Browsing by Author "Cristina Garusi"

Filter results by typing the first few letters
Now showing 1 - 11 of 11
  • No Thumbnail Available
    PublicationMetadata only
    Axillary web syndrome self-assessment questionnaire: Initial development and validation
    (2014-01-01) Luiz Felipe Nevola Teixeira; Paolo Veronesi; Visnu Lohsiriwat; Alberto Luini; Mario Casales Schorr; Cristina Garusi; Maria Claudia Simoncini; Luis Otavio Zanatta Sarian; Sara Gandini; Fabio Sandrin; Mario Rietjens; Istituto Europeo di Oncologia; Mahidol University; University of Health Sciences of Porto Alegre; Universidade Cidade de Sao Paulo
    © 2014 Elsevier Ltd. Introduction: Despite the great strides made in medical knowledge, surgery still remains a necessary part of the breast cancer treatment. Surgical procedures still lead to post surgical sequelae. The axillary web syndrome (AWS) is one such sequela, which can lead to disability, reduced arm mobility and compromised quality of life. It is often unidentified and the literature regarding its assessment is limited.To improve diagnosis and patient education, the Screening Test AWS (ST-AWS) questionnaire was drafted and applied at the European Institute of Oncology (EIO). Materials and method: We prospectively recruited patients from October 2012 to December 2012. Patients who underwent sentinel lymph node biopsy and/or axillary dissection procedures were registered. Physical examination was set as a gold standard. Results: 88 patients completed the questionnaire. Among these, 32 patients had axillary web syndrome diagnosed, thus a 36% incidence.The questionnaire achieved a sensitivity of 94%, a specificity of 91%, a positive prevalence value (PPV) of 86%, a negative prevalence value (NPV) of 96% and an accuracy of 92%. Conclusion: Our questionnaire achieves high sensitivity and predictive values, and we would recommend it as a screening-tool for auto-diagnosis of the AWS.The main objective of the questionnaire is to enhance patient and therapist awareness of the problem, and prompt management to shorten the effects of this disability. Moreover, it may offer a tool to enhance body image acceptance after surgery.Further studies whereby the efficacy of the questionnaire is investigated in a larger, heterogeneous group and in different situations are warranted.
  • No Thumbnail Available
    PublicationMetadata only
    Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy?
    (2013-03-01) Visnu Lohsiriwat; Nicole Rotmensz; Edoardo Botteri; Mattia Intra; Paolo Veronesi; Stefano Martella; Cristina Garusi; Francesca De Lorenzi; Andrea Manconi; Giuseppe Lomeo; Mario Rietjens; Mario Schorr; Maximiliano Cassilha Kneubil; Jean Yves Petit; Istituto Europeo di Oncologia; Mahidol University; Universita degli Studi di Milano
    Background: The selections of nipple-sparing mastectomy (NSM) are principally depending on oncologic indication and oncologic safety. The main complication of NSM is nipple areolar complex (NAC) necrosis, and it is usually related to surgical technique. However, the patients' clinicopathological factors should be also considered. Method: We retrospectively reviewed 934 consecutive NSM patients during 2002-2007 at the European Institute of Oncology, Milan, Italy. We identified a group of patient who had NAC excision because of NAC necrosis and compared this group with those who had successful NAC conservation. We analyzed the association between the risk of NAC necrosis and the clinicopathological features of the patients. Results: Among 934 NSM, 772 were invasive cancers and 162 were in situ cancers. Of the 934, 40 NAC (4.2 %) were removed during the postoperative period because of necrosis. When we considered age, BMI, menopausal status, smoking status, tumor size, axillary lymph node status, in situ or invasive cancer histology, presence of extensive situ component, grading, estrogen receptor, progesterone receptor, HER2/neu overexpression, Ki-67 proliferative index, and peritumoral vascular invasion, no association was observed between patients' clinicopathological features and NAC necrosis incidence. Conclusions: In our study, clinicopathological features have no significant impact on necrosis complication in therapeutic NSMs. Positive retroareolar margin is the risk of necrosis. Further studies are required to avoid bias due to the different cancer treatments such as different reconstruction techniques and intraoperative radiation protocols. The correlation between breast morphology and NAC necrosis should also be investigated in the future. © 2012 Society of Surgical Oncology.
  • No Thumbnail Available
    PublicationMetadata only
    Evaluation of lipofilling safety in elderly patients with breast cancer
    (2015-01-01) Prakasit Chirappapha; Mario Rietjens; Francesca De Lorenzi; Manconi Andrea; Alaa Hamza; Jean Yves Petit; Cristina Garusi; Stefano Martella; Benedetta Barbieri; Alessandra Gottardi; Istituto Europeo di Oncologia; Mahidol University
    Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. Background: Lipofilling is widely used in breast reconstruction after mastectomy with reconstruction or breast conserving surgery in patients with breast cancer. The aim of this study is focused on complications associated with lipofilling in elderly breast cancer patients with breast defects after breast conserving surgery or reconstruction. Methods: A total of 137 patients older than 60 years who underwent 153 lipofilling procedures were included. All patients had undergone breast lipofilling using Coleman’s technique. Estimated breast defect volume, lipofilling volume, and complications after lipofilling were obtained for analysis. Results: Most patients (67%) had only 1 lipofilling procedure. The median lipofilling volume to breast defect volume ratio was 1.5. No severe complications were found after treatment. Liponecrosis was detected in 10 of 153 breasts (7%) or 9 of 137 patients within 2 weeks after lipofilling and required surgical drainage in 2. No local recurrences were noted. Conclusions: The incidence of liponecrosis after lipofilling in elderly patients was relatively high, requiring surgical drainage in some cases. As a rough guide, the lipofilling volume should not exceed 1.5 times the defect volume, and close postoperative follow-up within the first 2 weeks is suggested for these patients.
  • No Thumbnail Available
    PublicationMetadata only
    Immediate breast reconstruction with prostheses after conservative treatment plus intraoperative radiotherapy. Long term esthetic and oncological outcomes
    (2012-06-01) Francesca De Lorenzi; Visnu Lohsiriwat; Benedetta Barbieri; Suanly Rodriguez Perez; Cristina Garusi; Jean Yves Petit; Viviana Galimberti; Mario Rietjens; Istituto Europeo di Oncologia; Mahidol University
    Electron intraoperative radiotherapy (ELIOT) has been introduced for breast conservative treatment (BCT) with promising oncological outcome. Thus, immediate breast reconstruction with prosthesis after BCT became possible due to minimal radiation effect on local tissue from ELIOT. We reported oncological and esthetical results of 29 BCT patients who had immediate implant reconstruction plus 21 Gy-ELIOT as the sole radiation treatment. All patients had prosthesis in ipsilateral breast and had simultaneous contralateral augmentation for symmetrical procedure. The average age was 52.3 years. There were stage Ia thirteen cases, stage Ib seven cases, stage IIa six cases and stage IIIb one case and two cases of intraepithelial neoplasia. From 54.2 (36-88) months follow up, the capsular contracture grading in the reconstructed breast from ELIOT-side is comparable with non-irradiated contralateral side. There was one patient who developed local recurrence (LR) and later on dead with breast related event (LR = 0.76% per year). There was no primary ipsilateral carcinomas and distant metastasis. © 2012 Elsevier Ltd.
  • No Thumbnail Available
    PublicationMetadata only
    Impact of medical discipline and observer gender on cosmetic outcome evaluation in breast reconstruction using transverse rectus abdominis myocutaneous (TRAM) flap and radiotherapy
    (2010-12-01) Maria Cristina Leonardi; Cristina Garusi; Luigi Santoro; Veronica Dell'Acqua; Fabio Rossetto; Florence Didier; Barbara Vischioni; Francesca De Lorenzi; Visnu Lohsiriwat; Jean Yves Petit; Roberto Orecchia; Istituto Europeo di Oncologia; Mahidol University; Universita degli Studi di Milano
    Background: Despite the complication rate, the majority of studies report a satisfactory cosmetic outcome in patients undergoing transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction both before and after radiotherapy (RT). The lack of a universal agreement on the use of a validated scale for cosmetic assessment in clinical practise leads to subjective criteria of evaluation and causes a great deal of interobserver variability. This study investigates whether there is any difference in the evaluation of cosmesis according to gender and specialisation of the observer. Methods: Fifty-two photographs of the patients who had undergone TRAM reconstruction for breast cancer, divided into three groups according to the treatment (TRAM only, TRAM→RT, RT→TRAM), were evaluated by 21 specialists, 10 male and 11 female from radiotherapy, breast surgery and plastic reconstructive surgery. Cosmetic outcome was classified using the four-category Harvard scale: a score of excellent/good was considered acceptable. Results: The overall rate of good/excellent ratings was 66.6%, which was lower than the score reported in the literature. A significantly worse score was registered in the TRAM→RT group compared with the other groups. The probability for male physicians to award a positive judgement is 24% higher than that of female ones. In general, there is a decent agreement among the judgement raters. Conclusions: No statistically significant difference in cosmetic evaluation was noted overall between male physicians and female ones. However, within each specialisation, the difference between the two genders was great. Breast surgeons gave the worst opinion, and among them female surgeons judged most severely, whereas plastic surgeons gave the best opinion, and among them females provided the highest favourable judgement. © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
  • No Thumbnail Available
    PublicationMetadata only
    Incidence, predictive factors, and prognosis for winged scapula in breast cancer patients after axillary dissection
    (2014-01-01) Luiz Felipe Nevola Teixeira; Visnu Lohsiriwat; Mario Casales Schorr; Alberto Luini; Viviana Galimberti; Mario Rietjens; Cristina Garusi; Sara Gandini; Luis Otavio Zanatta Sarian; Fabio Sandrin; Maria Claudia Simoncini; Paolo Veronesi; Istituto Europeo di Oncologia; Mahidol University; Universidade Federal de Ciencias da Saude de Porto Alegre; Universidade Cidade de Sao Paulo
    Purpose: Axillary lymph node dissection is part of breast cancer surgery, and winged scapula is a possible sequela. Data regarding its incidence, predictive factors, and patient prognosis remains inconsistent. Ignorance of its diagnosis may lead to undertreatment with physical morbidity. Methods: Breast cancer patients with axillary lymph node dissection were prospectively recruited. Postoperative examinations by the physiotherapy staff were performed. Results: One hundred eighty-seven patients were recruited during July-October 2012; 51 patients had a positive diagnosis (27.2 %), with 38 patients (86 %) who recovered completely from the winged scapula, while 6 patients (13 %) still had winged scapula at 6 months after surgery. One hundred thirty patients underwent mastectomy and 100 cases had immediate reconstruction. Age, BMI, previous shoulder joint morbidity, and breast surgery were not associated with winged scapula. Neoadjuvant treatment, mastectomy or conservative surgery, immediate reconstruction, tumor size, and nodal involvement also did not show any correlation. Breast reconstruction with prosthesis, even with serratus muscle dissection, does not increase the incidence of winged scapula. Conclusion: Winged scapula is not an uncommon incidence after breast cancer surgery. Physiotherapy is related to the complete recovery. The severity or grading of the winged scapula and the recovery time after physiotherapy should be investigated in the future studies. © 2014 Springer-Verlag.
  • No Thumbnail Available
    PublicationMetadata only
    Nipple sparing mastectomy: Does breast morphological factor related to necrotic complications?
    (2014-01-23) Prakasit Chirappapha; Jean Yves Petit; Mario Rietjens; Francesca De Lorenzi; Cristina Garusi; Stefano Martella; Benedetta Barbieri; Alessandra Gottardi; Manconi Andrea; Lomeo Giuseppe; Alaa Hamza; Visnu Lohsiriwat; Istituto Europeo di Oncologia; Mahidol University
    Copyright © 2014 The Authors. Background: Nipple sparing mastectomy (NSM) can be performed for prophylactic mastectomy and the treatment of selected breast cancer with oncologic safety. The risk of skin and nipple necrosis is a frequent complication of NSM procedure, and it is usually related to surgical technique. However, the role of the breast morphology should be also investigated. Method: We prospectively performed an analysis of 124 NSM from September 2012 to January 2013 at the European Institute of Oncology, Milan, Italy, focusing on necrotic complications. We analyzed the association between the risks of skin necrosis and the breast morphology of the patients. Results: Among 124 NSM in 113 patients, NSM procedures were associated with necrosis in 22 mastectomies (17.7%) among which included partial necrosis of nipple-areolar complex (NAC) in 15 of 124 NSM (12.1%) and total necrosis in 4 cases (3.5%). The NAC was removed in 5 NSM cases (4%). The volume of breast removed was the only significant factor increasing the risk of skin necrosis. The degree of ptosis was not significantly related to the necrosis risk. Conclusions: Large glandular specimen increases the risk of NAC necrosis. The degree of ptosis and the distance between the sternal notch and the NAC have no significant impact on necrotic complications in NSM. To reduce the necrotic complications in large breast after NSM, reconstruction should better be performed with autologous flap or slow skin expansion using the expander technique.
  • No Thumbnail Available
    PublicationMetadata only
    Paget's disease as a local recurrence after nipple-sparing mastectomy: Clinical presentation, treatment, outcome, and risk factor analysis
    (2012-06-01) Visnu Lohsiriwat; Stefano Martella; Mario Rietjens; Edoardo Botteri; Nicole Rotmensz; Mauro Giuseppe Mastropasqua; Cristina Garusi; Francesca De Lorenzi; Andrea Manconi; Maria Sommario; Benedetta Barbieri; Maximiliano Cassilha; Ilaria Minotti; Jean Yves Petit; Istituto Europeo di Oncologia; Mahidol University
    Background. Paget's disease is a rare clinical and histological type of local recurrence (LR) after breast cancer treatment both in case of conservative surgery or nipplesparing mastectomy (NSM) with or without intraoperative radiation. Methods. We performed an analysis of 861 NSM with electron beam intraoperative radiotherapy (ELIOT) patients treated at the European Institute of Oncology from 2002 to 2008, focused on Paget's disease local recurrence. Results. In 861 patients (713 invasive carcinoma and 148 intraepithelial neoplasia), there were 36 local recurrences (4.18%), and among these were 7 Paget's disease local recurrences (0.8%). Median follow-up was 50 months. Four cases presented with nipple areola complex (NAC) erosions, two crusted lesions, and one ulcerated NAC. The average latency period from the NSM to Paget's disease local recurrence is 32 months (range, 12-49). Complete NAC removal was performed in all seven recurrences. The average follow-up after NAC removal was 47.4 months (range, 20-78). We found neither locoregional relapse nor metastatic event in this group. All patients were alive without disease. Conclusions. Paget's disease local recurrence can be found in a significant proportion after NSM. Any suspicious lesion on NAC requires prompt pathological confirmation. Primary carcinoma with ductal intraepithelial neoplasia or invasive ductal carcinoma with extensive in situ component, negative hormonal receptor, high pathological grade, overexpression of HER2/neu, and "HER2 positive (nonluminal)" subtype tend to be significantly associated with more Paget's disease local recurrence and should be followed carefully. © 2012 Society of Surgical Oncology.
  • No Thumbnail Available
    PublicationMetadata only
    A subfascial variant of the deep inferior epigastric artery demonstrated by preoperative multidetector computed tomographic angiography: A case report
    (2010-02-18) Cristina Garusi; Visnu Lohsiriwat; Francesca De Lorenzi; Andrea Manconi; Elvio De Fiori; Massimo Bellomi; Istituto Europeo di Oncologia; Mahidol University
    Precise preoperative imaging by multidetector computed tomographic (MDCT) angiography for planning of deep inferior epigastric artery perforator (DIEP) flap dissection has been reported for enormous advantages in terms of reduced operative time and minimized flap-related complications. This case report shows a particularly rare anatomical subfascia variant of deep inferior epigastric artery (DIEA) which can be preoperatively demonstrated by MDCT angiogram. Therefore, the intraoperative finding also confirms the radiologic data and results in meticulous flap harvesting during incision on anterior rectus sheath. Additionally, the authors emphasize on performing preoperative high quality imaging for DIEP intervention precisely for specific vulnerable course of subfascial plane DIEP, which is rare but tends to be at risk without foreknowing its exact course. © 2009 Wiley-Liss, Inc.
  • No Thumbnail Available
    PublicationMetadata only
    Update on breast reconstruction techniques and indications
    (2012-07-01) Jean Yves Petit; Mario Rietjens; Visnu Lohsiriwat; Piercarlo Rey; Cristina Garusi; Francesca De Lorenzi; Stefano Martella; Andrea Manconi; Benedetta Barbieri; Krishna B. Clough; Istituto Europeo di Oncologia; Mahidol University; Paris Breast Centre
    Breast reconstruction is considered as part of the breast cancer treatment when a mastectomy is required. Implants or expanders are the most frequent techniques used for the reconstructions. Expander provides usually a better symmetry. A contralateral mastoplasty often is required to improve the symmetry. The nipple areola complex, which can be preserved in certain conditions, is usually removed and can be reconstructed in a second stage under local anesthesia. In case of radical mastectomy and/or radiotherapy, a musculocutaneous flap, such as rectus abdominis or latissimus dorsi autologous flaps, is required. When microsurgical facilities are available, free or perforator flaps respecting the muscle are preferred to decrease the donor site complications. In situ carcinomas or prophylactic mastectomy can be reconstructed immediately as well as invasive carcinoma according to the recent literature. Locally advanced breast cancer can be reconstructed after complete oncologic treatment. Radiotherapy of the thoracic wall is proposed in case of lymph node metastases, raising the discussion about the technique choice and the timing of the reconstruction. Plastic surgery procedures can improve the cosmetic results of the conservative surgery, also extending its indications and reducing both mastectomy and reexcision rates. Oncoplasty techniques are becoming more and more sophisticated, requiring the skill of trained plastic surgeons. Numerous publications confirm the psychosocial benefit resulting from the breast reconstruction. © Société Internationale de Chirurgie 2012.
  • No Thumbnail Available
    PublicationMetadata only
    The value of latissimus dorsi flap with implant reconstruction for total mastectomy after conservative breast cancer surgery recurrence
    (2011-04-01) Cristina Garusi; Visnu Lohsiriwat; Fabricio Brenelli; Viviana Enrica Galimberti; Francesca De Lorenzi; Mario Rietjens; Fabio Rossetto; Jean Yves Petit; Istituto Europeo di Oncologia; Faculty of Medicine, Siriraj Hospital, Mahidol University
    Total mastectomy is usually indicated after breast conservative treatment cancer recurrence. Breast reconstruction in this group can be performed with many options. We did 63 latissimus dorsi flap with implants reconstructions between 2001-2007. All of them were performed in breast cancer recurrence cases after breast conservative treatment and preceded for total mastectomy. The patient age range from 31 to 71 years old (50.1 ± 7.3 years). The follow-up was 36.5 ± 14.9 months (22-141 months). Neither flap loss nor significant major donor-site complication was recorded. The capsular contraction Baker's grade III was observed in 2 cases (3.1%). The rest were grade I-II and there was no grade IV contracture. We purpose that LD flap with implant can be performed in irradiated breast with low capsular contracture rate. It is suitable in total mastectomy reconstruction after conservative breast cancer surgery recurrence. © 2010 Elsevier Ltd.