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Papers by Eduardo Gonzalez

Mastology, 2020

You will not be right or wrong because the crowd does not agree with you. You will be right becau... more You will not be right or wrong because the crowd does not agree with you. You will be right because your data and reasoning are correct (Benjamín Graham).

Annals of Breast Surgery, 2021

Background: The objective of this study was to analyze the usefulness of immediate fat transfer t... more Background: The objective of this study was to analyze the usefulness of immediate fat transfer to prevent sequelae of both primary breast-conserving surgery and in a subgroup of patients with an indication for conservative surgery after neoadjuvant treatment. Methods: Ninety-one patients who underwent breast-conserving surgery and breast reconstruction with autologous fat transfer in the same surgery were included. Sixty-one underwent primary surgery without neoadjuvant treatment (BCT-AFT) and 30 patients underwent surgery after neoadjuvant treatment (BCT-AFT-NEO). Patients included in the BCT-AFT group had stage I (15%) and stage II (85%) disease, and their immunohistochemical profile was Luminal A 65.5% and Luminal B 34.5%. In the BCT-AFT-NEO group, 76.5% were stage III and the rest in stage II 24.5%, their immunohistochemical profile was Luminal A in 6.5%, Luminal B: 56.5%, triple negative: 26.5% and Her2+ 10%. All patients received adjuvant radiotherapy and systemic treatment in accordance with the Institution's guidelines. The fat was transferred to the breast tissue, the retromammary region and the subcutaneous tissue after glandular modeling. The mean volume of fat transferred was 85 g (range, 45-225 g). Results: The cosmetic evaluation showed very good or good results in 89% of the patients. Followup mammography at 6 and 18 months showed 2 BIRADS IV images that were biopsied and were cytosteatonecrosis. The overall rate of surgical complications for the entire series was 5.49%. The mean follow-up was 25.21 months in the BCT-AFT group and 20.9 months in the BCT-AFT-NEO group. None of the patients in either group developed locoregional recurrences during the study period. Two patients developed distant metastases Conclusions: This correctly indicated technique is promising in patients with invasive tumors with or without prior neoadjuvant treatment with an indication for conservative treatment. The high rate of good aesthetic results obtained was maintained in all patients beyond 18 months of radiotherapy. No local recurrences were recorded during the follow-up period in any of the subgroups analyzed. These variables need to be validated in longer-term follow-up and require multidisciplinary prospective trials to assess the role of immediate lipofilling in routine breast-conserving surgery in patients with breast cancer.

Plastic and reconstructive surgery. Global open, 2017

Digital mammography clearly distinguishes gland tissue density from the overlying nonglandular br... more Digital mammography clearly distinguishes gland tissue density from the overlying nonglandular breast tissue coverage, which corresponds to the existing tissue between the skin and the superficial layer of the fascia superficialis surrounding the gland (i.e., dermis and subcutaneous fat). Preoperative digital imaging can determine the thickness of this breast tissue coverage, thus facilitating planning and reducing the rate of necrotic complications after direct to implant (DTI) reconstruction in nipple sparing mastectomy (NSM). Thirty NSMs in 22 patients with type 3 tissue coverage (subcutaneous tissue thickness of 2 cm or more) were selected for DTI reconstruction after NSM to evaluate immediate skin flap/nipple areola complex ischemic complications and patient satisfaction. We experienced no wound healing problems or ischemic complications immediately after surgery in our population. Only 1 seroma was observed as a short-term complication. Quality of life and patients' satisf...

Gland surgery, 2015

The surgical treatment of breast cancer has evolved rapidly in recent decades. Conservative treat... more The surgical treatment of breast cancer has evolved rapidly in recent decades. Conservative treatment was adopted in the late 1970s, with rates above 70%, and this was followed by a period during which the indications for surgical intervention were expanded to those patients at high risk for BRCA1, BRCA2 mutations, and also due to new staging standards and use of nuclear magnetic resonance. This increase in the indications for mastectomy coincided with the availability of immediate breast reconstruction as an oncologically safe and important surgical procedure for prevention of sequelae. Immediate reconstruction was first aimed at correcting the consequences of treatment, and almost immediately, the challenge of the technique became the achievement of a satisfactory breast appearance and shape, as well as normal consistency. The skin-sparing mastectomy (SSM) in conservation first and nipple-areola complex (NAC) later was a result of this shift that occurred from the early 1990s to t...

Gland surgery, 2013

Conservative surgery has become the primary alternative in the treatment of breast cancer, and co... more Conservative surgery has become the primary alternative in the treatment of breast cancer, and cosmetic outcome fundamental goal, as well as oncologic control. Different options to achieve these goals are presented. Oncoplastic treatment of breast cancer needs planning and knowledge of well-established plastic surgery techniques.

Cirugía Plástica Ibero-Latinoamericana, 2013

Las mamas tuberosas, denominadas así por Rees y Aston, y también llamadas hernias del complejo ar... more Las mamas tuberosas, denominadas así por Rees y Aston, y también llamadas hernias del complejo areolar (Bass), Snoopy deformity (Gruber), mamas tubulares (Williams), hipoplasia del polo inferior (Brink) o mamas de base estrecha (Puckett), son una malformacion en el desarrollo del volumen mamario en los cuadrantes inferiores con hernia areolar secundaria (placa areolar y músculo mamilar débiles), areola ancha y protruida (en la mitad de los casos), ascenso del surco submamario, mamas hipotróficas y raramente hipertróficas, con asimetrías en las dos terceras partes de las pacientes. Presentamos la estrategia quirúrgica adecuada para resolver esta patología utilizando solo implantes anatómicos de gel cohesivo sin necesidad de tallar colgajos glandulares. De esta manera, disminuimos la morbilidad quirúrgica, ofreciendo resultados estables y con alta satisfaccion por parte de las pacientes.

Oncoplastic and Reconstructive Breast Surgery, 2013

Oncoplastic surgery was incorporated into the primary treatment of breast cancer to prevent the d... more Oncoplastic surgery was incorporated into the primary treatment of breast cancer to prevent the damaging consequences of this treatment and produced a significant benefit both aesthetically and psychologically without altering the oncological safety. In the conservative treatment although there are many reconstructive techniques to prevent sequelae, for different reasons there are a number of patients with unsatisfactory results magnified by the effects of radiotherapy. Traditionally, aggressive techniques with high rates of complications (autologous tissue, prosthetic) and unstable results were used for the reconstruction of these defects; however, in recent years the introduction of lipotransference opened up a promising new stage, achieving results in many cases that are highly satisfactory, stable, and with lower morbidity.

Ecancermedicalscience, 2013

Advances in reconstructive breast surgery with new materials and techniques now allow us to offer... more Advances in reconstructive breast surgery with new materials and techniques now allow us to offer our patients the best possible cosmetic results without the risks associated with oncological control of the disease. These advances, in both oncological and plastic surgery, have led to a new specialisation, namely oncoplastic breast surgery, which enables us to undertake large resections and, with advance planning, to prevent subsequent deformities. This is particularly important when more than 30% of the breast volume is removed, as it allows us to obtain precise information for conservative surgery according to the site of the lesion, and also allows us to set the boundary between conservative surgery and mastectomy.Given the existence of new alloplastic materials and new reconstructive techniques, it is essential for our patients that surgeons involved in breast cancer treatment are trained in both the oncological as well as the reconstructive and aesthetic fields, to enable them t...

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2013

Background and aim: Skin-sparing mastectomy (SSM) and immediate one-step breast reconstruction wi... more Background and aim: Skin-sparing mastectomy (SSM) and immediate one-step breast reconstruction with implants has become an increasingly popular, effective treatment for selected patients with breast carcinoma. However, it is associated with high complication rates. Breast augmentation with polyurethane-covered implants (PCIs) has consistently had optimal short-term and long-term results with low rates of capsular contracture. The aim of this study was to evaluate the clinical and aesthetic outcomes of immediate one-step breast reconstruction with PCI after SSM in early breast cancer patients at a single institution. Methods: We reviewed the records of 221 consecutive breast cancer patients who underwent one-stage immediate reconstruction with PCI after SSM from 1995 through 2005. Patient and tumour characteristics, type of reconstruction, postoperative complications, aesthetic results and recurrence rate were analysed. Results: The mean age of the patients was 52 AE 11 years (range, 30e76; standard deviation (SD), 11). The American Joint Committee on Cancer (AJCC) pathologic stages were 0 (10%), I (63.3%) and II (26.7%). Thirty-nine (17.65%; confidence interval (CI) Z 13.04e23.1) of the 221 patients had complications; seven had prosthesis extrusion requiring an implant (five due to skin necrosis, one due to infection and one due to late haematoma). In six of these seven cases, the procedure was indicated for local recurrence after conservative breast surgery with adjunctive radiation therapy (rescue procedure). Thirty-two (14.4%) patients had minor complications: 12 had cutaneous rash, four had malpositioned implants and 16 had inadequate implant projection. At long-term follow-up, four (1.8%) patients had developed grade IV capsular contracture associated with postoperative radiation therapy. At a median follow-up of 98 months (range, 36e156), 14 (6.3%) patients had tumour recurrence and 12.2% had distant metastasis. Nineteen patients had died of cancer, and 192 (86.8%) remained disease free.