Riassunto
Le innovazioni tecnologiche e tecniche hanno apportato notevoli cambiamenti sia nella chirurgia senologica oncologica, sia nella chirurgia ricostruttiva. Nel corso degli ultimi cinque anni ci sono stati importanti cambiamenti nel trattamento chirurgico del carcinoma della mammella e sono stati introdotti nella pratica clinica con una rapidità sempre crescente. La chirurgia conservativa ha impiegato circa vent’anni per essere accettata e applicata su larga scala e sono stati necessari 25 anni di pubblicazioni per dimostrarne la sicurezza oncologica [1]. La biopsia del linfonodo sentinella è stata introdotta come procedura di routine solo alcuni anni dopo la pubblicazione dei risultati preliminari. Quest’ultima è solo un esempio delle diverse tecniche e tecnologie introdotte negli ultimi cinque anni, tra le altre si annoverano la IORT, le nuove tecniche di localizzazione delle lesioni non palpabili, la nipple spearing mastectomy. Molti fattori possono spiegare questo rapido cambiamento. La diagnosi di tumori di sempre minori dimensioni ha rappresentato e rappresenta tuttora un importante stimolo allo sviluppo di tecniche chirurgiche sempre meno aggressive. L’approccio chirurgico e le tecniche in uso 10 anni fa non sono più applicabili oggi. Le pazienti sono consapevoli delle innovazioni acquisite e richiedono il trattamento “migliore”. La legge della domanda/offerta spinge ospedali e chirurghi a proporre terapie e trattamenti sempre più moderni. Questa spinta all’innovazione presenta però anche un risvolto negativo, l’applicazione clinica di nuove procedure sperimentali può in alcuni casi rivelarsi eccessiva soprattutto se i benefici di esse non sono ancora stati dimostrati e sono ancora in corso trial clinici.
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Bibliografia
Fisher B, Jeong JH, Anderson S et al (2002) Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Eng J Med 347: 567–575
Manasseh DME, Willey SC (2006) Invasive carcinoma: mastectomy and staging the axilla. In: Spear SL (ed) Surgery of the breast. Vol. 1. 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 132–139
Early Breast Cancer Trialists Collaborative Group (EBCTCG) (2005) Effect of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15 years survival: an overview of randomised trials. Lancet 366:2087–2106
Schwartz GF, Giuliano AE, Veronesi U (2002) The Consensus Conference Committee. In: Proceeding of the consensus conference on the role of sentinel node biopsy in carcinoma of the breast. April 19–22, 2001, Philadelphia. Cancer 94:2542–2551
Tafra L, Lannin DR, Swanson MS et al (2001) Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulphur colloid and isosulfan blue dye. Ann Surg 233:51–59
Sandrucci S, Casalegno PS, Percivale P et al (1999) Sentinel lymph node mapping and biopsy for breast cancer: a review of the literature relative to 479 procedures. Tumori 85:425–434
Simmons RM, Fish SK, Gayle L et al (1999) Local and distant recurrence rates in skin-sparing mastectomies compared with non-skin-sparing mastectomies. Ann Surg Oncol 6:676–681
Kroll SS, Khoo A, Singletary E et al (1999) Local recurrence risk after skin-sparing and conventional mastectomy: a 6-year follow-up. Plast Reconstr Surg 104:421–425
Toth BA, Forley BG, Calabria R (1999) Retrospective study of the skin-sparing mastectomy in breast reconstruction. Plast Reconstr Surg 104:77–84
Datta G, Carlucci S, Bussone R (2008) Star and comet incisions for skin sparing mastectomy. J Plast Reconstr Aesth Surg [Epub ahead of print]
Skoll PJ, Hudson DA (2002) Skin sparing mastectomy using a modified Wise pattern. Plast Reconstr Surg 110:214–217
Jabor MA, Shayani P, Collins DR Jr et al (2002) Nipple—areola reconstruction: satisfaction and clinical determinants. Plast Reconstr Surg 110:457–463
Chung AP, Sacchini V (2008) Nipple sparing mastectomy: where are we now? Surg Oncol 17:261–266
Simmons RM, Brennan M, Christos P et al (2002) Analysis of nipple areolar involvement with mastectomy: can the areola be preserved? Ann Surg Oncol 9:165–168
Petit JY, Veronesi U, Orecchia R et al (2006) Nipple-sparing mastectomy in association with intraoperative radiotherapy (ELIOT) a new type of mastectomy for breast cancer. Breast Cancer Res Treat 96:47–51
Regolo L, Ballardini B, Gallarotti E et al (2008) Nipple sparing mastectomy: an innovative skin incision for an alternative approach. Breast 17:8–11
Querci della Rovere G, Nava M, Bonomi R et al (2008) Skin reducing mastectomy with breast reconstruction and sub-pectoral implants. Plast Reconstr Surg 61:1303–1308
Grisotti A, Calabrese C (2006) Conservative treatment of breast cancer: reconstructive problems. In: Spear SL (ed) Surgery of the breast. Vol. 1. 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 147–216
Clough KB, Lewis JS, Couturaud B et al (2003) Oncoplastic techniques allow extensive resections for breast conserving therapy of breast carcinomas. Ann Surg 237:26–34
Clough KB, Thomas SS, Couturaud B et al (2004) Reconstruction after conservative treatment for breast cancer: cosmetic sequelae classification revisited. Plast Reconstr Surg 114:1743–1753
Spear SL, Boehmler JH, Bogue DP, Mafi AA (2008) Options in reconstructing the irradiated breast. Plast Reconstr Surg 122:379–388
Petit JY, Rietjens M, Garusi C (2001) Breast reconstructive techniques in cancer patients: which ones, when to apply, which immediate and long term risks? Oncol Hematol 38:231–239
Richetti A (2008) Conventional, intraoperative, partial radiotherapy and aesthetic outcomes. In: Proceeding of conference on oncoplastic surgery of the breast cancer. Rapallo 20–21 Oct
Kronovitz SJ, Robb GL (2006) Controversies regarding immediate reconstruction: aesthetic risks of radiation. In: Spear SL (ed) Surgery of the breast. Vol. 1. 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 679–699
Spear SL, Schwarz K (2006) Prosthetic reconstruction in radiated breast. In: Spear SL (ed) Surgery of the breast Vol. 1. 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 515–530
Adams WP Jr, Potter JK (2006) Breast implant: materials and manufacturing past, present and future. In: Spear SL (ed) Surgery of the breast. Vol. 1. 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 424–437
Missana MC, Laurent I, Barreau L, Balleyguier C (2007) Autologous fat transfer in reconstructive breast surgery: indications, technique and results. J Can Surg 33:685–690
Rigotti G, Marchi A, Galie M et al (2007) Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells. Plast Reconstr Surg 119:1409–1422
Chan CW, McCulley SJ, Macmillan RD (2008) Autologous fat transfer — a review of the literature with a focus on breast cancer surgery. J Plast Reconstr Aesthet Surg 61:1438–1448
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Bruschi, S., Bogetti, P., Bussone, R. (2011). Senologia oncologica e ricostruttiva. In: Nuove tecnologie chirurgiche in oncologia. Springer, Milano. https://doi.org/10.1007/978-88-470-2385-7_9
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DOI: https://doi.org/10.1007/978-88-470-2385-7_9
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