Michela Massa

Interaction Between Breast Cancer Cells and Adipose Tissue Cells Derived from Fat Grafting

BACKGROUND Adipose tissue transplantation has the benefit of providing both regenerative and aesthetic outcomes in breast cancer treatment. However, the transplanted tissue can stimulate the growth of residual cancer cells. OBJECTIVES The aim of this study is to identify the interactions between adipose tissue cell subpopulations and human cancer cell lines. METHODS Intact adipose tissue from lipofilling procedures as well as fibroblasts derived from adipose tissue, were cocultured in the presence of MDA-MB-231, MCF-7 e ZR-75-1 breast cancer cell lines. The influence on cancer cell lines of fibroblasts, induced to differentiate into specific adipocytes, was also assayed. RESULTS All cancer cell lines displayed a significant increase in proliferation rate when cocultured in the presence of either intact adipose tissue or induced adipocytes. To a lesser extent, uninduced fibroblasts stimulate breast cancer cell proliferation. CONCLUSIONS Recent studies have shown that the microenvironment surrounding breast cancer cells may stimulate growth and promote progression of residual cancer cells when surgery is performed on the main tumor mass. Accordingly, the graft of adipose tissue could potentially promote or accelerate the development of a subclinical tumor or support its locoregional recurrence. Our data suggest that adipocytes have a remarkable influence on the proliferation of cancer cell lines. The oncological safety of the lipofilling procedure outcome is still debated; thus, further studies and consistent follow-up examination are needed.

Preliminary Experience Using Oncoplastic Techniques of Reduction Mammaplasty and Intraoperative Radiotherapy: Report of 2 Cases

BackgroundSince 2004 in the Department of Oncological Integrated Surgery at the National Institute for Cancer Research of Genoa, we have applied different techniques of reduction mammaplasty for a subgroup of 26 patients with medium- to large-sized and ptotic breasts who are candidates for conservative surgery.MethodsIn this series of patients, the choice between different techniques of breast reduction (superior or inferior pedicled or with free areola–nipple graft) depended only on cancer position. The chosen technique minimized reshaping and displacement of residual glandular flaps. In September 2009, the radiotherapists at the Institute began to apply intraoperative radiotherapy (IORT) to early breast cancer, and at the time of this report, more than 200 patients have been treated.ResultsThis report describes two cases of reduction mammaplasty associated with this new and easily performed radiotherapy option (IORT) and discusses its advantages and cautions.ConclusionsClose collaboration between surgical oncologist, plastic surgeon, and radiotherapist is essential before and during surgery to obtain adequate tumor resection and good aesthetic results and to minimize postoperative complications.

Aesthetic Evaluation in Oncoplastic and Conservative Breast Surgery: A Comparative Analysis

Background: In conservative breast surgery, the achievement of a satisfactory cosmetic result could be challenging; oncoplastic techniques may be helpful in many cases. A comparative analysis was performed among 3 groups of patients undergoing oncoplastic techniques plus external radiation therapy or intraoperative radiotherapy (IORT) and breast conservative surgery plus external radiation therapy; long-term oncologic results in terms of disease relapse and aesthetic outcomes were compared. Methods: Ninety-six patients were considered: 32 patients treated with oncoplastic surgery, 16 then subjected to radiotherapy (group 1) and another 16 treated with IORT (group 2); 64 patients treated by conservative surgery and radiotherapy formed the control group (group 3). Patients were asked to give a judgment on the cosmetic result considering the following parameters: breast symmetry, appearance of the residual scar, symmetry between the 2 nipple-areola complexes, global aesthetic judgment, and satisfaction about the result. Results: With respect to the oncological and aesthetic outcome, the statistical significance of the results obtained in the 3 groups was calculated using the chi-square test. The results, processed by the chi-square test, were not statistically significant; however, the overall judgments expressed by the patients of all 3 groups were more than satisfactory (scores greater than or equal to 6). Conclusions: In our experience, when the inclusion criteria are satisfied and the equipment is available, oncoplastic techniques associated with IORT should be considered the treatment of choice for breast cancer in early stage. The excellent cosmetic results and patient’s satisfaction encourage us to continue on this way.

Atomic force microscopy for biomechanical and structural analysis of human dermis: A complementary tool for medical diagnosis and therapy monitoring

Skin mechanical properties are usually measured considering the entire skin thickness and very little is known about the mechanical behaviour of individual skin layers. We propose atomic force microscopy (AFM) as a tool to quantify nanoscale changes in the biomechanical properties and ultrastructure of human papillary dermis exposed to different mechanical and physical stimuli. Samples from 3 human skin biopsies were studied: one stretched by obesity, one subjected to a high level of sun exposure and normal skin as control. Slices of the papillary dermis layer were harvested at controlled depths from each skin biopsy and 25 μm2 areas of each slice were imaged and D‐periodicity of collagen fibres measured by AFM, together with their stiffness. Standard histological analysis was also carried out to correlate biochemical properties and their distribution with stiffness and topography. We obtained similar stiffness values between the sample affected by obesity and the control sample at any depth level into the dermis, while the sun‐exposed sample presented a significantly lower stiffness. Additionally, all samples presented an increase in the stiffness at higher depths into the papillary dermis layer. Collagen fibres close to the epidermis of sample affected either by obesity and sun exposure—the former even more than the latter—are thicker and present a larger D‐period than those in the control sample. Our results open the possibility to use structural and mechanical analysis based on AFM as a complementary tool for medical diagnosis and therapy monitoring.

Copertura delle perdite di sostanza della faccia anteriore ginocchio in esiti chirurgia protesica

Management of anterior knee defects represents quite a challenging situation and still a matter of debate, above all in case of exposed knee prosthesis. To promote wound healing, the tissue transferred should provide adequate blood supply and appropriately fill the defect. In our experience, the gastrocnemius flap and the proximal-based saphenous neurocutaneous artery flap are the most suitable and favourable options because of the reliability and safety of vascular supply and the relative ease of harvest.

Fascio-cutaneous flaps for chest wall reconstruction after massive inflammatory breast cancer: a case series

BackgroundInflammatory breast cancer represents a rare condition that presents poor prognosis with high risk of recurrences and greatly affects patients’ quality of life. The resective surgical treatment frequently requires challenging reconstructive solutions to restore a proper tissue layer for the chest wall. Reconstructive methods are nowadays still matter of debate.MethodsA retrospective review of all cases of massive inflammatory breast cancer that underwent mastectomy and reconstruction with fasciocutaneous flaps from October 2009 to September 2014 was performed at our department. Patient demographics, indications, flap specifics, complications, and number of operations were collected.ResultsOur review identified five cases. A lateral thoracic flap was planned in two cases, a modified lateral thoraco-dorsal flap in one case, a combination of scapular and pubic flaps in other case, and a thoraco-epigastric and lateral thoracic flap association in the remaining case. The mean patient age was 60 years (range, 35 to 76 years). Flap dimensions ranged from 9cm to 14 cm in width and 20 to 24 cm in length. Partial necrosis of the flap distal part occurred in two cases requiring minor flap revision.ConclusionsResective surgical treatment of inflammatory breast cancer might require a challenging reconstructive planning. In this scenario, fasciocutaneous flaps are an interesting option due to their versatility, easiness of harvesting, low morbidity, and complications rate.Level of Evidence: Level IV, therapeutic study.

Redefinition of Nasal Alar Rim After Dog Bite

A36-year old male patient presented with a distortion of the right nasal alar rim due to second intention healing after a dog bite occurred 10 years ago (Figure 1). The cicatricial alar margin retraction and the resulted asymmetry caused him subjective psychological discomfort and difficulties in social life especially in the relationship with his young sons. He presented at the authors’ department with the aim of restoring nasal natural aspect, with the request to minimize the extent of facial scars. How would you reconstruct this defect?

Is current clinical practice modified about intraoperative breast irradiation

After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

Surgical Correction of Ambiguous Genitalia in 46-Year-Old Woman

The aim of feminizing genitoplasty is to recreate the normal female anatomy, such as in the case of clitoris hypertrophy caused by a sexual development disorder as a result of genetic, hormonal, iatrogenic, tumoral, or idiopathic factors [10]. In the past, the enlarged clitoris structure was amputated. This procedure achieves a satisfactory cosmetic result and was supported by the theory that the clitoris had no function [1]. However, previous papers have emphasized the importance of the clitoris in psychosexual development, demonstrating that patients who had undergone clitorectomy developed sexual inhibitions and ambivalence toward sexual activity [8]. Subsequently, Lattimer [6] described a more refined technique, ‘‘recession clitoroplasty,’’ later argued by Randolph and Hung [10], in which the clitoris is reduced and relocated while preserving the sensitive top of the glans. However, the recession and suture of the hypertrophied clitoris beneath the central pubis, could lead to painful erection in puberty. Novel techniques for reduction were suggested in the 1970s, leaving untouched the ventral mucosa along a third of the circumference to preserve blood supply to the glans [2]. The actual approach of many authors is to preserve as much of the dorsal neurovascular bundle [11] as possible. Moreover, authors started including labioplasty in the technique for clitoroplasty by using the dorsal excess foreskin to reconstruct the rudimentary or absent labia minora [5]. Based on a careful study of these techniques, we report a case of a mature woman in which we combined the most important points of other techniques with our refinements. A 46-year-old woman, diagnosed at infancy with X0/ XY mosaicism by fetal lymphocyte analysis, underwent surgery in childhood to remove gonads (a testicle in one side and an ovotestis in the other) and has been treated with hormonal therapy. She is in a stable heterosexual relationship and has a true sexual identity. She presented as an adult with an enlarged clitoris and with a scrotal aspect of the labia majora, which she found socially embarrassing (Fig. 1). After long psychotherapeutic support she was referred for plastic surgery for treatment of genital malformation. Preoperative magnetic resonance imaging was performed to confirm the clinical findings. The enlarged clitoris was 2 cm long and increased to 3.5 cm with arousal. The labia minora were rudimentary and the labia majora were hypertrophic with a scrotal appearance. Clitoroplasty and reduction of the labia majora were performed in a one-stage procedure. A bladder catheter was placed in a normally positioned urethra. A small area of the clitoris to be preserved was designed and a longitudinal dorsal incision was made and extended proximally on the Presented at the 59th National Congress of Plastic and Reconstructive Surgery, Siena, Italy, September 23–26, 2010.