title: The role of oxidized regenerate cellulose to prevent cosmetic defects in oncoplastic breast surgery.
abstract: BACKGROUND
  Breast conserving surgery (BCS) combined with postoperative radiotherapy has become the gold standard of locoregional treatment for the majority of patients with early-stage breast cancer, offering equivalent survival and improved body image and lifestyle scores as compared to mastectomy. In an attempt to optimize the oncologic safety and cosmetic results of BCS, oncoplastic procedures (OPP) have been introduced in recent years combining the best principles of surgical oncology with those of plastic surgery. However, even with the use of OPP, cosmetic outcomes may result unsatisfying when a large volume of parenchyma has to be removed, particularly in small-medium size breasts.
  
  
  OBJECTIVE
  The aim of this article is to report our preliminary results with the use of oxidized regenerate cellulose (ORC) (Tabotamp fibrillar, Johnson & Johnson; Ethicon, USA) as an agent to prevent cosmetic defects in patients undergoing OPP for breast cancer and to analyze the technical refinements that can enhance its efficacy in optimizing cosmetic defects.
  
  
  METHODS
  Different OPP are selected based on the location and size of the tumor as well as volume and shape of the breast. After excision of the tumor, glandular flaps are created by dissection of the residual parenchyma from the pectoralis and serratus muscles and from the skin. After careful haemostasis, five layers of ORC are positioned on the pectoralis major in the residual cavity and covered by advancement of the glandular flaps. Two additional layers of ORC are positioned above the flaps and covered by cutaneous-subcutaenous flaps.
  
  
  RESULTS
  The use of ORC after OPP has shown promising preliminary results, indicating a good tolerability and positive effects on cosmesis.
  
  
  CONCLUSIONS
  This simple and reliable surgical technique may allow not only to reduce the rate of post-operative bleeding and infection at the surgical site but also to improve cosmetic results.
authors.affiliation: Multidisciplinary Breast Center, School of Medicine,Catholic University of the "Sacred Heart", Rome, Italy. franceschinigianluca@gmail.com
authors.forename: G
authors.initials: G
authors.lastname: Franceschini
authors.forename: G
authors.initials: G
authors.lastname: Visconti
authors.forename: D
authors.initials: D
authors.lastname: Terribile
authors.forename: C
authors.initials: C
authors.lastname: Fabbri
authors.forename: S
authors.initials: S
authors.lastname: Magno
authors.forename: A
authors.initials: A
authors.lastname: Di Leone
authors.forename: M
authors.initials: M
authors.lastname: Salgarello
authors.forename: R
authors.initials: R
authors.lastname: Masetti
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002483:Cellulose, Oxidized / Q000627:therapeutic use*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control; D047630:Depsipeptides; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects; D015412:Mastectomy, Segmental / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D012384:Rome; D013524:Surgical Flaps / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002483:Cellulose, Oxidized; D047630:Depsipeptides; C030051:didemnins