Gianluca Franceschini | Università Cattolica del Sacro Cuore (Catholic University of the Sacred Heart) (original) (raw)

Associate Professor of General Surgery and Head of Oncoplastic Surgery for the breast cancer treatment at the "Fondazione Policlinico Universitario Agostino Gemelli IRCCS", Catholic University, Rome - Italy.

Senior breast surgeon with expertise in the surgical treatment of breast tumors and oncoplastic techniques; over 4.000 surgical procedures for breast cancer in the past 10 years.

Author of over 200 scientific papers in international journals and 15 textbook chapters (Orcid ID 0000-0002-2950-3395; Scopus Author ID 23027478400).

Professor at the School of Specialization in General Surgery, Plastic Surgery and Oncology at the Catholic University of Rome, Italy.

Member of Editorial Board for following scientific journals: The Breast Journal; Journal of Personalized Medicine; Translational Cancer Research; Annali Italiani di Chirurgia; Frontiers in Surgery; Minerva Chirurgica (Minerva Surgery); European Review for Medical and Pharmacological Sciences; European Journal of Breast Health; Frontiers in Oncology; Future Oncology; International Journal of Breast Cancer; Breast Cancer: Basic and Clinical Research; Translational Oncology; Cancer Treatment and Research Communications; Annals of Breast Surgery; Precision Cancer Medicine; Surgery in Practice and Science; Clinical and Experimental Obstetrics & Gynecology”; Technology in Cancer Research and Treatment; BMC Women’s Health.

Winner of the price with Medal, awarded by the President of "The Royal College of Radiologists", for the best work published in the scientific journal "Clinical Radiology" in 2010 (Diffusion-weighted imaging in breast cancer: relationship between apparent diffusion coefficient and tumour aggressiveness. Clinical Radiology. 65; 2010; 1005-1012).

Winner of the prize about "The Awards for High Quality Publications" awarded by the Catholic University in 2020 (Internal surgical use of biodegradable carbohydrate polymers. Warning for a conscious and proper use of oxidized regenerated cellulose. Carbohydr Polym. 2019 Jul 15;216:213-216).

Creator of the "ADAPTED01 Breast Cancer" application, available on the Google Play Store, used in breast cancer oncology.

Founding Partner and Member of the non-profit Organization, “Susan G. Komen Italia”.

Research and Teaching Fellow in the HopeXChange Medical Centre in Kumasi (Ghana).

Member of “REPRISE” (Register of the Scientific Experts for Italian Ministry of Education – MIUR).

Permanent Member of the College of Italian Breast Surgeons.
Phone: 0039.3201803270
Address: Largo Agostino Gemelli, 8
Rome - Italy

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Papers by Gianluca Franceschini

Frontiers in Oncology, Jun 24, 2022

Reproductive Sciences, Jul 14, 2023

Pharmacogenomics research and personalized medicine, 2021

Reports of Practical Oncology & Radiotherapy, Jul 1, 2020

focuses on the first experience in literature of a patient with a complicated Adult Onset Still's... more focuses on the first experience in literature of a patient with a complicated Adult Onset Still's Disease-related heart failure who thereafter underwent adjuvant radiotherapy for left breast cancer. Background: AOSD is a rare autoimmune inflammation-related disease, in which life-threatening pulmonary and cardiac complications can occur. In literature, AOSD is often associated with cancer, as paraneoplastic syndrome, but there are few data about primary AOSD and management of oncological therapies. Materials and Methods: A patient who needed adjuvant breast cancer radiotherapy underwent tumour board evaluation to define feasibility of an RT in a patient with of a history of a heart life-threatening complication 2 years before AOSD. Results of the review were discussed by a multidisciplinary panel of experts that chose the type of surgery, radiotherapy and monitoring of patient. Results: Literature review confirmed association of AOSD with BC in some pts and uniqueness of this treatment management experience. Patient underwent RT according to schedule of 40.05/2.67 Gy/fx on residual left breast and 10/2 Gy/fx on tumour bed with the gating technique. The panel chose to keep immunosuppressive therapy with anakinra. No complications were observed at clinical, ECG and laboratory examinations. Maximum toxicity was G2 skin. At first follow up AOSD signs of flare were negative. Conclusion: In conclusion, when oncological treatments, especially radiotherapy, are mandatory for AOSD pts, multidisciplinary management and tailored monitoring are necessary to avoid acute adverse effects and allow pts to complete therapies.

Lancet Oncology, Mar 1, 2022

BACKGROUND Patients with HER2-positive metastatic breast cancer have a high risk of developing br... more BACKGROUND Patients with HER2-positive metastatic breast cancer have a high risk of developing brain metastases. Efficacious treatment options are scarce. We investigated the activity and safety of pyrotinib plus capecitabine in patients with HER2-positive metastatic breast cancer and brain metastases. METHODS We did a multicentre, single-arm, two-cohort, phase 2 trial in eight tertiary hospitals in China. Patients aged 18 years or older who had radiotherapy-naive HER2-positive brain metastases (cohort A) or progressive disease after radiotherapy (cohort B), with an Eastern Cooperative Oncology Group performance status of 0-2, received pyrotinib 400 mg orally once daily, and capecitabine 1000 mg/m2 orally twice daily for 14 days, followed by 7 days off every 3 weeks until disease progression or unacceptable toxicity. The primary endpoint was confirmed intracranial objective response rate by investigator assessment according to the Response Evaluation Criteria In Solid Tumours (version 1.1). Activity and safety were analysed in patients with at least one dose of study drug. The study is ongoing, but recruitment is complete. The study is registered with ClinicalTrials.gov, NCT03691051. FINDINGS Between Jan 29, 2019, and July 10, 2020, we enrolled 78 women: 51 (86%) of 59 patients in cohort A and 18 (95%) of 19 patients in cohort B had previous exposure to trastuzumab. Median follow-up duration was 15·7 months (IQR 9·7-19·0). The intracranial objective response rate was 74·6% (95% CI 61·6-85·0; 44 of 59 patients) in cohort A and 42·1% (20·3-66·5; eight of 19 patients) in cohort B. The most common grade 3 or worse treatment-emergent adverse event was diarrhoea (14 [24%] in cohort A and four [21%] in cohort B). Two (3%) patients in cohort A and three (16%) in cohort B had treatment-related serious adverse events. No treatment-related deaths occurred. INTERPRETATION To our knowledge, this is the first prospective study showing the activity and safety of pyrotinib plus capecitabine in patients with HER2-positive breast cancer and brain metastases, especially in radiotherapy-naive population. This combination deserves further validation in a randomised, controlled trial. FUNDING National Cancer Centre Climbing Foundation Key Project of China, Jiangsu Hengrui Pharmaceuticals. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.

The standard of care for metastatic breast cancer (MBC) is systemic therapies with imbrication of... more The standard of care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment in case of symptomatology onset. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive disease presentations are even more common, leading to a change of paradigm of focal treatments. In fact, acknowledgement of behaviour of disease in these setting of patients is carrying aim of radiotherapy towards modalities with radical intent. The aim of this literature review is to analyse available clinical data regarding disease behaviour, imaging, radiotherapy and chemo-radiotherapy integration outcomes for understanding bone metastasis from breast cancer and the potential impact of targeting it.

Annals of Oncology, 2020

No abstract availabl

Frontiers in Oncology, Nov 9, 2023

Surgical treatment of breast cancer has significantly evolved over the last years. Quality of lif... more Surgical treatment of breast cancer has significantly evolved over the last years. Quality of life and cosmetic outcomes became an important part of breast cancer management. Indications for different types of breast and axillary techniques are reviewed in this article. We also consider a frequent but not widely known complication of breast surgery: axillary cording.

Cancers, Sep 21, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Clinical Breast Cancer, Oct 1, 2020

A correlation between phenotypical tumor characteristics, quantitative classical immunohistochemi... more A correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) from Oncotype DX results was used to develop a decision supporting system for clinical use. We created a freely available nomogram based on quantitative IHC results that allows prediction of RS £ 25 or £ 20. Prospective studies will test this application in clinical practice. Purpose: Oncotype DX (ODX) predicts breast cancer recurrence risk, guiding the choice of adjuvant treatment. In many countries, access to the test is not always available. We used correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) assessed by ODX to develop a decision supporting system for clinical use. Patients and Methods: Breast cancer patients who underwent ODX testing between 2014 and 2018 were retrospectively included in the study. The data selected for analysis were age, menopausal status, and pathologic and IHC features. IHC was performed with standardized quantitative methods. The data set was split into two subsets: 70% for the training set and 30% for the internal validation set. Statistically significant features were included in logistic models to predict RS 25 or 20. Another set was used for external validation to test reproducibility of prediction models. Results: The internal set included 407 patients. Mean (range) age was 53.7 (31-80) years, and 222 patients (54.55%) were > 50 years old. ODX results showed 67 patients (16.6%) had RS between 0 and 10, 272 patients between 11 and 25 (66.8%), and 68 patients > 26 (16.6%). Logistic regression analysis showed that RS score (for threshold 25) was significantly associated with estrogen receptor (P ¼ .004), progesterone receptor (P < .0001), and Ki-67 (P < .0001). Generalized linear regression resulted in a model that had an area under the receiver operating characteristic curve (AUC) of 92.2 (sensitivity 84.2%, specificity 80.1%) and that was well calibrated. The external validation set (183 patients) analysis confirmed the model performance, with an AUC of 82.3 and a positive predictive value of 91%.

Ejso, 2020

No abstract availabl

Ejso, May 1, 2021

No abstract availabl

Journal of Clinical Oncology

e12618 Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR)... more e12618 Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that allows to improve aesthetic results and patient quality of life. Traditionally, implants have been placed in a submuscolar (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of prosthesis is increasingly used in order to avoid morbidities related to manipulation of PMM. The aim of this study was to compare outcomes of SM vs PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: In this retrospective observational study we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our Istitution from January 2018 to December 2021. Conservative mastectomy was performed in 155 of the 400 patients that underwent NAC during the study period. Patients were divided in 2 groups based on the positionin...

Journal of Personalized Medicine, Mar 28, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Austin Journal of Surgery, 2021

Introduction: Granular cell tumor is a rare neoplasm of soft tissue and only in 1% of cases, it c... more Introduction: Granular cell tumor is a rare neoplasm of soft tissue and only in 1% of cases, it can shows a malignant behaviour. It is presumed to be a tumor originating from perineural or putative Schwann cells of peripheral nerves. Materials and Methods: We reviewed five patients affected by Granular cell tumor of the breast treated between January 2011 and January 2021 at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome, Italy. Results: All of the granular cell tumors presented as solitary, painless and firm lump, highly suggestive of malignancy. The radiological findings were heterogeneous and non-specific. All lesions presented as masses, more clearly evident on ultrasound as hypoechoic lesions, with irregular shape, blurred contours and borderline features. The tumors were composed of large polygonal cells with abundant eosinophilic granular cytoplasm and small, central nuclei, being immunohistochemically positive for S100, Vimentin (with variable staini...

Minerva surgery, 2021

No abstract availabl

The American Surgeon, 2021

Dear Editor I read with interest the original article of Huang J and would like to add some helpf... more Dear Editor I read with interest the original article of Huang J and would like to add some helpful advice to optimize total operating time in breast cancer patients undergoing mastectomy. When a breast-conserving approach cannot guarantee adequate local control and good cosmetic results, mastectomy should be selected; common indications to mastectomy include extensive or multicentric disease, inability to obtain clear surgical margins with conservative surgery, large tumor size with respect to the breast size, as well as cases with contraindications for radiotherapy as well as patient preference. Various surgical techniques can be adopted when a mastectomy is planned; however, “conservative mastectomies” (skin-sparing and nipple-sparing mastectomy) combined with immediate breast reconstruction are used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer; these innovative and complex techniques allow to optimize oncological and aesthetic outcomes and to increase patient quality of life. I agree with Huang J that “a number of preoperative factors such as BMI, unilateral vs bilateral mastectomy, type of mastectomy and reconstruction, use of intraoperative frozen sections, and receipt of neoadjuvant chemotherapy can influence operating room times. However, when a mastectomy is performed, surgeon’s knowledge and experience are necessary requirements to increase the chance of success and reduce operation times; mastectomy, especially when combined with immediate breast reconstruction, involves a series of more complex and demanding procedures that need adequate learning and specific surgical practice. I think that technical capacity and individual ability but also other attributes as decision-making skills and the repetitive performance of standardized tasks are essential prerequisites in order to optimize total operating time in patients undergoing mastectomy; so some specific steps should always be followed to save time, as:

The Breast Journal, 2019

Breast cancer treatment has gone through a dramatic shift over the past three decades, trending a... more Breast cancer treatment has gone through a dramatic shift over the past three decades, trending away from radical procedures toward breast-conserving techniques that provide patients with greater esthetic satisfaction. As a result, breast-conserving surgery (BCS) combined with adjuvant radiotherapy is now considered the "gold standard" for early breast cancer treatment, having confirmed same oncological outcomes of mastectomy. 1,2 In addition to offering overlapping rates of overall/disease-free survival (DFS) and local recurrence, the aim of BCS is to reach a

Frontiers in Oncology, Jun 24, 2022

Reproductive Sciences, Jul 14, 2023

Pharmacogenomics research and personalized medicine, 2021

Reports of Practical Oncology & Radiotherapy, Jul 1, 2020

focuses on the first experience in literature of a patient with a complicated Adult Onset Still's... more focuses on the first experience in literature of a patient with a complicated Adult Onset Still's Disease-related heart failure who thereafter underwent adjuvant radiotherapy for left breast cancer. Background: AOSD is a rare autoimmune inflammation-related disease, in which life-threatening pulmonary and cardiac complications can occur. In literature, AOSD is often associated with cancer, as paraneoplastic syndrome, but there are few data about primary AOSD and management of oncological therapies. Materials and Methods: A patient who needed adjuvant breast cancer radiotherapy underwent tumour board evaluation to define feasibility of an RT in a patient with of a history of a heart life-threatening complication 2 years before AOSD. Results of the review were discussed by a multidisciplinary panel of experts that chose the type of surgery, radiotherapy and monitoring of patient. Results: Literature review confirmed association of AOSD with BC in some pts and uniqueness of this treatment management experience. Patient underwent RT according to schedule of 40.05/2.67 Gy/fx on residual left breast and 10/2 Gy/fx on tumour bed with the gating technique. The panel chose to keep immunosuppressive therapy with anakinra. No complications were observed at clinical, ECG and laboratory examinations. Maximum toxicity was G2 skin. At first follow up AOSD signs of flare were negative. Conclusion: In conclusion, when oncological treatments, especially radiotherapy, are mandatory for AOSD pts, multidisciplinary management and tailored monitoring are necessary to avoid acute adverse effects and allow pts to complete therapies.

Lancet Oncology, Mar 1, 2022

BACKGROUND Patients with HER2-positive metastatic breast cancer have a high risk of developing br... more BACKGROUND Patients with HER2-positive metastatic breast cancer have a high risk of developing brain metastases. Efficacious treatment options are scarce. We investigated the activity and safety of pyrotinib plus capecitabine in patients with HER2-positive metastatic breast cancer and brain metastases. METHODS We did a multicentre, single-arm, two-cohort, phase 2 trial in eight tertiary hospitals in China. Patients aged 18 years or older who had radiotherapy-naive HER2-positive brain metastases (cohort A) or progressive disease after radiotherapy (cohort B), with an Eastern Cooperative Oncology Group performance status of 0-2, received pyrotinib 400 mg orally once daily, and capecitabine 1000 mg/m2 orally twice daily for 14 days, followed by 7 days off every 3 weeks until disease progression or unacceptable toxicity. The primary endpoint was confirmed intracranial objective response rate by investigator assessment according to the Response Evaluation Criteria In Solid Tumours (version 1.1). Activity and safety were analysed in patients with at least one dose of study drug. The study is ongoing, but recruitment is complete. The study is registered with ClinicalTrials.gov, NCT03691051. FINDINGS Between Jan 29, 2019, and July 10, 2020, we enrolled 78 women: 51 (86%) of 59 patients in cohort A and 18 (95%) of 19 patients in cohort B had previous exposure to trastuzumab. Median follow-up duration was 15·7 months (IQR 9·7-19·0). The intracranial objective response rate was 74·6% (95% CI 61·6-85·0; 44 of 59 patients) in cohort A and 42·1% (20·3-66·5; eight of 19 patients) in cohort B. The most common grade 3 or worse treatment-emergent adverse event was diarrhoea (14 [24%] in cohort A and four [21%] in cohort B). Two (3%) patients in cohort A and three (16%) in cohort B had treatment-related serious adverse events. No treatment-related deaths occurred. INTERPRETATION To our knowledge, this is the first prospective study showing the activity and safety of pyrotinib plus capecitabine in patients with HER2-positive breast cancer and brain metastases, especially in radiotherapy-naive population. This combination deserves further validation in a randomised, controlled trial. FUNDING National Cancer Centre Climbing Foundation Key Project of China, Jiangsu Hengrui Pharmaceuticals. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.

The standard of care for metastatic breast cancer (MBC) is systemic therapies with imbrication of... more The standard of care for metastatic breast cancer (MBC) is systemic therapies with imbrication of focal treatment in case of symptomatology onset. Recently, thanks to implementation of radiological and metabolic exams and development of new target therapies, oligometastatic and oligoprogressive disease presentations are even more common, leading to a change of paradigm of focal treatments. In fact, acknowledgement of behaviour of disease in these setting of patients is carrying aim of radiotherapy towards modalities with radical intent. The aim of this literature review is to analyse available clinical data regarding disease behaviour, imaging, radiotherapy and chemo-radiotherapy integration outcomes for understanding bone metastasis from breast cancer and the potential impact of targeting it.

Annals of Oncology, 2020

No abstract availabl

Frontiers in Oncology, Nov 9, 2023

Surgical treatment of breast cancer has significantly evolved over the last years. Quality of lif... more Surgical treatment of breast cancer has significantly evolved over the last years. Quality of life and cosmetic outcomes became an important part of breast cancer management. Indications for different types of breast and axillary techniques are reviewed in this article. We also consider a frequent but not widely known complication of breast surgery: axillary cording.

Cancers, Sep 21, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Clinical Breast Cancer, Oct 1, 2020

A correlation between phenotypical tumor characteristics, quantitative classical immunohistochemi... more A correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) from Oncotype DX results was used to develop a decision supporting system for clinical use. We created a freely available nomogram based on quantitative IHC results that allows prediction of RS £ 25 or £ 20. Prospective studies will test this application in clinical practice. Purpose: Oncotype DX (ODX) predicts breast cancer recurrence risk, guiding the choice of adjuvant treatment. In many countries, access to the test is not always available. We used correlation between phenotypical tumor characteristics, quantitative classical immunohistochemistry (IHC), and recurrence score (RS) assessed by ODX to develop a decision supporting system for clinical use. Patients and Methods: Breast cancer patients who underwent ODX testing between 2014 and 2018 were retrospectively included in the study. The data selected for analysis were age, menopausal status, and pathologic and IHC features. IHC was performed with standardized quantitative methods. The data set was split into two subsets: 70% for the training set and 30% for the internal validation set. Statistically significant features were included in logistic models to predict RS 25 or 20. Another set was used for external validation to test reproducibility of prediction models. Results: The internal set included 407 patients. Mean (range) age was 53.7 (31-80) years, and 222 patients (54.55%) were > 50 years old. ODX results showed 67 patients (16.6%) had RS between 0 and 10, 272 patients between 11 and 25 (66.8%), and 68 patients > 26 (16.6%). Logistic regression analysis showed that RS score (for threshold 25) was significantly associated with estrogen receptor (P ¼ .004), progesterone receptor (P < .0001), and Ki-67 (P < .0001). Generalized linear regression resulted in a model that had an area under the receiver operating characteristic curve (AUC) of 92.2 (sensitivity 84.2%, specificity 80.1%) and that was well calibrated. The external validation set (183 patients) analysis confirmed the model performance, with an AUC of 82.3 and a positive predictive value of 91%.

Ejso, 2020

No abstract availabl

Ejso, May 1, 2021

No abstract availabl

Journal of Clinical Oncology

e12618 Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR)... more e12618 Background: Conservative mastectomy with immediate prosthetic breast reconstruction (IPBR) is an oncologically accepted technique that allows to improve aesthetic results and patient quality of life. Traditionally, implants have been placed in a submuscolar (SM) plane beneath the pectoralis major muscle (PMM). Recently, prepectoral (PP) placement of prosthesis is increasingly used in order to avoid morbidities related to manipulation of PMM. The aim of this study was to compare outcomes of SM vs PP IPBR after conservative mastectomy in patients with histologically proven breast cancer treated with neoadjuvant chemotherapy (NAC). Methods: In this retrospective observational study we analyzed two cohorts of patients that underwent mastectomy with IPBR after NAC in our Istitution from January 2018 to December 2021. Conservative mastectomy was performed in 155 of the 400 patients that underwent NAC during the study period. Patients were divided in 2 groups based on the positionin...

Journal of Personalized Medicine, Mar 28, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Austin Journal of Surgery, 2021

Introduction: Granular cell tumor is a rare neoplasm of soft tissue and only in 1% of cases, it c... more Introduction: Granular cell tumor is a rare neoplasm of soft tissue and only in 1% of cases, it can shows a malignant behaviour. It is presumed to be a tumor originating from perineural or putative Schwann cells of peripheral nerves. Materials and Methods: We reviewed five patients affected by Granular cell tumor of the breast treated between January 2011 and January 2021 at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome, Italy. Results: All of the granular cell tumors presented as solitary, painless and firm lump, highly suggestive of malignancy. The radiological findings were heterogeneous and non-specific. All lesions presented as masses, more clearly evident on ultrasound as hypoechoic lesions, with irregular shape, blurred contours and borderline features. The tumors were composed of large polygonal cells with abundant eosinophilic granular cytoplasm and small, central nuclei, being immunohistochemically positive for S100, Vimentin (with variable staini...

Minerva surgery, 2021

No abstract availabl

The American Surgeon, 2021

Dear Editor I read with interest the original article of Huang J and would like to add some helpf... more Dear Editor I read with interest the original article of Huang J and would like to add some helpful advice to optimize total operating time in breast cancer patients undergoing mastectomy. When a breast-conserving approach cannot guarantee adequate local control and good cosmetic results, mastectomy should be selected; common indications to mastectomy include extensive or multicentric disease, inability to obtain clear surgical margins with conservative surgery, large tumor size with respect to the breast size, as well as cases with contraindications for radiotherapy as well as patient preference. Various surgical techniques can be adopted when a mastectomy is planned; however, “conservative mastectomies” (skin-sparing and nipple-sparing mastectomy) combined with immediate breast reconstruction are used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer; these innovative and complex techniques allow to optimize oncological and aesthetic outcomes and to increase patient quality of life. I agree with Huang J that “a number of preoperative factors such as BMI, unilateral vs bilateral mastectomy, type of mastectomy and reconstruction, use of intraoperative frozen sections, and receipt of neoadjuvant chemotherapy can influence operating room times. However, when a mastectomy is performed, surgeon’s knowledge and experience are necessary requirements to increase the chance of success and reduce operation times; mastectomy, especially when combined with immediate breast reconstruction, involves a series of more complex and demanding procedures that need adequate learning and specific surgical practice. I think that technical capacity and individual ability but also other attributes as decision-making skills and the repetitive performance of standardized tasks are essential prerequisites in order to optimize total operating time in patients undergoing mastectomy; so some specific steps should always be followed to save time, as:

The Breast Journal, 2019

Breast cancer treatment has gone through a dramatic shift over the past three decades, trending a... more Breast cancer treatment has gone through a dramatic shift over the past three decades, trending away from radical procedures toward breast-conserving techniques that provide patients with greater esthetic satisfaction. As a result, breast-conserving surgery (BCS) combined with adjuvant radiotherapy is now considered the "gold standard" for early breast cancer treatment, having confirmed same oncological outcomes of mastectomy. 1,2 In addition to offering overlapping rates of overall/disease-free survival (DFS) and local recurrence, the aim of BCS is to reach a