The impact of COVID-19 pandemic on breast surgery in Italy: a multi-centric retrospective observational study.

COVID-19 pandemic had an impact on surgical activities. The aim of this multi-centric, retrospective study was to evaluate the impact of the COVID-19 pandemic on breast surgery. The patients who operated during the pre-pandemic year 2019 were compared to those operated in 2020. Fourteen Breast Care Units provided data on breast surgical procedures performed in 2020 and 2019: total number of breast-conserving surgery (BCS), number of 1st level oncoplastic breast surgery (OBS), number of 2nd level OBS; total number of mastectomies, mastectomies without reconstruction, mastectomies with a tissue expander, mastectomies with direct to implant (DTI) reconstruction, mastectomies with immediate flap reconstruction; total number of delayed reconstructions, number of expanders to implant reconstructions, number of delayed flap reconstructions. Overall 20.684 patients were included: 10.850 (52.5%) operated during 2019, and 9.834 (47.5%) during 2020. The overall number of breast oncologic surgical procedures in all centers in 2020 was 8.509, compared to 9.383 in 2019 (- 9%). BCS decreased by 744 cases (- 13%), the overall number of mastectomies decreased by 130 cases (- 3.5%); mastectomy-BCS ratio was 39-61% in 2019, and 42-58% in 2020. Regarding immediate reconstructive procedures mastectomies with DTI reconstruction increased by 166 cases (+ 15%) and mastectomies with immediate expander reconstruction decreased by 297 cases (- 20%). Breast-delayed reconstructive procedures in all centers in 2020 were 142 less than in 2019 (- 10%). The outburst of the COVID-19 pandemic in 2020 determined an implemented number of mastectomies compared to BCS, an implemented number of immediate breast reconstructions, mainly DTI, and a reduction of expander reconstruction.

Patient Satisfaction and Clinical Outcomes Following 414 Breast Reductions: Application of BREAST-Q.

BACKGROUND: The aim of this study was to measure breast satisfaction and quality of life using the BREAST-Q Reduction Module in a large sample of postoperative patients having breast reduction using the inverted T technique. METHODS: With due approval from the ethics committee of our university, 414 patients who were seen in consultation for breast reduction surgery between 2005 and 2015 performed by the same team were asked to fill out BREAST-Q surveys. The patient factors collected for all those undergoing breast reduction included age, body mass index, incision pattern, areola complex pedicle used, amount of tissue resected, concurrent procedures, and complications. RESULTS: At our Department of plastic, reconstructive, and aesthetic surgery, 414 women underwent reduction mammoplasty with the inverted T technique from 2005 to 2015. All patients answered the BREAST-Q reduction mammoplasty postoperative module. Postoperative patients who presented with severe hypertrophy and asymmetry Grade C were more satisfied than others. CONCLUSIONS: Our study represents the largest number of patients who answered the BREAST-Q reduction mammoplasty module. The goal of breast surgery should be the attainment of patient satisfaction with good breast volume, shape, and symmetry. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors. http://www.springer.com/00266.

Ten years experience with breast reconstruction after salvage mastectomy in previously irradiated patients: analysis of outcomes, satisfaction and well-being.

OBJECTIVE: Reconstruction following mastectomy offers women an opportunity to mollify some of the emotional and aesthetic effects of this devastating disease. PATIENTS AND METHODS: The authors reviewed the files of 83 patients who underwent immediate postmastectomy reconstruction with tissue expander between January of 2003 and June of 2012 at our hospital. The patients were divided into two groups: Group A (study group) included 30 patients with previous quadrantectomy and radiotherapy who underwent salvage mastectomy after local recurrence; Group B (control group) included 53 patients submitted to primary radical mastectomy. We submitted Breast-Q reconstruction post-operative module to all of our patients. RESULTS: The median follow-up time for the whole group was 36 months (range = 12-144 months). Between group A and group B, there were no significant differences. In the group A, the median time from RT to reconstruction was 24 months (range = 9-192 months). The overall rate of complications was not similar between the two groups (66.6% vs. 58.5%; p = NS). However, the  major complications occurred mostly in the irradiated group, showing a trend of statistical significance (53.3% vs. 32.0%; p = 0.07). In this group, the occurrence of major complications was not different according to time from RT to reconstruction (p = 0.313). In particularly, patients from the irradiated group (group A) had a significantly higher risk of grade III-IV capsular contracture (relative risk 3.75, p = 0.02) and autologous salvage reconstruction (relative risk 10.4, p = 0.02). CONCLUSIONS: The results of this study prove that heterologous reconstruction is still possible following salvage mastectomy in previously irradiated patients.

Breast hypertrophy and asymmetry: a retrospective study on a sample of 344 consecutive patients.

BACKGROUND: Preoperative evaluation of the anatomical features of the region around the breast is strongly recommended in order to choose the most appropriate technique of reductive mammaplasty. Normally breast hypertrophy presents itself as a bilateral clinical picture, but no study in the literature refers to the incidence of volumetric asymmetry. AIMS: This study aims to analyze weight differences between the right and left breast on a selected sample of patients who underwent reductive mammaplasty or mastopexy over the last five years at our Plastic Surgery Unit and have maintained a good postoperative symmetry for at least 1 year subsequently. PATIENTS AND METHOD: 344 consecutive cases treated between January 2005 and April 2010 were considered for this study. Patients were classified according to the degree of hypertrophy and age. Breast asymmetry was scored, according to the senior author's original classification, on the weight difference of glandular resection. RESULTS AND CONCLUSION: In 20% of the patients a difference greater than 200 g was found. The statistical analysis showed no significant differences in the predominant side (left or right). Breast hypertrophy is confirmed as a substantially bilateral pathology, but in 1 out of 5 patients a difference of more than one quadrant can be present: thus a careful evaluation is essential in order to decide the correct surgical strategy.

A locally aggressive solitary fibrous tumor of the leg: Case report and literature review.

INTRODUCTION: The solitary fibrous tumor (SFT) is a rare soft tissue tumor with a substantially benign clinical behavior. However, malignant neoplasms with local recurrence or distant metastases have been reported. PRESENTATION OF THE CASE: The authors present a case of an aggressive SFT of the leg, in a 55 years old Caucasian man. Radiological, histological and molecular findings are reported. The differential diagnosis, therapy and outcome of this rare tumor are also discussed. DISCUSSION: An extensive review of literature showed SFT's clinical behavior as substantially benign, anyway aggressive or malignant neoplasms have been described. The potential risk of local recurrence and distant metastasis thus suggests wide surgical resection and careful long-term follow-up. Differential diagnosis may be quite laborious as SFT can mimic a variety of benign and malignant mesenchymal tumors; immunohistochemical analysis for CD34, CD99, vimentin and bcl-2 is then mandatory. CONCLUSION: Our clinical experience confirmed that SFT may have an aggressive behavior, however, conservative surgical treatment may be successful in the long term.

Heterologous reconstruction and radiotherapy: the role of latissimus dorsi flap as a salvage.

AIM: The versatility and effectiveness of the latissimus dorsi flap as salvage in complicated heterologous reconstructions, especially with regards to radiotherapy, is examined in this retrospective review of our 10-year experience. METHOD: Twenty-eight patients with complicated heterologous reconstruction were divided into three groups: (1) 15 patients with mastectomy and immediately expander reconstruction and radiation; (2) 9 patients with previous QUART, salvage mastectomy and immediate expander reconstruction; (3) 4 patients with radical mastectomy without radiation. RESULTS: The most common complications were capsular contracture and radiodermitis in Group 1, cutaneous fistula in Group 2. Recipient site complications, after latissimus dorsi flap, were observed in seven patients (five smokers), five in Group 1, two in Group 2. Cosmetic result was scored excellent and good in 25 patients (89%). CONCLUSION: This study shows as a favourable and cosmetically satisfactory reconstruction can be achieved when combining an implant with a latissimus dorsi flap allowing the salvage of the entire heterologous reconstruction.

Hemobilia and occult cystic artery stump bleeding after a laparoscopic cholecystectomy: endovascular treatment with N-butyl cyanoacrylate.

Hemobilia is a rare phenomenon. In this case report we present an emergent transcatheter glue embolization (in which N-butyl cyanoacrylate is used as an embolizing agent) due to arteriobilary fistula occurred following the laparoscopic cholecystectomy in a 41-year-old woman.

Segmental costovertebral anomaly presenting with horn-like appearance in the chest.

Several types of abnormalities of the ribs have been reported. Many of these anomalies usually result in the correct diagnosis thanks to the characteristic radiological appearances. But some of the anomalies are rare and it is important to recognize and get accustomed to differing appearances of these osseous abnormalities in order to differentiate the pathological processes and to diagnose the syndromes which may accompany rib anomalies. The localized costovertebral anomaly with horn-like appearance, which has not yet been described in literature, is presented in this paper.

Acquired spontaneous intercostal abdominal hernia: case report and a comprehensive review of the world literature.

Intercostal hernias develop most often as a result of a blunt or penetrating thoracoabdominal trauma. We know of no prior report of a spontaneously occuring intercostal hernia. This study presents a review of the published literature that deals with this uncommon phenomenon, along with a discussion of our patient's clinical presentation and imaging findings.

[Role of cutaneous thoraco-abdominal flap in the surgical treatment of advanced stage breast tumors]. / Il ruolo del lembo cutaneo toraco-addominale nel trattamento chirurgico degli stadi avanzati del tumore della mammella.

Chest wall reconstruction following extensive resection due to advanced breast cancer or radionecrosis still represents a challenge for both oncologic and reconstructive surgeons. A multitude of techniques including pedicle muscle transposition, free muscle flaps and omental flaps have always been considered, despite the morbidity of donor site. The authors describe a new cutaneous thoraco-abdominal flap to cover full thickness defects up to 600 cm2. 16 patients underwent chest wall reconstruction with the aforementioned technique. No major complications occurred. This technique proved to be a very good options to cover large chest wall defects in patients with advanced or recurred breast cancer or radionecrosis.

[Strategic approach to immediate breast reconstruction with submuscular-fascial tissue expanders]. / L'approccio strategico alla ricostruzione mammaria immediata con gli espansori tissutali sottomuscolofasciali.

Breast reconstruction can be accomplished with implants, autologous tissue or both. Thanks to the widespread of microsurgical techniques autologous tissue reconstruction has become a frequent option in many departments although it is mostly considered a second choice. The aim of this study was to review our experience covering the past five years in immediate breast reconstruction with tissue expanders. From January 2000 to January 2005 279 patients underwent immediate breast reconstruction with submuscular tissue expanders. Tissue expander was chosen according to dimension, shape and volume of the healthy breast. Operating time, early and late complications, interference with neo-adjuvant therapies as well as timing and surgical techniques of second-step reconstruction were also considered. No major complications occurred. Tissue expander, beyond proving itself a valid and safe option in immediate breast reconstruction, also decreased the psychological distress following a mastectomy.