Cicero Urban was born in Ponta Grossa (Brazil) in 1972. He is the Vice-President of the Brazilian Society of Mastology, former Dean at Positivo University Medical School, and former Chair of the Department of Surgery at Nossa Senhora das Graças Hospital in Curitiba, Brazil. He is a reviewer for numerous journals, and has authored and co-authored more than 150 peer-reviewed papers, 70 book chapters, and had also organized 6 books, 2 of them in Oncoplastic Surgery and Breast Reconstruction, which were published in English, Portuguese and Italian. His fields interest are oncoplastic surgery, breast implants, aesthetics and quality of life evaluation after breast reconstruction, bioethics, and medical education.
Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results ... more Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs. Objectives Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement. Methods A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital. Results The average follow-up time was 8.5 months (range, 3–17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, ...
Grey scale abdominal ultrasound was used in a total of 146 children for primary diagnostic evalua... more Grey scale abdominal ultrasound was used in a total of 146 children for primary diagnostic evaluation of abdominal masses and for follow-up of patients with malignant diseases. Of 93 patients examined for a suspected abdominal mass, 6 showed to have an intraabdominal tumour. In each case the site of tumour origin could be ascertained by ultrasound. The remaining 87 patients showed no pathological findings and have been tumour-free at routine follow-up studies. Sonography proved to be also useful in the follow-up of patients with malignant diseases. Local recurrence or metastases could be ruled out on the basis of sonographic findings alone in 32 out of 35 surgically treated patients, in 3 children with non-resectable tumours, changes in tumour size during radio- and chemotherapy could be studied. Diagnostic ultrasound was also of great importance in the assessment of complications after surgery, radio- and chemotherapy. So the early detection of hydronephrosis in 2 patients with treated nephroblastoma prevented a damage of the remaining kidney. Due to the high accuracy of sonography, invasive diagnostic methods could be restricted to a small number of patients in whom ultrasound failed to provide adequate information.
ARTIGOS ORIGINAIS ARTIGO DE REVISÃO RELATO DE CASO SUMÁRIO EDITORIAL Rev Bras Mastologia. 2013;23... more ARTIGOS ORIGINAIS ARTIGO DE REVISÃO RELATO DE CASO SUMÁRIO EDITORIAL Rev Bras Mastologia. 2013;23(3):59 C aros(as) amigos(as) mastologistas, Estamos trabalhando para reconstruir a Revista Brasileira de Mastologia (RBM). Para isso, várias ações estão sendo desenvolvidas: 1) Reformulamos os nosso corpo editorial, criando Editores Associados de várias especialidades integra-das à Mastologia: Oncologia Clínica, Medicina Translacional, Anatomia Patológica, Oncogenética, Rádio-Oncologia, Radiologia (Imagem), Estatística, Física Médica e Fisioterapia, além de Editores Associados Internacionais. Elaboramos um Corpo Editorial Técnico de pesquisadores que, além de avaliarem os artigos submetidos, facilitarão a nossa ascensão no Qualis da CAPES; 2) Atualmente, a nossa revista não tem mais indexações. Somos, desta forma, Qualis C, o que desmotiva o envio de trabalhos originais. Para que possamos solicitar novamente a indexação pelo LILACS (Qualis B5) e pelo SciELO (Qualis B4), deveremos, em pri...
Lamellipodin protein (Lpd), encoded by the RAPH1 gene, modulates the assembly of actin cytoskelet... more Lamellipodin protein (Lpd), encoded by the RAPH1 gene, modulates the assembly of actin cytoskeleton through its binding to the Ena/VASPs proteins, and acts in cellular motility and lamelipodial protrusion. The region where RAPH1 gene is located (2q33) is deleted in various types of cancer and the gene expression changes in tumors when compared to normal tissues. Amplifications and deletions of the RAPH1 gene were investigated in breast carcinoma samples, in order to determine the possible relationship of the gene with breast cancer tumorigenesis and lymph node metastasis. RAPH1 gene alterations were determined by relative quantification, standard curve method using Real-time PCR technique in samples of tumor and peripheral blood from 52 patients. Regression and correlation analyses were conducted using gene alterations and clinicopathological data. All samples analyzed were altered, with 63.5 % deletion cases and 36.5 % amplification cases. The logistic regression and correlation analysis with clinicopathological data did not show significant results. The results suggest that although the RAPH1 gene was deleted or amplified in all samples, the Lpd does not seem to play a major role in tumorigenesis of mammary carcinomas and probably other proteins, also involved in the process of cellular motility and metastasis, are acting more effectively for or against the migration of breast tumor cells.
MicroRNAs derived from extracellular vesicles (EV-miRNAs) are circulating miRNAs considered as po... more MicroRNAs derived from extracellular vesicles (EV-miRNAs) are circulating miRNAs considered as potential new diagnostic markers for cancer that can be easily detected in liquid biopsies. In this study, we performed RNA sequencing analysis as a screening strategy to identify EV-miRNAs derived from serum of clinically well-annotated breast cancer (BC) patients from the south of Brazil. EVs from three groups of samples (healthy controls (CT), luminal A (LA), and triple-negative (TNBC)) were isolated from serum using a precipitation method and analyzed by RNA-seq (screening phase). Subsequently, four EV-miRNAs (miR-142-5p, miR-150-5p, miR-320a, and miR-4433b-5p) were selected to be quantified by quantitative real-time PCR (RT-qPCR) in individual samples (test phase). A panel composed of miR-142-5p, miR-320a, and miR-4433b-5p distinguished BC patients from CT with an area under the curve (AUC) of 0.8387 (93.33% sensitivity, 68.75% specificity). The combination of miR-142-5p and miR-320a ...
Although immediate breast reconstruction after mastectomy is oncologically safe for most patients... more Although immediate breast reconstruction after mastectomy is oncologically safe for most patients, its use remains low worldwide. In addition, there are many disparities in its availability which are related to race, sociodemographic factors, and financial and cultural barriers. Then, delayed breast reconstruction remains an option for many patients. There are some surgical procedures that have minor risks, and many of them can be performed in day surgery, like expanders and definitive implants. However, in irradiated patients, it is necessary to do breast reconstruction with autologous flaps. So, the aim of this chapter was to cover the indications, preoperative evaluation, operative techniques, and complications related to delayed breast reconstruction.
Surgeons play an influential role in the care of the breast cancer patient. Oncoplastic surgery a... more Surgeons play an influential role in the care of the breast cancer patient. Oncoplastic surgery allows for an oncologic-aesthetic-functional individualized surgical approach. In this way, lateral pedicle mammoplasty is a valuable tool. It is particularly well suited for tumors of the upper-medial and medial quadrants of the breast. Tumors in these areas frequently result in bad aesthetic outcomes using traditional lumpectomy and quadrantectomy techniques. And no man’s land area is a very sensible area to the patient; therefore, all efforts should be made to avoid deformities there. Lateral pedicle mammoplasty has a low level of complications and allows the surgeon to perform a wide excision with disease-free margin, without compromising the overall shape of the breast and the no man’s land. In this chapter, main indications, pre-operative planning, step-by-step surgery, complications, advantages, and limitations of this technique are described.
BackgroundRoutine use of magnetic resonance imaging (MRI) in the staging of patients with early b... more BackgroundRoutine use of magnetic resonance imaging (MRI) in the staging of patients with early breast cancer is still controversial. Oncoplastic surgery (OP) allows for wider resections without compromising the aesthetic results. This study aimed to assess the impact of preoperative MRI on surgical planning and on indications of mastectomy.MethodsProspective study including T1-T2 breast cancer patients treated between January 2019 and December 2020 in the Breast Unit of the Hospital Nossa Senhora das Graças in Curitiba, Brazil. All patients had indication for breast conserving surgery (BCS) with OP and did a breast MRI after conventional imaging.Results131 patients were selected. Indication for BCS was based on clinical examination and conventional imaging (mammography and ultrasound) findings. After undergoing breast MRI, 110 patients (84.0%) underwent BCS with OP and 21 (16.0%) had their surgical procedure changed to mastectomy. Breast MRI revealed additional findings in 52 of 13...
Introduction: Surgery is the mainstay treatment of breast cancer and has been improving in aesthe... more Introduction: Surgery is the mainstay treatment of breast cancer and has been improving in aesthetic outcomes even in locally advanced disease. Radical mastectomies are being replaced by less aggressive surgeries with immediate breast reconstruction. Nipple-Sparing Mastectomy (NSM) preserves Nipple Areolar Complex (NAC) along with the entire breast skin envelope and is associated with better aesthetic results and quality of life, improving patient satisfaction. Since NSM is a relatively recent technique and few studies have shown the feasibility of NSM after neoadjuvant chemotherapy (NACT), there are some concerns and controversies about its oncological safety, especially, with regard to the NAC recurrence due to the remaining tissue in the retroareolar area. This study compares the long-term oncological outcomes and correlated factors of NSM and skin-sparing mastectomy (SSM) after NACT. Methods: After approval by the institution’s ethics committee a retrospective review was conduct...
Introduction: There is a consensus that breast reconstruction makes an important positive contrib... more Introduction: There is a consensus that breast reconstruction makes an important positive contribution to the quality of life of breast cancer patients. However, a large proportion of breast cancer survivors have unmet expectations surrounding reconstruction after mastectomy, particularly in relation to appearance. Approximately 40% of women who underwent breast reconstruction after mastectomy reported their reconstruction to be worse than expected. There is little consensus about what impact specific factors have on women`s satisfaction with breast reconstruction process and outcomes. Objectives: To delineate factors affecting preoperative native breast satisfaction and expectation with the surgery using the BREAST-Q in patients prior to oncological breast surgery following breast reconstruction. Methods: A prospective cross-sectional trial with breast cancer patients enrolled from November 2019 to December 2020 at Hospital Nossa Senhora das Graças Breast Unit in Curitiba, Brazil. ...
Although immediate breast reconstruction after mastectomy is oncologically safe for most patients... more Although immediate breast reconstruction after mastectomy is oncologically safe for most patients, its use remains low worldwide. In addition, there are many disparities in its availability which are related to race, sociodemographic factors, and financial and cultural barriers. Then, delayed breast reconstruction remains an option for many patients. There are some surgical procedures that have minor risks, and many of them can be performed in day surgery, like expanders and definitive implants. However, in irradiated patients, it is necessary to do breast reconstruction with autologous flaps. So, the aim of this chapter was to cover the indications, preoperative evaluation, operative techniques, and complications related to delayed breast reconstruction.
Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results ... more Background Direct-to-implant (DTI) breast reconstruction provides high-quality aesthetic results in appropriate candidates. Most commonly, implants are placed in the subpectoral space which can lead to pain and breast animation. Surgical and technological advances have allowed for successful prepectoral implant placement which may eliminate these trade-offs. Objectives Here we present early outcomes from 153 reconstructions in 94 patients who underwent prepectoral DTI. We sought to determine whether these patients have less postoperative pain and narcotic use than subpectoral implant or expander placement. Methods A retrospective review was performed for all prepectoral DTI reconstructions at our institution from 2015 to 2016. Data were collected on postoperative pain and narcotic use while in hospital. Results The average follow-up time was 8.5 months (range, 3–17 months) and the overall complication rate was 27% (n = 41) with the most common complications being skin necrosis (9%, ...
Grey scale abdominal ultrasound was used in a total of 146 children for primary diagnostic evalua... more Grey scale abdominal ultrasound was used in a total of 146 children for primary diagnostic evaluation of abdominal masses and for follow-up of patients with malignant diseases. Of 93 patients examined for a suspected abdominal mass, 6 showed to have an intraabdominal tumour. In each case the site of tumour origin could be ascertained by ultrasound. The remaining 87 patients showed no pathological findings and have been tumour-free at routine follow-up studies. Sonography proved to be also useful in the follow-up of patients with malignant diseases. Local recurrence or metastases could be ruled out on the basis of sonographic findings alone in 32 out of 35 surgically treated patients, in 3 children with non-resectable tumours, changes in tumour size during radio- and chemotherapy could be studied. Diagnostic ultrasound was also of great importance in the assessment of complications after surgery, radio- and chemotherapy. So the early detection of hydronephrosis in 2 patients with treated nephroblastoma prevented a damage of the remaining kidney. Due to the high accuracy of sonography, invasive diagnostic methods could be restricted to a small number of patients in whom ultrasound failed to provide adequate information.
ARTIGOS ORIGINAIS ARTIGO DE REVISÃO RELATO DE CASO SUMÁRIO EDITORIAL Rev Bras Mastologia. 2013;23... more ARTIGOS ORIGINAIS ARTIGO DE REVISÃO RELATO DE CASO SUMÁRIO EDITORIAL Rev Bras Mastologia. 2013;23(3):59 C aros(as) amigos(as) mastologistas, Estamos trabalhando para reconstruir a Revista Brasileira de Mastologia (RBM). Para isso, várias ações estão sendo desenvolvidas: 1) Reformulamos os nosso corpo editorial, criando Editores Associados de várias especialidades integra-das à Mastologia: Oncologia Clínica, Medicina Translacional, Anatomia Patológica, Oncogenética, Rádio-Oncologia, Radiologia (Imagem), Estatística, Física Médica e Fisioterapia, além de Editores Associados Internacionais. Elaboramos um Corpo Editorial Técnico de pesquisadores que, além de avaliarem os artigos submetidos, facilitarão a nossa ascensão no Qualis da CAPES; 2) Atualmente, a nossa revista não tem mais indexações. Somos, desta forma, Qualis C, o que desmotiva o envio de trabalhos originais. Para que possamos solicitar novamente a indexação pelo LILACS (Qualis B5) e pelo SciELO (Qualis B4), deveremos, em pri...
Lamellipodin protein (Lpd), encoded by the RAPH1 gene, modulates the assembly of actin cytoskelet... more Lamellipodin protein (Lpd), encoded by the RAPH1 gene, modulates the assembly of actin cytoskeleton through its binding to the Ena/VASPs proteins, and acts in cellular motility and lamelipodial protrusion. The region where RAPH1 gene is located (2q33) is deleted in various types of cancer and the gene expression changes in tumors when compared to normal tissues. Amplifications and deletions of the RAPH1 gene were investigated in breast carcinoma samples, in order to determine the possible relationship of the gene with breast cancer tumorigenesis and lymph node metastasis. RAPH1 gene alterations were determined by relative quantification, standard curve method using Real-time PCR technique in samples of tumor and peripheral blood from 52 patients. Regression and correlation analyses were conducted using gene alterations and clinicopathological data. All samples analyzed were altered, with 63.5 % deletion cases and 36.5 % amplification cases. The logistic regression and correlation analysis with clinicopathological data did not show significant results. The results suggest that although the RAPH1 gene was deleted or amplified in all samples, the Lpd does not seem to play a major role in tumorigenesis of mammary carcinomas and probably other proteins, also involved in the process of cellular motility and metastasis, are acting more effectively for or against the migration of breast tumor cells.
MicroRNAs derived from extracellular vesicles (EV-miRNAs) are circulating miRNAs considered as po... more MicroRNAs derived from extracellular vesicles (EV-miRNAs) are circulating miRNAs considered as potential new diagnostic markers for cancer that can be easily detected in liquid biopsies. In this study, we performed RNA sequencing analysis as a screening strategy to identify EV-miRNAs derived from serum of clinically well-annotated breast cancer (BC) patients from the south of Brazil. EVs from three groups of samples (healthy controls (CT), luminal A (LA), and triple-negative (TNBC)) were isolated from serum using a precipitation method and analyzed by RNA-seq (screening phase). Subsequently, four EV-miRNAs (miR-142-5p, miR-150-5p, miR-320a, and miR-4433b-5p) were selected to be quantified by quantitative real-time PCR (RT-qPCR) in individual samples (test phase). A panel composed of miR-142-5p, miR-320a, and miR-4433b-5p distinguished BC patients from CT with an area under the curve (AUC) of 0.8387 (93.33% sensitivity, 68.75% specificity). The combination of miR-142-5p and miR-320a ...
Although immediate breast reconstruction after mastectomy is oncologically safe for most patients... more Although immediate breast reconstruction after mastectomy is oncologically safe for most patients, its use remains low worldwide. In addition, there are many disparities in its availability which are related to race, sociodemographic factors, and financial and cultural barriers. Then, delayed breast reconstruction remains an option for many patients. There are some surgical procedures that have minor risks, and many of them can be performed in day surgery, like expanders and definitive implants. However, in irradiated patients, it is necessary to do breast reconstruction with autologous flaps. So, the aim of this chapter was to cover the indications, preoperative evaluation, operative techniques, and complications related to delayed breast reconstruction.
Surgeons play an influential role in the care of the breast cancer patient. Oncoplastic surgery a... more Surgeons play an influential role in the care of the breast cancer patient. Oncoplastic surgery allows for an oncologic-aesthetic-functional individualized surgical approach. In this way, lateral pedicle mammoplasty is a valuable tool. It is particularly well suited for tumors of the upper-medial and medial quadrants of the breast. Tumors in these areas frequently result in bad aesthetic outcomes using traditional lumpectomy and quadrantectomy techniques. And no man’s land area is a very sensible area to the patient; therefore, all efforts should be made to avoid deformities there. Lateral pedicle mammoplasty has a low level of complications and allows the surgeon to perform a wide excision with disease-free margin, without compromising the overall shape of the breast and the no man’s land. In this chapter, main indications, pre-operative planning, step-by-step surgery, complications, advantages, and limitations of this technique are described.
BackgroundRoutine use of magnetic resonance imaging (MRI) in the staging of patients with early b... more BackgroundRoutine use of magnetic resonance imaging (MRI) in the staging of patients with early breast cancer is still controversial. Oncoplastic surgery (OP) allows for wider resections without compromising the aesthetic results. This study aimed to assess the impact of preoperative MRI on surgical planning and on indications of mastectomy.MethodsProspective study including T1-T2 breast cancer patients treated between January 2019 and December 2020 in the Breast Unit of the Hospital Nossa Senhora das Graças in Curitiba, Brazil. All patients had indication for breast conserving surgery (BCS) with OP and did a breast MRI after conventional imaging.Results131 patients were selected. Indication for BCS was based on clinical examination and conventional imaging (mammography and ultrasound) findings. After undergoing breast MRI, 110 patients (84.0%) underwent BCS with OP and 21 (16.0%) had their surgical procedure changed to mastectomy. Breast MRI revealed additional findings in 52 of 13...
Introduction: Surgery is the mainstay treatment of breast cancer and has been improving in aesthe... more Introduction: Surgery is the mainstay treatment of breast cancer and has been improving in aesthetic outcomes even in locally advanced disease. Radical mastectomies are being replaced by less aggressive surgeries with immediate breast reconstruction. Nipple-Sparing Mastectomy (NSM) preserves Nipple Areolar Complex (NAC) along with the entire breast skin envelope and is associated with better aesthetic results and quality of life, improving patient satisfaction. Since NSM is a relatively recent technique and few studies have shown the feasibility of NSM after neoadjuvant chemotherapy (NACT), there are some concerns and controversies about its oncological safety, especially, with regard to the NAC recurrence due to the remaining tissue in the retroareolar area. This study compares the long-term oncological outcomes and correlated factors of NSM and skin-sparing mastectomy (SSM) after NACT. Methods: After approval by the institution’s ethics committee a retrospective review was conduct...
Introduction: There is a consensus that breast reconstruction makes an important positive contrib... more Introduction: There is a consensus that breast reconstruction makes an important positive contribution to the quality of life of breast cancer patients. However, a large proportion of breast cancer survivors have unmet expectations surrounding reconstruction after mastectomy, particularly in relation to appearance. Approximately 40% of women who underwent breast reconstruction after mastectomy reported their reconstruction to be worse than expected. There is little consensus about what impact specific factors have on women`s satisfaction with breast reconstruction process and outcomes. Objectives: To delineate factors affecting preoperative native breast satisfaction and expectation with the surgery using the BREAST-Q in patients prior to oncological breast surgery following breast reconstruction. Methods: A prospective cross-sectional trial with breast cancer patients enrolled from November 2019 to December 2020 at Hospital Nossa Senhora das Graças Breast Unit in Curitiba, Brazil. ...
Although immediate breast reconstruction after mastectomy is oncologically safe for most patients... more Although immediate breast reconstruction after mastectomy is oncologically safe for most patients, its use remains low worldwide. In addition, there are many disparities in its availability which are related to race, sociodemographic factors, and financial and cultural barriers. Then, delayed breast reconstruction remains an option for many patients. There are some surgical procedures that have minor risks, and many of them can be performed in day surgery, like expanders and definitive implants. However, in irradiated patients, it is necessary to do breast reconstruction with autologous flaps. So, the aim of this chapter was to cover the indications, preoperative evaluation, operative techniques, and complications related to delayed breast reconstruction.
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