ROME BREAST SURGERY SYMPOSIUM RECONSTRUCTION AND AESTHETIC: OBTAINING SAFETY AND RESULTS

Roy de Vita, M.D. Stefano Pompei, M.D.

Rome, Sheraton Golf Parco de’ Medici

June 4-5-6, 2014

Under the Patronage of SICPRE Organizing Secretariat and CME Provider

Organizing Secretariat Event Manager: Michela Scarani - 0039 06 87757099 Project Manager: Patrizia Serenella - 0039 06 87756028 [email protected] www.alfafcm.com

Italian CME ACCREDITATION INFORMATION Nr. 3282 - 93162 Nr. 10,5 CME Credits The Congress is intended for the following figures (maximum 200 registrations) MEDICAL DOCTORS Disciplines: General Surgery; Oncology; Radiotherapist; Plastic and Reconstructive Surgery; Obstetrics & Gynecology; Thoracic Surgery; Dermatology and Venereology. NURSES In order to obtain CME Credits, participants must: • Attend 100 % of the Sessions indicated in the Program • Fill in the personal data form, the form evaluating the event, and the learning questionnaire, and give them back to the Organizing Secretariat at the end of the Congress

The CME certificate will be sent by certified e-mail after the Congress to the e-mail address given on the personal data form CONTENTS

Faculty 5 Pre-Congress Courses Program 6 Congress Program 8 Practical Information 28 Useful Numbers 29 Visit Rome 30 Sponsor 36 2

Scientifi c Program ROME BREAST SURGERY SYMPOSIUM RECONSTRUCTION AND AESTHETIC: OBTAINING SAFETY AND RESULTS

Scientifi c Committee Roy de Vita, M.D. Stefano Pompei, M.D.

Scientifi c Secretariat Ornella Abate Alfredo Altieri Floriana Arelli Ernesto Buccheri Guido Caravelli Maurizio Costantini Maria Chiara Drago Stefano Feliciano Lara Labardi Pierpaolo Gullo Fabio Marcasciano Massimo Panimolle Marcello Pozzi Antonio Varanese Giovanni Zoccali 3

Dear Friends,

Restoration of breast shape and morphology has been integrated in the breast cancer treatment regimens since many decades. Since breast reconstruction is considered to be an important therapeutic intervention as radiother- apy, chemotherapy, and tumor excision therapy the evolution of this fi eld was inevitable. The continuous improvement of breast reconstruction guidelines and surgical techniques, as well as the increasing availability of diff erent types of implants and biological or synthetic aids, justifi ably resulted in various combinations of instructions and opinions on Breast Reconstruction. There is, however, a shared consensus: The “multidisciplinary approach” ensures the best results in breast cancer treatment as well as breast reconstruction. A successful breast reconstruction includes, of course, the aesthetic result, and the parameters of an aesthetically appealing breast remain the same as in Cosmetic Surgery. We believe the benefi t of knowledge sharing is tremendous and therefore International Opinion Leaders in the fi eld of “Senology” are gathered in this meeting to present their experience and re- search results. This Symposium includes not only presentations but also constructive discussions and videoconfer- ences from experts around the globe about indications, results and complications. Attention is equally given to reconstructive as well as aesthetic breast surgery since the two fi elds are interdependent. Opinion-leaders will participate in special “boxe-ring” sessions that will consist in debates and critical discussion of crucial topics. We would like to welcome you here and we hope you enjoy the conference as much as you enjoy Rome in June.

Roy de Vita Stefano Pompei 4 5

FACULTY

Scientific Committee Roy de Vita Stefano Pompei

International Faculty Italian Faculty Claudia Albornoz, New York - USA Pietro Berrino, Genoa Eric Auclair, Paris - France Luigi Cataliotti, Florence Ricardo Baroudi, Campinas - Brasil ​​​​​ Valerio Cervelli, Rome Antonio Roberto Bozola, San José de Rio Preto - Brasil​​ Flori Degrassi, Rome Karl Heinz Breuing, Essen - Germany Franco Di Filippo, Rome Mitch Brown, Toronto - Canada Stefano Drago, Rome Peter Gabriel Cordeiro, New York - USA​​​​​ Lucio Fortunato, Rome José Luis MartÍn Del Yerro Coca, Madrid - Spain Giovanni Battista Grassi, Rome Michael Douek, Londra - UK Andrea Grisotti, Milan Jian Farhadi, Londra - UK Riccardo Masetti, Rome Luiz Fernando Frascino, San José de Rio Preto - Brasil Paolo Persichetti, Rome Clifford Hudis, New York - USA​​​​​ Enrico Robotti, Bergamo Steven Kronowitz, Houston - USA Marzia Salgarello, Rome Douglas Macmillan, Nottingham - UK Pierluigi Santi, Genoa Patrick Mallucci, London - UK Maurizio Valeriani, Rome Ricardo Marujo, São Paulo - Brasil​​​​ Michele Zocchi, Milan Jaume Masià, Barcelona - Spain Colleen McCarthy, New York - USA​​​​​ Stephen McCulley, Nottingham - UK Babak J. Mehara, New York - USA​​​​​ José Mendes Junior, Sorocaba - Brasil​​​​ Virgilio Sacchini, New York - USA​​​​​ 6

PRE-CONGRESS COURSES PROGRAM

June 4th 08.00 - 08.30 REGISTRATION

08.30 - 10.30 NEW TRENDS AND REFINEMENTS IN BR Discussants: M. Douek, J. Masià • Prevention and management of early complications in BR - J. Farhadi • Autologous or implant based immediate BR? - D. Macmillan • ADM + implant based reconstruction - M. Brown • Actual role of two stages reconstruction - P. Cordeiro • Reshaping of residual breasts after BCT - D. Macmillan • Impact of RT on implant based and autologour reconstruction - S. Kronowitz Discussion and “take home concepts”

10.30 - 11.00 COFFEE BREAK

11.00 - 13.00 HOT TOPICS IN BREAST ENLARGEMENT Discussants: E. Robotti, J. Mendes • Fat and/or implant for breast enlargement - E. Auclair • The access choice - L.F. Frascino • The choice of the implant shape: my personal criteria for different cases -J.L. M. Del Yerro Coca; P. Mallucci • Revisional breast augmentation - R. Marujo Discussion and “take home concepts” 7

YOUR NOTES 8

CONGRESS PROGRAM

June 4th

13.00 - 13.45 REGISTRATION

13.45 - 14.00 OPENING AND WELCOME - R. DE VITA, S. POMPEI GREETING SESSION - R. MAZZOLA

14.00 - 15.15 VIDEOCONFERENCE SESSION FROM MEMORIAL SLOAN KETTERING CANCER CENTER, NEW YORK Coordinator in Rome: P. Cordeiro • Current State of Breast Surgery - V. Sacchini • New developments in adjuvant therapy - C. Hudis • Understanding lymphedema: what is the best approach to treatment? - B. Mehrara • Quality of life and patient satisfaction after breast reconstruction-what do our patients really think? - C. McCarthy • Do high volume breast centers provide better outcome in autologous reconstruction? - C. Albornoz Discussion and “take home concepts”

15.15 - 15.40 OPENING LECTURES • Quality control in breast cancer surgery - L. Cataliotti • Local treatment of Breast Cancer: where are we today? - R. Masetti • The role of the “Breast Unit” and volunteer associations - F. Degrassi 9

YOUR NOTES 10

June 4th

15.40 - 16.40 FOCUS ON BCS WITH PARTIAL RESECTIONS Discussants: S. Kronowitz, P. Persichetti • Oncological features in BCT - M. Douek • Consideration of the outcome in BCS - D. Macmillan • Superior and inferior pedicle flaps after BCS - S. McCulley • Local perforator flaps for partial defect in BR - J. Masià Discussion and “take home concepts”

16.40 - 17.10 COFFEE BREAK

17.10 - 18.10 CRITICAL CHOICES IN BR Discussants: G.B. Grassi, M. Salgarello • Risk factors for mastectomy flap necrosis and strategies to manage them - L. Fortunato • Optimal incisions in SSM and NSM for implant breast reconstruction - F. Di Filippo • Choosing the right prosthesis in one stage implant reconstruction - K. Breuing • Treatment proposals in breast carcinoma in genetically predisposed patients - S. Drago • Therapeutic Mammaplasty for BCS in smaller breasts - D. Macmillan Discussion and “take home concepts” 11

YOUR NOTES 12

June 4th

18.10 - 19.00 BR AND RT Discussants: M.Douek , J. Farhadi • “Immediate-delayed” BR and RT - S. Kronowitz • Polyurethane implants: defining their role and their long term outcome in BR with and no RT S. Pompei • Effect of RT on autologous tissue - S. McCulley • ADM and implant reconstruction with RT - M. Brown Discussion and “take home concepts”

19.00 - 19.15 CLOSING REMARKS 13

YOUR NOTES 14

June 5th

08.30 - 09.30 THE ADM ERA Discussants: S. McCulley, P. Santi • The learning curve in ADM use - J. Farhadi • The M.D. Anderson experience with ADM - S. Kronowitz • Alloplastic Meshes: an effective alternative to ADM ? - K. Breuing • Experience with different kinds of ADM - M. Douek • ADM and Meshes: do they have a future? - R. de Vita Discussion and “take home concepts”

09.30 - 10.20 BR: PRESENT AND FUTURE TRENDS Discussants: M. Douek, A. Grisotti • The fat grafting in BR : technique and outcome - P.L. Santi • Oncoplastic approach in extremes ages - G.B. Grassi • Adipose-derived Stem Cell (ADSC): present and future - V. Cervelli • Management of breast edema: limphonode transfer - J. Masià Discussion and “take home concepts”

10.20 - 11.00 COFFEE BREAK 15

YOUR NOTES 16

June 5th

11.00 - 12.00 AUTOLOGOUS BR: DEFINING A REALISTIC ROLE Discussants: P. Cordeiro, P. Santi • Indications for non abdominal free flaps - J. Masià • Tips and tricks for DIEP flap reconstruction - S. McCulley • Impact of RT on immediate autologous BR - S. Kronowitz • Extended LD flap: a realistic alternative to implants - E. Robotti Discussion and “take home concepts”

12.00 - 12.55 THE BOXING RING CONTROVERSIAL TOPICS ON RECONSTRUCTIVE SURGERY Referees: D. Macmillan, S. Kronowitz • BR with ADM: Does it have a realistic future? - J. Farhadi vs P. Cordeiro • Fat grafting and oncological safety - P. Cordeiro vs M. Zocchi Discussion and “take home concepts”

12.55 - 14.00 LUNCH 17

YOUR NOTES 18

June 5th

14.00 - 15.00 THE ABSTRACTS’ CHALLENGE RESULTS AND STABILITY OVER TIME HAVING THE COMMON DENOMINATOR OF BR AND AESTHETIC SURGERY Judges: J.L.M. Del Yerro Coca, L.F. Frascino, E. Robotti Discussion and “take home concepts”

15.00 - 16.15 VIDEOCONFERENCE SESSION FROM SÃO PAULO, BRAZIL Coordinators in Rome: E. Auclair, L.F. Frascino Faculty from São Paulo: R. Baroudi, A.R. Bozola • Preferences of pedice • Long term results regarding types of scars: myths and reality • Mammoplasties after extreme weight loss • Mastopexy with no implants: upper pole fullness • How to avoid recurrence of ptosis • Hypomastia and high degrees of ptosis: how to manage them Discussion and “take home concepts”

16.15 - 16.45 COFFEE BREAK 19

YOUR NOTES 20

June 5th

16.45 - 18.30 THE BOXING RING CONTROVERSIAL TOPICS ON BREAST AUGMENTATION Referees: J. Farhadi, L.F. Frascino • Round vs shaped implants - J.L.M. Del Yerro Coca vs J. Mendes • The accesses: periareolar/fold vs axilla - M. Brown vs R. Marujo • Textured vs micropolyurethane - R. de Vita vs S. Pompei • Lipoaugmentation: fat alone vs fat and implants - E. Auclair vs M. Zocchi Discussion and “take home concepts”

18.30 - 18.45 CLOSING REMARKS 21

YOUR NOTES 22

June 6th

08.30 - 10.00 REVISIONAL AESTHETIC BREAST SURGERY Discussants: L.F. Frascino, R. Marujo, M. Valeriani • How to avoid rotation and malposition deformities in breast augmentation with anatomical im- plants - J.L.M. Del Yerro Coca • Defects and restoring the IMF - M. Brown • The role of ADM in revisional breast surgery - J. Farhadi • The use of fat in revisional breast surgery - E. Auclair • Capsular contracture: how to manage it - A. Grisotti • Explantation of implants: tips and tricks - P. Mallucci • Unusual complications: how one solves them - J. Mendes Discussion and “take home concepts”

10.00 - 10.30 COFFEE BREAK

10.30 - 11.40 CORE TOPICS IN MASTOPEXY/REDUCTION MAMMOPLASTY Discussants: J.L.M. Del Yerro Coca, M. Brown • Preference of superior pedicles - L.F. Frascino • The Periareolar approach - P. Berrino • Inverted T and vertical scar: why and when - R. Marujo • Mastopexy and fat grafting - A. Grisotti • Tuberous breast and other challenging deformities - P. Mallucci Discussion and “take home concepts” 23

YOUR NOTES 24

June 6th

11.40 - 13.00 ROUND TABLE COMPLICATIONS IN AESTHETIC BREAST SURGERY: HOW ONE TRIES TO PREVENT AND SOLVE THEM Discussants: E. Auclair, J. Mendes Speakers: P. Berrino, K. Breuing, J.L.M. Del Yerro Coca, L.F. Frascino, P. Mallucci, M. Salgarello Discussion and “take home concepts”

13.00 - 13.10 CLOSING REMARKS - R. DE VITA, S. POMPEI 25

YOUR NOTES 26

YOUR NOTES 27

YOUR NOTES 28

PRACTICAL INFORMATION

Organizing Secretariat

Alfa FCM Srl Headquarters: Via Paolo Emilio, 7 - 00192 Rome Legal Office: Viale Mazzini, 6 - 00195 Rome E-mail address: [email protected] Telephone numbers: 0039 0687757099 - 0039 06 87758855 Fax number: 0039 0687758886 Congress Website: www.romebreastsurgery.it Website: www.alfafcm.com

Conference Venue Dinner 5th June Sherathon Golf Parco de’ Medici Hotel TERRAZZA SAVOIA 39, Viale Salvatore Rebecchini Sherathon Golf Parco de’ Medici Hotel Rome, 00148 39, Viale Salvatore Rebecchini GPS ‘41.816049,12.412311’ Rome, 00148 Italy Telephone number: 0039 (06) 65288 GPS ‘41.816049,12.412311’ Fax number: 0039 (06) 65287060 Telephone number: 0039 (06) 65288 Fax number: 0039 (06) 65287060 29

USEFUL NUMBERS

Healthcare Flying Squad: 118 Opened Pharmacies: 06-228941

Transportation Taxi Service (Roma Capitale): 06-0609 Rome Public Transport (Atac Spa): 800-431784 (www.atac.roma.it) Regional Public Transport (Cotral): 800-150008 (www.cotralspa.it) National Trains Service (Trenitalia): 89.20.21

Public Safety Firefighters: 115 State Police: 113 Municipal Police: 06-67691 Italian Police: 112 Rome Central Police Station: 06-4826.035 - 06-4826.976 30

VISIT ROME

Ancient Capital of the Roman Empire, seat of Catholic Cristianity and cradle of Western Civilization, the city of Rome bears witness to nearly three millennia of history. Its historic centre, a UNESCO world heritage site, is rich in vistas of rare beauty and priceless artistic treasures. There’s more to see here than in any other city in the world, with the relics of over two thousand years of inhabitation packed into its sprawling urban area. You could spend a month here and still only scratch the surface There are of course the city’s classical features, most visibly the , and the Forum and Pala- tine Hill; but from here there’s an almost uninterrupted sequence of monuments - from early Chris- tian basilicas, Romanesque churches, Renaissance palaces, right up to the fountains and churches of the Baroque period, which perhaps more than any other era has determined the look of the city today. There is the modern epoch too, from the ponderous Neoclassical architecture of the post-Unifica- tion period to the self-publicizing edifices of the Mussolini years.

MAIN ATTRACTIONS

Capitoline Hill was the original Capitol of the ancient city and continues to serve as the seat of the city’s govern- ment. The main feature of the area is Michelangelo’s Piazza del Campidoglio, a testimony to the superiority of Renais- sance town planning. The piazza is bordered by three palaces: the Palazzo dei Conservatori and the twin structures of the Palazzo dei Senatori and Palazzo Nuovo which house the Musei Capi- tolini, containing the largest collection of classical statues in the world. Among the notable statues found here are the Dying Gaul and the Satyr, the Capitoline Wolf with Romulus and Remus and the Spinario. Paths cut along the side of the hill from the Campidoglio giving way to panoramic views of the an- cient sites of the Forum and Colosseum. Address: Piazza del Campidoglio; Telephone: 060608 Opening time: Museums open Tuesday to Sunday 9am to 8pm; Admission: €6.50

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Roman Forum (Foro Romano) The site of ancient Rome’s commercial, political and reli- gious centre retires in the valley between the Capitoline and Palatine hills. The Forum’s main thorough fare, , slices through the old market square and former civic centre. To make sense of the ruins and relics of the old Republic it is helpful to consult a map of the area. Some of the best preserved and most notable monuments include the impressive Arch of Septimus Severus - a construction designed to celebrate Roman vic- tory over the Parthinians - and the former atrium of the House of the Vestal Virgins and . Also of note are the Temple of Antoninus and Faustina, and the , built to celebrate Titus’ destruction of Jerusalem in AD70. To the right of the arch are stairs snaking up the through a series of terraces to the Farnese gardens. The scented avenue festooned with roses and orange trees gives way to a vista over the Forum. Address: Via dei Fori Imperiali; Telephone: 06 3996 7700; Opening time: Daily 8.30am to 1 hour before sunset Admission: €9.00 + pre booking fee €1,50 : Ticket lasts 2 days

The Colosseum This enduring symbol of ancient Rome tenaciously clings to its foundations as the site of former gladiatorial con- quests. Its architecture boasts an impressive array of Doric, Ionic and Corinthian columns and an underground net- work of cells, corridors, ramps and elevators that were used to transport animals from their cages to the arena. The magnificence of the original structure has been erod- ed through the years of pillaging and earthquakes so that only a skeletal framework remains. Address: Piazza del Colosseo; Telephone 06.39967700; Opening time: Daily 8.30am to 1 hour before sunset Admission: €9.00 + pre booking fee €1,50 : Ticket is valid for Colosseum and lasts 2 days

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Pantheon The stately Pantheon is one of the world’s most inspiring architectural designs. Fittingly built as a temple to the Gods by Hadrian in 120AD, its perfectly proportioned floating dome rests seductively on sturdy marble columns. The only light source flowing through the central oculus was used by the Romans to measure time (with the aid of a sundial) and the dates of equinoxes and solstices. The south transept houses the Carafa Chapel and the tomb of Fra Angelico rests under the left side of the altar. About 125 years ago, Raphael’s tomb was discovered here (fans still bring him flowers). Vittorio Emanuele II, king of Italy, and his successor, Umberto I, are interred here as well. Address: Piazza della Rotonda; Telephone: 06 6830 0230; Opening time: Monday to Saturday between 8.30am and 7.30pm and Sunday from 9am to 6pm; Admission: Free

The and The graceful steps built in 1725, elegantly curve their way from the Piazza di Spagna to the Church of Santa Trinità dei , a pastel tinted neoclassical building. The steps and the square take their names from the Span- ish Embassy, which used to be headquartered here The shopper’s paradise of Via Condotti leads back from the Spanish steps to , and during spring the steps are decorated with pink azaleas. At the foot of the steps lies Bernini’s boat-shaped Barcaccia fountain and to the right is Keats-Shelley Memorial House. The steps and the piazza below are always packed with a crowd: strolling, reading in the sun, brows- ing the vendors’ carts, and people-watching. Address: Piazza di Spagna Opening time: Shops are usually opened Monday to Saturday between 10:00am and 7.30pm and Sunday from 10:30am to 7:30pm; 33

Trevi Fountain (Fontana di Trevi) The tiny Piazza di Trevi has been immortalised through this fountain built for Pope Clement XII. Today this newly restored gem is a must on everybody’s itinerary. Supplied by water from the Acqua Vergine aqueduct and a triumph of the baroque style, it was based on the design of Nicolo Salvi and was completed in 1762. The design centers on the triumphant figure of Neptunus Rex, standing on a shell chariot drawn by winged steeds and led by a pair of tritons. Two allegorical figures in the side niches represent good health and fertility. Tossing a coin into the fountain is supposed to guarantee a return trip to Rome Address: Piazza di Trevi Opening time Always opened with the exception of Mondays when they clean the fountain

St Peter’s Basilica (Basilica di San Pietro) The Basilica lies above the reputed site of St. Peter’s tomb. It is an overwhelming interior containing notable sculp- tures including Michelangelo’s Pieta, which is protected by bullet-proof glass since the damaging attack on it in 1972. In the central aisle stands Arnolfo da Cambio’s bronze stat- ue of St Peter, its foot worn down by the constant flow of pilgrims’ kisses. Proudly resting above the papal altar is Bernini’s Throne of St Peter. The Vatican Grottoes, containing papal tombs, can be reached by steps from the statue of St Long- inus. The Necropolis is located one level below the grottoes. This is the legendary site of St Peter’s tomb and advance permission has to be obtained to view it. Address: Piazza San Pietro; Telephone: 06 6988 4466; Opening time: Daily between 7am and 7pm (April to September) and 7:00am to 6:00pm (October to March); Admission: Free ​ 34

The & Vatican Museums The Sistine Chapel’s famous ceiling painted by Michelan- gelo looms above the frescoes on the side walls that were painted by an illustrious team of artists that included Bot- ticelli, Ghirlandaio, Roselli, Pinturicchio, Signorelli and della Gatta. The altar wall is covered by Michelangelo’s Last Supper, revealing the figure of Christ hovering above centre and flanked by Mary and other saintly figures.

The Vatican Museums provide an inspiring visit to one of the world’s greatest collections of art. The galleries stretch over four miles (six km) and include the magnificent , the Etrus- can Museum and the Pio-Clementino Museum which boasts the world’s largest collection of Clas- sical statues. Address: Viale Vaticano; Telephone: 06 6988 Opening time: Monday to Saturday between 09:00am 06:00pm , last entry at 04:00pm Closed on Sundays (with the exception of last Sunday every Month) and Religious Holidays Admission: €14,oo. Free on the last Sunday of every month 35

Bus Tour City Sightseeing Rome will allow you to travel through history and visit the places where the ancient Romans lived their social and political life as well as to admire the great Papal Rome, with its fine buildings and beautiful churches, by just sitting comfortable on board our buses. You will be able to visit the many churches, monuments, palaces, squares and streets of Imperial and Christian Rome, of Baroque and Modern Rome. Each bus has a highly technological, multilingual commentary sys- tem in eight languages available for every passenger, which will not only keep you entertained, but also well informed about the city. You can admire the great monuments of ancient Rome like the Imperial Forums, the Coliseum and the . You will see the most beautiful Christian places like St. Peter’s Basilica and . One must also visit the squares and streets where the was written such as , Piazza della Repubblica, and Piazza Barberini. Then you can enjoy a walk among the coffee shops of the Dolce Vita in and later drive along the river Tevere and admire Trastevere, one of the old quarters of the City, with its typical restaurants and bars, where you can taste typical Roman dishes. Start from Terminal A: Termini-Marsala (Via Marsala, 7) Arrive to Terminal B: Largo Di Villa Peretti (Largo Di Villa Peretti, 1) Duration 100’ Price 22 euro Tel. +39 06 69797554 / +39 06 2283957 36

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