these data HtrA1 could be considered as a possible marker of an occurring IUGR in preeclamptic women