Specialista in chirurgia plastica e ricostruttiva
Un professionista che reclama credibilità deve avere un'attività scientifica. Le pubblicazioni sono un attestato della comunità scientifica sul proprio valore. Nel nostro mestiere l'autoreferenzialità non è ammessa. In questa sezione ci sono le mie più recenti pubblicazioni.
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Direct to implant breast reconstruction by using SERI®, preliminary report.
Journal of experimental & clinical cancer research: CR. 11/2014
ABSTRACT: Background There has been a ¿rising tide¿ in mastectomy utilization that can be attributed to more skin-sparing mastectomies (SSMs) performed concurrently with immediate breast reconstruction. We report our experience of the first use of SERI® Surgical Scaffold (SERI®; Allergan, Inc.) in 21 cases of direct to implant (DTI) breast reconstruction after SSM.Methods Our retrospective experience, from April 2013 to May 2014, is based on 21 cases of direct to implant (DTI) breast reconstruction after SSM (9 monolateral 6 bilateral). All the patients were oncological with a preoperative cancer stage was into 0¿2 stage. In order to assess the level of satisfaction with the aesthetical result, on 4¿13 months post-operative patients were asked to complete a questionnaire that evaluated various parameters by means of a Visual Analogue Scale (V.A.S.).ResultsOver a 13-months period, a total of 15 patients underwent 21 immediate breast reconstructive procedures with Allergan Natrelle 410 style implants plus SERI® after SSMs. Definitive histological examination give evidence of 5 patients intraductal carcinoma, 6 patients multifocal carcinoma and 4 patients carcinoma in situ. 6 bilateral cases of direct to implant (DTI) breast reconstruction after SSM had a monolateral oncological treatment and on the other side a prophylactic treatment. At the end of the short follow up (minimum 6 months) all the patient were cancer free with an excellent outcome. Complication rate presents just one implant exposure followed by a revised surgery. At V.A.S. the mean patient satisfaction was 5,77 (good), 4,09 (fair) for sensitivity of the nipple areola complex, 6,33 (good) assessment of implant position, 6,28 (good) self esteem, 5,2 (good) attraction ability, 4,99 (fair) intimate life, 6,81 (good) overall feelings about breast reconstruction, 6,71 (good) simmetry.Conclusions The really encouraging results of our early experience will help surgeons introducing SERI® into their practice to select appropriate patients for direct-to-implant single-stage immediate breast reconstruction. A larger study cohort and longer follow-up times are required to identify additional predictors and indications.
Technique to achieve the symmetry of the new inframammary fold.
Canadian journal of surgery. Journal canadien de chirurgie 08/2014
Non-pegylated liposomal Doxorubicin-cyclophosphamide in sequential regimens with taxanes as neoadjuvant chemotherapy in breast cancer patients.
Journal of Cancer. 01/2014
ABSTRACT: Purpose: Chemotherapy regimens containing anthracyclines and taxanes represent the landmark of neoadjuvant systemic therapy of breast cancer. In advanced breast cancer patients liposomal anthracyclines (LA) have shown similar efficacy and less cardiac toxicity when compared to conventional anthracyclines. We performed this retrospective analysis in order to evaluate the efficacy and tolerability of neoadjuvant regimens including LA outside of clinical trials in routine clinical practice. Methods: Fifty operable or locally advanced, HER2 negative, breast cancer patients were retrospectively identified in 5 Italian cancer centres. Nineteen patients had received 4 cycles of non-pegylated liposomal doxorubicin (NPLD) and cyclophosphamide, followed by 4 cycles of docetaxel, every 3 weeks. In 25 patients the reverse sequence was employed, and a third subgroup of 6 patients received 4 cycles of NPLD/cyclophosphamide every 3 weeks followed by 4 cycles of weekly carboplatin and paclitaxel. Results: We observed 10 pathological complete responses (pCR) (20.0%, 95%CI, 9% to 31%), and 35 (70%, 95%CI, 57.3% to 82.7%) partial responses (pPR), whereas no patients progressed onto therapy. In the small subset of triple negative tumors the pCR rate was 37.5%, and in tumors expressing ER and/or PgR it was 16.7%. A pCR rate of 26.5% was observed in tumors with high Ki-67, whereas in tumors with low Ki-67 only one (6.2%) pCR was observed (p=0.14). Treatments were well tolerated. The most common toxicities were myelosuppression and palmar-plantar erytrodysesthesia; 4 asymptomatic and transient LVEF decrease have been recorded, without any case of clinical cardiotoxicity. Conclusions: NPLD-cyclophosphamide and taxanes sequential regimens were proven effective and well tolerated in breast cancer patients with contra-indication to conventional anthracyclines undergoing neoadjuvant chemotherapy, even outside of clinical trials in everyday clinical practice.
Transcutaneous lower blepharoplasty, painless suture removal.
The Journal of craniofacial surgery 09/2013
ABSTRACT: Despite being referred to as one of the more challenging procedures in plastic surgery, lower blepharoplasty is one of the most commonly requested and performed aesthetic procedures.Our experience, from February 2007 to March 2012, is based on 214 transcutaneous lower blepharoplasty procedures in which the skin flap was sutured by means of the epidermal-dermal U stitch, a new, simple, and reliable method. Patients were followed up for a mean period ranging from 7 to 70 months. To our knowledge, the literature proposes a single-stitch closure or continuous suture in transcutaneous lower blepharoplasty using nylon or silk 4-5-0 to close the skin incision (1-3-5). According to our experience before 2007 based on patients' reports, single-stitch subciliary suture removal is a source of stress for the patient that causes anxiety, discomfort, and pain.Thus, in February 2007, following transepithelial lower blepharoplasty, we started using a new, simple way to suture the subciliary skin flap adopting the epidermal-dermal U nylon 5-0 stitch to avoid any discomfort and drastically reduce the level of anxiety and pain at the time of suture removal. According to our experience, the healing of the wound does not require any subsequent scar revision resulting from healing defects or pathological scar tissue; the complication rate in our series is in keeping with that reported by other authors in the literature.In conclusion, our experience indicates that the suture technique we describe is an easily reproducible, rapid, discomfort-free, and painless means of removing stitches.
Natrelle Style 510 in breast augmentation surgery.
Journal of Plastic Reconstructive & Aesthetic Surgery 10/2012
Hematoma following rhytidectomy, an alternative drainage.
Aesthetic Plastic Surgery 02/2011
A trick for dressing after liposuction
Aesthetic Plastic Surgery 02/2011
Nipple reconstruction using a star flap enhanced by scar tissue: the Regina Elena Cancer Institute experience.
Aesthetic Plastic Surgery 02/2011
ABSTRACT: We propose a new, simple, and reliable method of nipple reconstruction using a star flap and a free graft of a linear fragment of scar tissue. The harvested fragment is deepithelialized and fixed under the flap to give the reconstruction consistency and make it steady. The study included 218 nipple reconstructions performed between 2002 and 2008. In an attempt to estimate their satisfaction, patients were then asked to complete a 1-year postoperative questionnaire. Patients were directed to use a numerical scale of 1-10, with 1 as the worst outcome and 10 as the best possible outcome. The average projection of the nipple in the immediate postoperative period was 7.08 ± 0.5 mm (mean ± standard deviation). After 1 year, the average projection of the reconstructed nipple was 6.08 ± 0.5 mm. The average diameter of the reconstructed nipple in the immediate postoperative period was 14.9 ± 3 mm. After 1 year, the average diameter of the reconstructed nipple was 14.2 ± 4 mm. The average patient satisfaction with nipple projection was 7.28, sensation of the nipple, 4.11; color of the nipple, 6.36; position of the reconstructed nipple, 7.34; and symmetry compared with the opposite nipple-areola complex, 7.97. Overall patient satisfaction was 6.61. We maintain that the technique presented here is safe, easy to perform, and reproducible and improves the long-term projection of the reconstructed nipple.
Cost of surgical intervention for reconstructive therapy of HIV-associated facial lipoatrophy.
Patient Preference and Adherence 01/2011
ABSTRACT: This study aims to assess direct cost of reconstructive interventions with facial fillers for treatment of HIV (human immunodeficiency virus)-associated facial lipoatrophy (FLA). Evaluation was performed on data from patients enrolled in one arm of a comparative study of immediate versus delayed reconstructive treatment of facial lipoatrophy. Median costs were standardized for efficacy, estimated using data reported by physicians and patient reported outcomes. The variations of the results were evaluated with a sensitivity analysis. Evaluation was performed on 66 patients characterized by significant differences in terms of severity of FLA. Total cost resulted of €140,416.15, with a median cost per patient of €2126.04 (interquartile range [IQR]: 1599-2822). Taking into consideration severity of disease, median costs were €1641.67 (IQR: 1326.67-2126.04) and 2557.12 (IQR: 1939.34-2872.04) (P = 0.0) respectively for patients with low and high severity scores at baseline. Significant differences in term of cost-effectiveness ratios were also found between patients with different severity of FLA, and sensitivity analysis showed that these ratios increase with higher severity scores at baseline and vary widely depending on the costs of filler. Although these results cannot be considered representative because of important limitations, the present study suggests the severity of disease as an important determinant of costs.