Reverse Expansion for Breast Reconstruction after Skin-sparing and Nipple-sparing Mastectomy: Our First 100 Cases.

Patients with breast cancer have experienced advancements both in oncological treatment and in aesthetics as a result of developments in reconstructive techniques. We aimed to present our experience with the reverse expansion technique, summarizing the results of our first 100 cases of reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy. Methods: From January 2010 to September 2018, 253 breast reconstruction procedures were performed on 100 patients. The reverse expansion technique consists of autologous fat tissue transplantation requiring the combined use of a skin expander and of multiple lipofilling sessions. At the beginning of every session the breast expander was deflated by removing a saline volume similar to that of the fat to be injected. Results: Overall, 56 breast reconstructions after skin-sparing mastectomy and 44 after nipple-sparing mastectomy were performed. An average of 661.5 cm3 of fat per session was harvested and an average of 305.3 cm3 per breast was injected. The average number of sessions to achieve breast reconstruction was 2.53. Only four complications after 253 procedures (1.5%) were reported: one donor site hemorrhage due to genetic lack of coagulation factors, and three surgical site infections. Conclusions: Considering the large number of positive factors such as a fast postoperative recovery, an easy learning curve, a lack of need of a specialized surgical team, a natural look of the breast shape, and the soft consistency of the grafted tissue, we believe this technique could be the first choice for autologous reconstruction after skin-sparing mastectomy and nipple-sparing mastectomy.

Reverse Expansion Following Nipple Sparing Mastectomy: A Natural, Safe and Effective Autologous Technique for Breast Reconstruction.

The majority of surgeons choose an implant-based breast reconstruction after mastectomy. Nevertheless, lipofilling is a constantly growing technique allowing a complete breast reconstruction without prosthesis. We introduce our experience using reverse expansion for breast reconstruction following a nipple-sparing mastectomy (NSM) with a subpectoral skin expander. In the period January 2010-August 2021, 106 breast reconstruction procedures were performed on 50 patients after a NSM. We harvested an amount of fat tissue using a 2.5 mm liposuction cannula, we centrifuged it 3 min at 4000 rpm and injected in the recipient site using 3 ml syringes and Coleman cannulas. At the beginning of every session, the breast expander was deflated of a saline volume similar to the one of the fat to be injected. We harvested an average of 679.2 ccs of fat per session and injected an average of 319.3 ccs per breast. The mean number of sessions has been 2.4 per breast. The average number of sessions in a radiotreated patients' subgroup has been slightly higher than a control group. The mean follow-up time was 63.5 months and we observed no complications in 105 over 106 procedures. Lipofilling has proven to be a safe and effective technique for complete breast reconstruction. Our procedure considers the use of a breast expander as a device to prepare the recipient site. Reverse expansion after a NSM allows a like-with-like reconstruction and it might be the first reconstructive choice in a selected group of patients.Level of Evidence IV 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 .

Impact of intraoperative radiotherapy on cosmetic outcome and complications after oncoplastic breast surgery.

Breast cancer is one of the most common tumors in the population worldwide. Conservative breast surgery (CBS) is one of the preferred surgical options, because both the oncologic and esthetic needs of the patient can be addressed. CBS surgical outcomes tend to be more effective with reduced chances of disease recurrence when radiotherapy (RT) treatment is considered as an adjunct treatment, either applied during surgery (IORT) and/or after (EBRT). The purpose of our study was to compare surgical outcomes between IORT and EBRT after CBS. In the past 5 years, we performed CBS in 489 patients in our clinic. Of these patients, 83 underwent adjunct treatment with IORT and 109 were treated with EBRT in accordance with our university approved clinical protocol. Surgical outcomes, early complication rates, and esthetic results were compared between these two groups of CBS patients, with a mean follow-up time of 17 months. IORT allowed breast irradiation treatment to be performed without effecting overlying skin, thus cosmetic outcomes tended to be favorable. Esthetic postoperative results assessed with the Breast Cancer Conservation Treatment (BCCTcore) software showed that the differences between IORT and EBRT were not statistically significant (including those patients that underwent further oncoplastic techniques after EBRT). The disease recurrence rates between the two groups were not significantly different. IORT is a safe, fast, and feasible technique that provides effective and comparable CBS outcomes for patients with breast cancer.

[A new transportable machine for the preservation of livers to be transplanted by means of hyperbaric oxygenation perfusion]. / Una nuova macchina trasportabile per la conservazione mediante perfusione iperbarica ossigenata del fegato da trapiantare.

The preservation of livers to be transplanted is currently obtained by static cold storage at 4 C degrees and flushing with UW solution. New methods of preservation are being studied that take advantage of machines for continuous hypothermic perfusion of the organ. Such machines have permitted a lengthening of preservation times and the use of livers from non-beating-heart donors. In an attempt to eliminate the damage due to hypothermia, to lengthen preservation times, and to extend the availability of livers to be transplanted, also using those subjected to short periods of warm ischaemia, we have constructed a transportable machine that produces a hyperbaric atmosphere and allows continuous perfusion of the liver. Ten pig livers from beating-heart donors were perfused with Ringer solution in hyperbaric conditions with oxygen at temperatures ranging from 10 to 25 degrees C for periods of up to 24 hours and studied by means of histopathological analysis and tests of mitochondrial activity (FAU) in order to verify cell viability. The group of livers perfused up to 15 hours yielded an FAU value of 169.40 +/- 5.5 compared to the value of the non-perfused livers (controls) established as 100 and those perfused up to 24 hours had a FAU value of 139.18 +/- 10.7 compared to the controls established as 100, thus demonstrating cell viability. The viability of the organs after preservation with our procedure in the hyperbaric oxygenation perfusion machine gives us good reason to believe that, after appropriate further confirmation of the results, it will be possible to use the machine for the transplantation both of livers subjected to warm ischaemia and of livers preserved for longer periods than is currently the case.