Aesthetic results following breast cancer surgery: A prospective study on 6515 cases from ten Italian Senonetwork breast centers.

Breast cancer treatment has deeply changed in the last decades, since clinical and oncological cure cannot be achieved without patient's satisfaction in term of aesthetic outcomes. Several methods have been proposed to objectively assess these results. However, Italian breast centers have not yet agreed on measurable, reproducible and validated aesthetic outcome indicators to monitor their performance. METHODS: The study was designed and conducted by Senonetwork, a not-for-profit association of Italian breast centers. Ten breast centers were selected based on specific eligibility criteria. This multicentre observational prospective study recruited 6515 patients with diagnosis of in situ or invasive breast cancer who underwent breast surgery in the years 2013-2016. Thirteen indicators of aesthetic results and of related quality of care were analyzed. Data collection and analysis were conducted using a common study database. RESULTS: On average, seven out of ten centers were able to collect data on the proposed indicators with a proportion of missing values < 25%. By expert consensus based on study results, some seven indicators have been defined as "mandatory" while the remaining six have been defined as "recommended" because they require further refinement before they can be proposed for monitoring aesthetic outcomes or because there are doubts on the feasibility of data collection. The minimum standard is reached for 5 of 13 indicators. This finding and the wide range between centers reveal that there is ample room for improvement. CONCLUSIONS: From the present study useful measurable aesthetic parameters have emerged, leading to the definition of target objectives that breast centers can use for benchmarking and improvement of quality of care.

'Reverse expansion': A new technique of breast reconstruction with autologous tissue.

The treatment for breast cancer is sometimes long and requires a multidisciplinary approach. In 2010, in our centre, we began to perform fat grafting for breast reconstruction using the so-called 'reverse expansion' technique. This consists of the insertion of a skin expander during mastectomy, in its expansion and then in its gradual deflation in the surgical theatre during fat grafting. We performed a complete breast reconstruction in 57 patients by reverse expansion. We harvested fat from the fat excess areas using a normal liposuction cannula. From each patient, an average of 640 ccs of was collected and then centrifuged in a 4000-rpm centrifuge for 3 min. The obtained adipocytes were then injected in the operated breast using a normal lipofilling cannula. We injected an average of 318.05 ccs of adipocytes for each patient each time. The average number of sessions per patient was 3.6. Reverse expansion can be a safe and effective technique for breast reconstruction in all the breast cancer patients.