Breast Surgery Unit

Reggio nell'Emilia, Italy

Breast Surgery Unit

Reggio nell'Emilia, Italy
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Stevens R.J.G.,Breast Surgery Unit | Stevens S.G.,Breast Surgery Unit | Rusby J.E.,Breast Surgery Unit
International Journal of Surgery | Year: 2015

Introduction: Action On Plastic Surgery (AOPS) criteria for funding of gynaecomastia surgery are: the patient should be post-pubertal, have a BMI ≤ 25 kg/m2, endocrine and drug causes and breast cancer should be excluded and the patient should demonstrate psychological distress. We evaluated how NHS funding for gynaecomastia surgery varies between Clinical Commissioning Groups (CCGs) in England and whether there is a "postcode lottery". Methods: The gynaecomastia surgery policies for 211 CCGs in NHS England were reviewed against the AOPS criteria and grouped according to their funding policies: group 1 (if criteria met, funding approved); group 2, (if criteria met, prior approval required); group 3 (no criteria, individual funding request only) and group 4 (no funding). Results: Policies were available for all CCGs. Fifty-nine (28.0%) CCGs were in group 1, 87 (41.2%) in group 2, 44 (20.9%) in group 3 and 21 (10.0%) in group 4. Of those in groups 1 and 2, five (3.4%) CCGs used all six AOPS criteria. Approximately 70% CCGs with criteria (in groups 1 and 2) stipulated that the patient should be post-pubertal, have a BMI ≤ 25 kg/m2 and endocrine and drug causes should be excluded. Breast cancer should be excluded in 51.4% and the patient should show psychological distress in 13.7% CCGs. Of those in groups 1 and 2, 118 (80.8%) CCGs specified additional criteria. Conclusions: CCGs do not use the AOPS criteria uniformly and restrict surgery according to their own criteria. Overall, there is a "postcode lottery" for gynaecomastia surgery within NHS England. © 2015 IJS Publishing Group Limited.


PubMed | Breast Unit, Breast Surgery Unit, Breast Oncology Unit, Radiation Oncology and 2 more.
Type: Journal Article | Journal: Medical oncology (Northwood, London, England) | Year: 2016

The aim of this study was to evaluate local control, survival and toxicity profile of a consecutive cohort of early-stage breast cancer (EBC) patients treated with adjuvant hypofractionated radiotherapy (HF) with no boost delivered to the lumpectomy cavity, after breast-conserving surgery (BCS). Between 2005 and 2015, a total of 493 women affected with EBC were treated with HF (46Gy/20 fractions or 40.05Gy/15 fractions) to the whole breast without boost to tumor bed, because of age and/or favorable tumor characteristics. The primary endpoint was 5-year actuarial local control (LC); secondary endpoints included survival, toxicity profile and cosmesis. Median follow-up was 57months (range 6-124). Actuarial 5-year overall, cancer-specific, disease-free survival and LC were 96.3, 98.9, 97.8 and 98.6%, respectively. On multivariate analysis, tumor stage (T1 vs. T2) and hormonal status (positive vs. negative estrogen receptors) were significantly correlated with LC. Only 2% of patients experienced G3 acute skin toxicity. Late toxicity was mild with only 1 case of G3 fibrosis. Most of the patients (95%) had good-excellent cosmetic results. HF to the whole breast with no boost delivered to the tumor bed is a safe and effective option for a population of low-risk breast cancer patients after BCS, with excellent 5-year LC, mild toxicity profile and promising cosmetic outcome. A subgroup of patients with larger tumors and/or with no estrogen receptor expression may potentially benefit from treatment intensification with a boost dose to the lumpectomy cavity.


PubMed | Weizmann Institute of Science and Breast Surgery Unit
Type: Journal Article | Journal: Magnetic resonance in medicine | Year: 2016

Evaluate the usefulness of diffusion-weighted spatiotemporally encoded (SPEN) methods to obtain apparent diffusion coefficient (ADC) maps of fibroglandular human breast tissue, in the presence of silicone implants.Seven healthy volunteers with breast augmentation were scanned at 3 Tesla (T) using customized SPEN sequences yielding separate silicone and water (1) H images in one scan, together with their corresponding diffusion-weightings.SPENs ability to deliver multiple spectrally resolved images in a single scan, coupled to the methods substantial robustness to magnetic field heterogeneities, served to acquire ADC maps that could be freed from contributions that did not belong to fibroglandular tissue.SPEN-based sequences incorporating spectral discrimination and diffusion-weighting enable the acquisition of reliable ADC maps despite the presence of dominant signals from silicone implants, thereby opening new screening possibilities for the identification of malignancies in breast augmented patients.


PubMed | Breast Surgery Unit, University of Florence and Senology Radiology
Type: Journal Article | Journal: Future oncology (London, England) | Year: 2016

This study evaluates, for the first time, the safety of eribulin in metastatic breast cancer patients concomitantly treated with palliative radiotherapy (RT). Patients & materials: A total of 17 patients were pretreated for metastatic breast cancer. Patients received eribulin mesylate and bone RT.The most frequent grade 3 hematologic adverse events were neutropenia (56%) and anemia (20%). Mean pain score decreased from 2 (baseline) to 0.7 (end of observation). Analgesic score remained stable (1.8 vs 1.6). Bone pain scores dropped within a few weeks and remained below baseline values throughout the analysis. The overall response rate was 29%, and the clinical benefit rate was 59%.Eribulin is characterized by a manageable safety profile also when combined with palliative RT.


PubMed | Breast Surgery Unit
Type: | Journal: International journal of surgery (London, England) | Year: 2015

Action On Plastic Surgery (AOPS) criteria for funding of gynaecomastia surgery are: the patient should be post-pubertal, have a BMI 25 kg/m(2), endocrine and drug causes and breast cancer should be excluded and the patient should demonstrate psychological distress. We evaluated how NHS funding for gynaecomastia surgery varies between Clinical Commissioning Groups (CCGs) in England and whether there is a postcode lottery.The gynaecomastia surgery policies for 211 CCGs in NHS England were reviewed against the AOPS criteria and grouped according to their funding policies: group 1 (if criteria met, funding approved); group 2, (if criteria met, prior approval required); group 3 (no criteria, individual funding request only) and group 4 (no funding).Policies were available for all CCGs. Fifty-nine (28.0%) CCGs were in group 1, 87 (41.2%) in group 2, 44 (20.9%) in group 3 and 21 (10.0%) in group 4. Of those in groups 1 and 2, five (3.4%) CCGs used all six AOPS criteria. Approximately 70% CCGs with criteria (in groups 1 and 2) stipulated that the patient should be post-pubertal, have a BMI 25 kg/m(2) and endocrine and drug causes should be excluded. Breast cancer should be excluded in 51.4% and the patient should show psychological distress in 13.7% CCGs. Of those in groups 1 and 2, 118 (80.8%) CCGs specified additional criteria.CCGs do not use the AOPS criteria uniformly and restrict surgery according to their own criteria. Overall, there is a postcode lottery for gynaecomastia surgery within NHS England.


PubMed | San Gallicano Dermatologic Institute IRCCS IFO, Breast Surgery Unit, University of Padua, Oncologic Surgery and 5 more.
Type: Journal Article | Journal: Journal of surgical oncology | Year: 2016

Angiosarcoma is an aggressive vascular neoplasm with a high propensity for local recurrence. Electrochemotherapy is an emerging skin-directed therapy, exerting prominent cytotoxic activity, and antivascular effects. Its efficacy in angiosarcoma has not been investigated.This multicenter retrospective analysis reviewed patients who underwent electrochemotherapy from 2007 to 2014 for superficial advanced angiosarcomas. Bleomycin was administered intravenously and delivered within tumors by means of percutaneously applied electric pulses, according to the European Standard Operating Procedures for Electrochemotherapy. Tumor assessment was performed using RECIST (version 1.1). Toxicity (CTCAE, v4.0) and local progression-free survival (LPFS) were also evaluated.Nineteen patients (13 with locally advanced and 6 with metastatic angiosarcomas) were treated. Tumor sites were: scalp (n=5), breast (n=8), other skin sites (n=3), and soft tissue (n=3). Target lesions (n=54) ranged in size from 1.5 to 2.5cm (median, 2cm). Treatment was well tolerated. After 2 months, an objective response was observed in 12/19 (63%) patients, complete in 8 (42%). One-year LPFS within treatment field was 68%. Local symptom improvement included palliation of bleeding (5/19 patients) and pain relief (6/19 patients).Electrochemotherapy may represent a new locoregional treatment for selected patients with superficial angiosarcomas. J. Surg. Oncol. 2016;114:246-253. 2016 Wiley Periodicals, Inc.


PubMed | Asur Marche Area Vasta 1, Breast Surgery Unit, San Gerardo Hospital, University of Naples Federico II and Sheba Medical Center
Type: | Journal: Aesthetic plastic surgery | Year: 2016

The demand for reconstructive breast surgery after mastectomy is increasing among women and the two-stage option remains the most commonly performed technique. We conducted a self-controlled prospective clinical trial comparing the use of the serratus anterior fascia with the serratus anterior detached fibers to cover the inferolateral aspect of the expander in immediate two-stage breast reconstruction following conservative mastectomies as oncological or risk-reducing procedures.We analyzed the surgical outcome of 29 bilateral mastectomies and immediate reconstruction with the positioning of a tissue expander in a pocket beneath the pectoralis major and serratus anterior muscle on one side and in a pocket beneath the pectoralis major and a serratus anterior fascia flap on the other side. We considered all complications presenting in the first month after surgery and patient-reported early post-operative pain.Complication rates in the two groups did not significantly differ (p=0.237). The total amount of drainage and the time of drainage permanence were significantly lower for the subfascial group (p<0.05). Patient-reported early post-operative pain was significantly different between the two groups both at 24h (p<0.05) and at 5days (p<0.05) with significantly lower pain scores reported by the patients in the subfascial group.Our self-controlled prospective trial demonstrated an advantage in performing an implant-based two-stage breast reconstruction using a serratus anterior fascia flap when compared with the serratus muscle fibers use for inferolateral implant coverage following mastectomy. The use of the anterior serratus fascia flap for inferolateral implant coverage in two-stage breast reconstructions following mastectomy could be considered as a safe and effective technique, presenting lower morbidity for the patient when compared with the serratus muscle fibers use and lower costs when compared with biological and synthetic meshes use, achieving good outcomes in terms of post-operative complications and womens quality of life and satisfaction levels.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


PubMed | Breast Surgery Unit, San Gerardo Hospital, University of Naples Federico II, Sheba Medical Center and 3 more.
Type: | Journal: International journal of surgery case reports | Year: 2016

So called extreme oncoplastic surgery is emerging as a new promising concept in breast cancer surgery allowing successful breast conservation in selected patients with multicentric tumors.We report the case of a 48-year-old woman presenting with a multicentric breast cancer and successfully treated with an oncoplastic technique consisting in three radical lumpectomies followed by breast reshaping and simultaneous contralateral symmetrization.According to our experience, oncoplastic conserving breast surgery could represent a better option than the combination of mastectomy, reconstruction and radiation therapy, in terms of quality of life for selected patients affected by multicentric breast cancer.The surgical treatment for multicentric breast cancers remains controversial even though emerging evidences show good oncological and aesthetic outcomes following oncoplastic conserving breast surgery.


PubMed | Asur Marche Area Vasta 1, Breast Surgery Unit and University of Naples Federico II
Type: | Journal: International journal of surgery case reports | Year: 2016

True carcinosarcoma of the breast is an extremely rare condition, accounting for 0.08-0.2% of all breast malignancies. The correct definition of this tumor requires both a carcinomatous component and a malignant non-epithelial component of mesenchymal origin, without evidence of a transition zone between the two elements.We present a case of a 49-year-old woman presenting with a 4cm mass at the level of her left breast upper-outer quadrant with a histologic diagnosis of true carcinosarcoma of the breast.The most appropriate therapeutic regimens for breast carcinosarcoma are still unclear because of the rarity of this condition, but Breast Conserving Treatment (BCT) followed by adjuvant chemotherapy seems to provide a prognosis equalling that of usual Invasive Ductal Carcinoma of the breast.


PubMed | Breast Surgery Unit, San Gerardo Hospital, University of Naples Federico II, Sheba Medical Center and 2 more.
Type: | Journal: International journal of surgery case reports | Year: 2016

Primary angiosarcoma (AS) of the breast is a rare neoplasia that is not related to radiation exposure. It represents less than 0.05% of all malignant breast tumors. This lesion is characterized by aggressive patterns and poor prognosis and by the absence of typical features at radiologic examination. Currently there are not evidence-based guidelines regarding surgical and adjuvant treatment for this tumor even though wide surgical resection followed by chemo- radiotherapy appears to improve both disease free survival and overall survival. The aim of this study was to analyze the available series of AS patients suggesting the most reliable treatment options for this rare neoplasia.

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