Breast Surgery

CONSERVATIVE

• Traditional breast-conserving techniques.
• Advanced level I oncoplastic techniques (glandular and dermo-glandular reshaping) and Advanced level II oncoplastic techniques, such as: Pedicle mastoplasties, with or without autologous implants, Round-block techniques, Grisotti flap reconstructions.

RADICAL

• Traditional mastectomies.
• Conservative mastectomies, including: Nipple-Areola Complex (NAC)-sparing mastectomies, Skin-sparing mastectomies, Skin-reducing mastectomies. Conservative mastectomies are always followed by immediate breast reconstruction, performed using either an expander or, more commonly, implants. The preferred approach is the pre-pectoral technique, which spares the pectoralis major muscle.

AXIALLARY SURGERY

• For patients with clinically and radiologically negative axillary findings, a sentinel lymph node biopsy (SLNB) is performed using the OSNA biomolecular method. This approach provides real-time intraoperative results, reducing the risk of false negatives and enabling completion of the surgical plan (either lymph node preservation or full axillary dissection) during the same procedure.

For patients with confirmed metastatic involvement, primary axillary dissection is indicated

IMMEDIATE

• Performed simultaneously with the mastectomy procedure, this typically involves the use of tissue expanders (two-stage reconstruction) or definitive implants (single-stage reconstruction), preferably utilizing the pre-pectoral technique.

DELAYED

• Performed after adjuvant therapies, it is generally reserved for patients with locally advanced tumors, particularly those who have undergone preoperative chemotherapy and require radiotherapy. Delayed reconstruction often employs combined techniques, including lipofilling (autologous fat grafting) and the use of expanders.

AUTOLOGOUS FLAPS (muscular or myocutaneous)

• These are reserved for specific scenarios, such as: Severe complications like tissue necrosis, Volume deficits that cannot be corrected with implants, Radiotherapy-related damage that cannot be resolved with lipofilling.

LIPOFILLING

• This technique involves harvesting autologous fat tissue (usually from the abdominal or trochanteric regions) and grafting it into the breast.
• It can be utilized in conservative breast surgery to address volume deficits, correct significant aesthetic irregularities, or counteract chronic effects of radiotherapy. In reconstructive surgery, lipofilling is primarily used in delayed reconstruction, especially after radiotherapy, but it can also enhance immediate implant-based reconstruction, addressing aesthetic issues such as rippling.

SYMMETRY PROCEDURES

• These are performed on the contralateral breast to achieve symmetry after a mastectomy with reconstruction. Techniques include: Mastopexy, Breast augmentation or reduction surgery, Glandular and dermo-glandular reshaping.

• Mastopexy
• Breast reduction surgery.
• Correction of congenital or acquired malformations, including: Poland syndrome, Tuberous breast deformity, Various asymmetries.

The outpatient clinic offers:

• Initial consultations.
• Diagnostic evaluations including: Digital mammography, with or without contrast, Tomosynthesis, MRI, Ultrasound, with optional ultrasound-guided core needle biopsy or vacuum-assisted biopsy (V.A.A.B.) using Mammotome technology.
• Postoperative wound care and dressing changes.
• Communication and explanation of final diagnostic results.

The outpatient clinic focuses on:

• Initial evaluations for patients with congenital or acquired malformations requiring surgical correction, those considering reconstructive surgery, or those needing further adjustments following prior reconstruction.
• Management and adjustment of tissue expanders.
• Assessment of aesthetic and functional outcomes for patients who have undergone breast reconstruction.

The Hereditary-Familial Risk and Prophylactic Surgery Clinic, in collaboration with the C.O.U. of Medical Genetics, assesses the hereditary and familial risk in patients with breast cancer (both those already treated surgically and those awaiting surgery) and their family members. When indicated, the clinic prescribes genetic testing to detect mutations in the BRCA1 or BRCA2 genes.

BRCA mutations significantly increase the likelihood of developing breast cancer (including ipsilateral recurrence or new contralateral tumors in previously treated patients) and ovarian cancer.

The test results enable optimal surgical planning for breast cancer patients awaiting intervention. Additionally, for patients identified as mutation carriers, the results support the development of personalized risk-reduction strategies. These strategies, designed in collaboration with the D.S.O.U. of Breast Radiology and the C.O.U. of Obstetrics and Gynecology, include: Enhanced clinical and radiological surveillance and Prophylactic surgical interventions.

The entire decision-making process is supported at every stage by the Clinical Psychology Service, ensuring patients receive both comprehensive information and emotional support tailored to their needs.