Nipple sparing mastectomy with immediate breast reconstruction: a short term analysis of our experience.

Breast cancer surgery has greatly changed over the past decades; nowadays skin-sparing mastectomy (SSM) and immediate reconstruction is considered a valid oncological option to achieve good aesthetic results. The success of SSM led to several studies aimed to investigate NAC involvement whose removal increases the patient's sense of mutilation. In this study the Authors investigate the incidence of recurrences in nipple sparing mastectomy (NSM) comparing it with the other techniques to assess the actual risk of tumor involvement of the NAC; besides, they analyse the patients' satisfaction and the NSM impact on quality of life through the utilization of a questionnaire. Clinical complications, aesthetic as well as oncological and psychological results have been analysed. They conclude that in selected cases NSM can be performed without additional risks because the incidence of recurrence after NSM is similar to that of radical mastectomy. Moreover, the aesthetic and psychological outcome are considered positive by the patients.

Incidence of chromosomes 1 and 17 aneusomy in breast cancer and adjacent tissue: an interphase cytogenetic study.

BACKGROUND: Characterization of the biopathologic events underlying the early steps of breast carcinogenesis may have a dramatic impact on reducing breast cancer mortality. Genes involved in breast tumorigenesis are localized on chromosomes 1 and 17, and numeric aberrations of these chromosomes have been correlated with breast cancer tumorigenesis and progression. According to the field cancerization hypothesis, specific chromosome aberrations may be present in breast cancer and in normal-appearing adjacent tissue. The latter changes reflect the genomic damage that follows longterm carcinogenic exposure and precede the morphologically detectable neoplastic transformation. We hypothesize that detection of these aberrations in benign breast epithelium may provide a tool for molecular risk assessment. STUDY DESIGN: Using fluorescence in situ hybridization with centromere-specific probes, we determined the status of chromosomes 1 and 17 in fresh imprints of 28 samples of primary tumors and 54 samples of their surrounding uninvolved parenchyma taken from patients undergoing operations for breast carcinoma. Ten contralateral breast biopsy specimens collected from patients with previous breast carcinoma were also evaluated as a surrogate of a high-risk group to rule out the hypothesis that chromosomal aneusomy in tumor-adjacent tissue could be related to a paracrine effect of the primary tumor. Ten samples of benign breast tissue taken from patients at low risk were used as controls to define tolerance limits for aneusomy definition. RESULTS: Using threshold values of 40% of signal loss and 13% of signal gain to define chromosome aneusomy (ie, mean + 3 SDs of the control group signals), we found the following: 1) almost all primary breast tumors were aneusomic for chromosomes 1 and 17; 2) primary breast tumor and adjacent uninvolved parenchyma shared the same pattern of chromosomes 1 and 17 aneusomy in 66.7% of patients; and 3) chromosomes 1 and 17 aneusomies in contralateral benign breast samples from high-risk patients were not different from those in primary breast tumor or adjacent tissue samples. CONCLUSIONS: These results suggest that chromosomes 1 and 17 aneusomy may represent an intermediate biomarker of breast tumorigenesis potentially useful to detect patients at high risk of breast carcinoma who may benefit from preventive interventions.

Age as a risk factor in cervicofacial reconstruction.

The Authors report their experience from January 1980 to January 1998 with 392 reconstructive flaps for the oncological reconstruction of the cervicofacial district. One hundred and forty-two were conventional flaps, 187 were myocutaneous or pedicled muscular ones and 63 were microvascular. Ninety percent of the patients had Stage IV disease, 80% were tumors involving the oral cavity structures, 40% of the patients had received preoperative radiotherapy; 35% of the cases were recurrences. The complications related to the surgery were evaluated for each type of flap, comparing them to the same flaps employed in patients > 70. Complications were divided into major and minor that were observed at an overall rate of 22%. With the use of conventional flaps, there was an 11.3% rate of minor complications and a 5.6% rate of major ones. Examining the 187 myocutaneous or pedicled muscular flaps, 21% of the overall 27% were minor and 6% were major complications. Of the remaining 63 free flaps, minor complications were observed in 4.7% and major complications in 14.2% of cases. Thirty-four of the 392 flaps, 24 of which were myocutaneous or pedicled muscular and 10 free flaps, were utilized in elderly patients and compared with the 216 of the same type, in patients < 70. A comparative analysis shows that there was a major complication rate of 11.7% in the flaps employed on the elderly patients as opposed to 7.9% for those employed in the younger patients. In terms of minor complications, a 20.5% complication rate was observed for those > 70 as opposed to 16.7% for patients < 70. A more detailed analysis of these data, enabled to postulate that the smaller group of flaps used in elderly patients is statistically influenced by the "dilution" of the complication rate in favour of the larger group of younger patients. Furthermore, by appropriately correcting the risk factors due to concomitant diseases that were not related to surgery in the older patients, a realignment of the results may be seen. Therefore, a careful preoperative study must be carried out in the elderly patients with cervicofacial tumors who are eligible for surgery to establish and possibly treat the concomitant disease responsible for the increased peri- and postoperative morbidity. In conclusion, complications in elderly patients are correlated to the state of co-morbidity and neither to age nor to the duration of the operation. Responsiveness may therefore be obtained also in elderly patients employing sophisticated techniques such as microvascular flaps.

[Immediate breast reconstruction. A retrospective analysis of 7 years' experience]. / La ricostruzione mammaria immediata. Analisi retrospettiva su 7 anni di esperienza.

The collaboration between oncological and plastic surgeons proved to be essential in the multifaceted treatment of the neoplasms and high-risk lesions of the breast. It guarantees psychological advantages, and improves the quality of life of the patient, who is a candidate for demolition surgery. The authors analyse the results obtained over a 7-year period, through their experiences of 98 immediate breast reconstructions performed after subcutaneous simplex, Patey or Halsted mastectomies. They assessed the validity of this approach due to the brilliant esthetic results obtained, the minimal surgical time, and the low morbidity.

[Postmastectomy breast reconstruction using myocutaneous rectus abdominalis flap. Our experience]. / La ricostruzione mammaria dopo mastectomia con lembo miocutaneo di retto addominale. Nostra esperienza.

The paper compares the results of 34 patients undergoing reconstructive surgery following radical mastectomy using a TRAM flap with those reported in the literature. The parameters taken into consideration in this study were indications for reconstructive surgery, morbidity and the results of reconstruction. The monopedicle flap offered good cosmetic results and a low rate of complications if correctly and selectively used. This selection should exclude high-risk patients. The bipedicle flap is an effective alternative and the morbidity rate was no higher among the abdominal donor.

[Immediate reconstructive approach in neoplastic pathology and "high risk" of the breast]. / L'approccio ricostruttivo immediato nella patologia neoplastica ed "a rischio" della mammella.

One of the most important aims in oncology should be the quality of life, even in the cases of limited life expectancy. With this objective, the Authors report their experience of immediate breast reconstruction after surgical treatment for neoplasms and "high risk" lesions. In 76 cases they analyzed aesthetic results and morbidity. In immediate reconstruction after Patey mastectomies, the tissue expanders offered good cosmetic results with an acceptable complication rate in comparison with more complex methods as myocutaneous flaps. These flaps represent the alternative in selected cases of Halsted mastectomies, where the mutilation is not acceptable to the patient. In "high risk" lesions surgical approach, namely subcutaneous mastectomy, may be proposed in selected cases only. The Authors emphasize that subcutaneous mastectomy with an immediate submuscular reconstruction offer good aesthetic results especially in small size breasts with mild ptosis. The capsular contracture is however significant in 25% of the patients treated with these techniques.

Lonidamine and hyperthermia: clinical experience in melanoma. Preliminary results.

Lonidamine alone or in combination with hyperthermic perfusion, with or without melphalan, was investigated in 12 patients with stage II, III, and IV malignant melanoma. The authors evaluated the most effective methods and sequence of Lonidamine administration. Preliminary results suggest that the highest effectiveness is obtained with the simultaneous administration of Lonidamine and hyperthermia.