Contralateral Breast Symmetrisation in Immediate Prosthetic Breast Reconstruction after Unilateral Nipple-Sparing Mastectomy: The Tailored Reduction/Augmentation Mammaplasty

Salgarello, Marzia,Visconti, Giuseppe,Barone-Adesi, Liliana,Franceschini, Gianluca,Masetti, Riccardo Korean Society of Plastic and Reconstructive Surge 2015 Archives of Plastic Surgery Vol.42 No.3

Background In the literature on nipple-sparing mastectomy (NSM) with one-stage immediate implant reconstruction, contralateral symmetrisation has drawn little attention, with many surgeons still performing standard cosmetic mammaplasty procedures. However, standard implant-based mammaplasty usually does not result in proper symmetry with the mastectomy side, especially regarding breast projection, overall shape, and volume distribution. Methods We retrospectively reviewed 19 consecutive patients undergoing unilateral NSM with immediate prosthetic reconstruction and contralateral simultaneous symmetrisation by using the tailored reduction/augmentation mammaplasty technique between June 2012 and August 2013. Results The average follow-up time was 13 months (range, 10-24 months). No major complications, such as infection, haematoma, and nipple-areola complex necrosis, were experienced. Conclusions Our experience suggests that simultaneous contralateral symmetrisation with tailored reduction/augmentation mammaplasty after unilateral immediate implant reconstruction after NSM facilitates durable and pleasant symmetric outcomes.

Fat Graft in Prosthetic and Autologous Breast Reconstruction

Marzia Salgarello,Giuseppe Visconti,Eugenio Farallo 대한미용성형외과학회 2009 Archives of Aesthetic Plastic Surgery Vol.15 No.1

Nowadays autologous fat transplant represents an effective cell therapy, due to the fact that a fraction of the lipoaspirate consists of adipose-derived adult stem cells. In this study we retrospectively report the two-year experience of 41 patients treated with autologous fat transplant to repair different breast- related problems. A postoperatively 3 months interval follow-up was performed in association to imaging follow-up, using ultrasound as first step. According to the grading scale, we report the results assisted by the plastic surgeons and the patients. A total of 68 breasts were treated in 65 operations. 38 patients were treated unilaterally and 15 patients bilaterally. In the follow- up we evaluate the clinical outcome using a grading scale consisted of 5 crescent grades, from 1 to 5, based on the patient’s satisfaction and on the clinical evidence of the achievement of the desired target. A percentage of 70.7% are classified with a grade over 3. Among 12 patients, one developed small liponecrotic lesion. We confirm that placing small aliquots of fat in the recipient site strongly reduce the phenomenon of liponecrosis on sonography. Thus, our experience confirms that this procedure is an easy, safe, effective and reliable surgical procedure also in the breast.

Contralateral Breast Symmetrisation in Immediate Prosthetic Breast Reconstruction after Unilateral Nipple-Sparing Mastectomy: The Tailored Reduction/Augmentation Mammaplasty

Marzia Salgarello,Giuseppe Visconti,Liliana Barone-Adesi,Gianluca Franceschini,Riccardo Masetti 대한성형외과학회 2015 Archives of Plastic Surgery Vol.42 No.3

Background In the literature on nipple-sparing mastectomy (NSM) with one-stage immediate implant reconstruction, contralateral symmetrisation has drawn little attention, with many surgeons still performing standard cosmetic mammaplasty procedures. However, standard implant-based mammaplasty usually does not result in proper symmetry with the mastectomy side, especially regarding breast projection, overall shape, and volume distribution. Methods We retrospectively reviewed 19 consecutive patients undergoing unilateral NSM with immediate prosthetic reconstruction and contralateral simultaneous symmetrisation by using the tailored reduction/augmentation mammaplasty technique between June 2012 and August 2013. Results The average follow-up time was 13 months (range, 10–24 months). No major complications, such as infection, haematoma, and nipple-areola complex necrosis, were experienced. Conclusions Our experience suggests that simultaneous contralateral symmetrisation with tailored reduction/augmentation mammaplasty after unilateral immediate implant reconstruction after NSM facilitates durable and pleasant symmetric outcomes.

Images from 18F-DOPA Scan in Congenital Hyperinsulinism: Not Always a Clue for Diagnosis

Evelina Maines,Luca Giacomello,Mirko D’Onofrio,Matteo Salgarello,Rossella Gaudino,Laura Baggio,Andrea Bordugo 대한핵의학회 2017 핵의학 분자영상 Vol.51 No.4

Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in childhood (Horm Res 70:65-72, 2008; J Clin Endocr Metab 93:869- 875, 2008). 18−Fluoro-L-dihydroxy-phenylalanine (18FDOPA) positron emission tomography (PET) can detect areas of increased activity in the pancreas and may differentiate focal from diffuse CHI (J Clin Endocr Metab 93:869-875, 2008; Radiology 253:216-222, 2009). We here report the case of a girl who complained of recurrent episodes of severe hypoglycaemia despite previous partial pancreatectomy. To evaluate the need for additional surgical intervention, we performed 18F-DOPA PET/ computed tomography (CT), which showed a focal lesion corresponding to the anatomical region of the pancreatic tail. On the other hand, abdominal magnetic resonance imaging (MRI) clearly demonstrated that the 18F-DOPA uptake was in a loop of bowel occupying the previous surgical bed. Our case highlights that bowel uptake can be a possible pitfall in the interpretation of 18F-DOPA PET/CT in children affected by CHI, suggesting that when 18F-DOPA PET/CT results do not fit the clinical picture, magnetic resonance imaging (MRI) may allow a more accurate correlation of the radiotracer activity with the underlying anatomical or pathological structure.

Thin and superthin perforator flap elevation based on preoperative planning with ultrahigh-frequency ultrasound

Visconti, Giuseppe,Bianchi, Alessandro,Hayashi, Akitatsu,Cina, Alessandro,Maccauro, Giulio,Almadori, Giovanni,Salgarello, Marzia Korean Society of Plastic and Reconstructive Surge 2020 Archives of Plastic Surgery Vol.47 No.4

The ability to directly harvest thin and superthin perforator flaps without jeopardizing their vascularity depends on knowledge of the microsurgical vascular anatomy of each perforator within the subcutaneous tissue up to the dermis. In this paper, we report our experience with ultrahigh-frequency ultrasound (UHF-US) in the preoperative planning of thin and superthin flaps. Between May 2017 and September 2018, perforators of seven patients were preoperatively evaluated by both ultrasound (using an 18-MHz linear probe) and UHF-US (using 48- and 70-MHz linear probes). Thin flaps (two cases) and superthin flaps (five cases) were elevated for the reconstruction of head and neck oncologic defects and lower limb traumatic defects. The mean flap size was 6.5×15 cm (range, 5×8 to 7.5×23 cm). No complications occurred, and all flaps survived completely. In all cases, we found 100% agreement between the preoperative UHF-US results and the intraoperative findings. The final reconstructive outcomes were considered satisfactory by both the surgeon and the patients. In conclusion, UHF-US was found to be very useful in the preoperative planning of thin and superthin free flaps, as it allows precise anticipation of very superficial microvascular anatomy. UHF-US may represent the next frontier in thin, superthin, and pure skin perforator flap design.

Surgical therapy of vulvar cancer: how to choose the correct reconstruction?

Stefano Gentileschi,Maria Servillo,Giorgia Garganese,Simona Fragomeni,Francesca De Bonis,Giovanni Scambia,Marzia Salgarello 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.6

Objective: To create a comprehensive algorithmic approach to reconstruction after vulvarcancer ablative surgery, which includes both traditional and perforator flaps, evaluatinganatomical subunits and shape of the defect. Methods: We retrospectively reviewed 80 cases of reconstruction after vulvar cancerablative surgery, performed between June 2006 and January 2016, transferring 101 flaps. Weregistered the possibility to achieve the complete wound closure, even in presence of verycomplex defects, and the postoperative complications. On the basis of these experience,analyzing the choices made and considering the complications, we developed an algorithmto help with the selection of the flap in vulvoperineal reconstruction after oncologic ablativesurgery for vulvar cancer. Results: We employed eight types of different flaps, including 54 traditional fasciocutaneousV-Y flaps, 23 rectus abdominis myocutaneous flaps, 11 anterolateral thigh flaps, three V-Ygracilis myocutaneous flaps, three free style perforators V-Y flaps from the inner thigh, twoLimberg flaps, two lotus flaps, two deep inferior epigastric artery perforator flap, and onesuperficial circumflex iliac artery perforator flap. The structures most frequently involvedin resection were vulva, perineum, mons pubis, groins, vagina, urethra and, more rarely,rectum, bladder, and lower abdominal wall. Conclusion: The algorithm we implemented can be a useful tool to help flap selection. Thekey points in the decision-making process are: anatomical subunits to be covered, overallshape and symmetry of the defect and some patient features such as skin laxity or previousradiotherapy. Perforator flaps, when feasible, must be considered standard in vulvoperinealreconstruction, although in some cases traditional flaps remain the best choice.