Cicero Urban

• MD PhD
• Oncoplastic Surgery Consultant at Hospital Nossa Senhora das Graças

Historically, breast reconstruction was performed by plastic surgeons. The Brazilian Society of Mastology (SBM) implemented initiatives to improve breast surgeons’ training in oncoplastic techniques; however, the current proportion of surgeons performing these techniques remained unknown. This study aimed to determine the proportion of Brazilian br...

PURPOSE The nodal burden of patients with residual isolated tumor cells (ITCs) in the sentinel lymph nodes (SLNs) after neoadjuvant chemotherapy (NAC) (ypN0i+) is unknown, and axillary management is not standardized. We investigated rates of additional positive lymph nodes (LNs) at axillary lymph node dissection (ALND) and oncologic outcomes in pat...

Introduction Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fascio-cutaneous pedicled chest wall perforator flaps or local perforator fla...

Background: In patients with micro- and macrometastases in the sentinel lymph node (SLN) after neoadjuvant chemotherapy (NAC), additional positive nodes are found in >60% of cases and axillary lymph node dissection (ALND) is currently considered standard of care. The likelihood of finding additional positive lymph nodes in patients with residual is...

Background the use of nipple-sparing mastectomy (NSM) in local advanced breast cancer after neoadjuvant chemotherapy (NQT) is increasing, despite few studies on the subject. The aim of this systematic review was to determine the safety of NSM after neoadjuvant chemotherapy. Methods for this systematic review we searched MEDLINE; Cochrane; Scientif...

Background the use of nipple-sparing mastectomy (NSM) in local advanced breast cancer after neoadjuvant chemotherapy (NQT) is increasing, despite few studies on the subject. The aim of this systematic review was to determine the safety of NSM after neoadjuvant chemotherapy. Methods for this systematic review we searched MEDLINE; Cochrane; Scientif...

In this chapter, we analyze direct-to-implant prepectoral breast reconstruction in a single stage that is currently considered a cutting-edge, safe, and reproducible breast reconstruction technique, but with publications that systematically associate it with the use of different types of mesh. The question that we asked ourselves a few years ago an...

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 2...

Background: Routine 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. Me...

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...

O tumor de Krukenberg (TK) é uma entidade rara, caracterizada por neoplasia ovariana secundária a um tumor do trato gastrointestinal, freqüentemente bilateral, volumoso e assintomático. Afeta geralmente mulheres na quarta década de vida, correspondendo a l%-5% de todos os tumores ovarianos. Histologicamente são caracterizados por células neoplásica...

Neoplasia Endocrina Múltipla tipo 2B (NEM-2B) é uma síndrome incomum, herdada de forma autossômica dominante e com penetrância variável. Múltiplos órgãos são envolvidos, mas com uma tríade predominante de carcinoma medular de tireóide, feocromocitoma e ganglioneuromas do trato gastrointestinal. A maioria dos pacientes tem fácies característica, com...

Objective: The aim of this study was to report the results of prepectoral direct-to implant (DTI) reconstruction in nipple-sparing mastectomy (NSM), without acellular dermal matrices (ADM) or mesh. Methods: Multicenter cohort of patients, from 2013 to 2020, where all sizes and types of breasts, either for prophylactic or therapeutic surgical pur...

Several evidence has demonstrated the involvement of the ribosomal proteins (RPs) in many malignancies, however, the function and clinical relevance of the RPs in breast cancer remains unclear. The present study aims to contribute to the understanding of the role of the RPs in breast tumorigenesis and its clinical implications in the field of bioma...

Introduction Decision making in surgical oncology of the breast has increased its complexity over the last twenty years. This Delphi survey investigates the opinion of an expert panel about the decision making process in surgical procedures on the breast for oncological purposes. Methods Twenty-seven experts were invited to partake into a Delphi S...

Aim . Demand for nipple and skin sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenari...

Objective: Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast. Methods: Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconst...

Objective Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. Methods We conducted a retrospective r...

Breast cancer (BC) is the leading cause of death by this disease in women worldwide. Among the factors involved in tumorigenesis, long non-coding RNAs (lncRNAs) and their differential expression have been associated. Differences in gene expression may be triggered by variations in DNA sequence, including single nucleotide polymorphisms (SNPs). In t...

Male breast cancer (MBC) is a rare malignancy that accounts for about 1.8% of all breast cancer cases. In contrast to the high number of the "omics" studies in breast cancer in women, only recently molecular approaches have been performed in MBC research. High-throughput proteomics based methodologies are promisor strategies to characterize the MBC...

Long non-coding RNAs (lncRNAs) are functional transcripts with more than 200 nucleotides. These molecules exhibit great regulatory capacity and may act at different levels of gene expression regulation. Despite this regulatory versatility, the biology of these molecules is still poorly understood. Computational approaches are being increasingly use...

Introduction: Breast cancer (BC) is the most common type of cancer after non-melanoma skin tumors among Brazilian women, with 61.61 cases estimated for 100 thousand women in 2020. New biomarkers, such as miRNAs and selected proteins, are essential in personalized medicine. Objectives: To evaluate the expression and possible role of miR-146a-5p in s...

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 un...

The R337H is a TP53 germline pathogenic variant that has been associated with several types of cancers, including breast cancer. Our main objective was to determine the frequency of the R337H variant in sporadic breast cancer patients from Paraná state, South Brazil, its association with prognosis and its impact in genomic instability. The genotypi...

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...

Background and Objectives Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB iden...

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...

Pyoderma gangrenosum (PG) is a rare, ulcerative, and painful neutrophilic dermatosis of unknown cause associated with systemic diseases and/or pathergy phenomenon in 30% of cases. We report the case of a breast cancer patient submitted to oncoplastic conservative surgery followed by adjuvant radiotherapy, with long-term progression to PG. It’s rare...

Introduction: Breast reconstruction with prosthesis after mastectomy is currently the main reconstruction technique used in the world. The pre-pectoral prosthesis is progressively being more used, and has advantages in relation to the submuscular prosthesis, such as less pain in the postoperative period, decreased muscular deficit, breast animation...

Introduction: Mucinous cystadenocarcinoma (MCC) is a rare primary breast tumor, first described in 1998. It was removed from the WHO classification in 2012, due to lack of consensus about its definition. To our knowledge, only 25 cases have been published in the literature. Objective: Case report and discussion of a case of breast MCC diagnosed in...

Triple negative breast cancer (TNBC), a clinically aggressive breast cancer subtype, affects 15-35% of women from Latin America. Using an approach of direct integration of copy number and global miRNA profiling data, performed simultaneously in the same tumor specimens, we identified a panel of 17 miRNAs specifically associated with TNBC of ancestr...

Bioethics is the systematic study of the moral dimensions of the life sciences and health care, employing a variety of ethical methodologies in an interdisciplinary setting. The integration of bioethics in reconstructive breast cancer surgery is essential, because few diseases represent such a complexity from the scientific, psychological, therapeu...

The high level of responsibility in various vocations draws special attention to the educational programs required for competence. To be an aircraft pilot or naval commander, it is critically necessary to have a great number of hours spent at a simulator. The same condition must be expected from surgeons. The progressive evolution of breast surgery...

The first breast implants were created by Cronin [1] in 1962, and after that there was a big evolution in them. The initial concern was to find a biocompatible sort of material: properly tolerated by the body and also inert. In 1958, Scales [2] proposed a review of the criteria needed for implant considering biocompatibility:No chemical activityNo...

The incidence of breast cancer has increased all over the world, which can be a result of social-demographic changes and access to health-care services. Despite the increase in the incidence of breast cancer, an increase in mortality rate in developed countries has not been observed. Mammography is, currently, the most important method in breast ev...

It is estimated that 3% of all breast cancers may be diagnosed in pregnant women, and its incidence is expected to increase due to postpone childbearing. Management of this condition represents a challenge because, in contrast to other areas on breast oncology, there are no large randomized trials to guide surgical and clinical practice. Breast rec...

There are many gaps concerning satisfaction and quality of life of patients undergoing a breast cancer treatment. Some authors reveal high levels of satisfaction with their outcomes, though the findings are limited by the use of different methodologies and small series. Patients’ satisfaction is the result of the care and attention given as well as...

Although rupture is one of the main causes of implant removal, its real rate is difficult to quantify, especially in breast reconstruction. Most of the ruptures have no obvious traumatic origin and are silent or intracapsular, thus asymptomatic, and with a difficult diagnosis with conventional exams (mammogram and ultrasound). Magnetic resonance im...

Immediate breast reconstruction with anatomic form-stable implants, associated with skin and nipple-sparing mastectomies, represented one of the greatest advances in oncoplastic and reconstructive breast surgery. It has a low level of complications and decreases both the time spent in reconstructive surgeries and the number of surgeries for most pa...

Oncoplastic surgery (OP) represents such an evolution in breast cancer treatment. It allows better aesthetic-functional outcomes, broadening indications for breast-conserving treatment. Preoperative planning is the most important time in this kind of surgery. It implies in two fundamental aims: organization of surgical steps to follow in the theate...

Lipofilling is an autologous technique used in breast reconstruction. It is also known as “fat transfer,” “lipotransfer,” “fat injection,” or “fat transplantation,” as well as many other terminologies. The procedure consists of two major steps which are liposuction and lipoinjection of the patient’s own fat tissue and other tissue elements, either...

Breast cancer surgery has gone through various changes, and has become more complex and biologically individualized. Although the concern with local control of disease has still persisted, this is currently associated with an aesthetic-functional concept. Therefore, breast anatomy in the way it was traditionally approached requires updating. This c...

Disfiguring and mutilating surgeries can no longer be biologically and oncologically justified for most early breast cancer patients detected through screening programs. In this way, oncoplastic surgery represents a necessary evolution and a critical refinement in surgery. It combines oncologic and plastic surgery techniques in order to improve the...

The concept of oncoplastic surgery (OP) is not so complicated. If the surgeon can manage three “basic” reduction mammaplasty techniques such as techniques derived from the upper nipple and areola blood supply (superior pedicle) [1–3], techniques derived from the lower/posterior nipple and areola blood supply (inferior pedicle) [4–7], and techniques...

There are many algorithms and approaches for mastopexy and reduction patterns in oncoplastic surgery, including different skin reduction patterns, nipple and areola complex pedicles, and breast tissue rearrangements. Superior pedicle breast techniques are one of the most popular and useful in practice. Vertical and wise pattern techniques are highl...

Although one-step direct form-stable implant breast reconstruction has continued to grow in terms of popularity, immediate one- or two-stage tissue expander (definitive or temporary ones) remains as the preferred approach due to its relative simplicity. More conservative mastectomies, with the preservation of the inframammary fold, skin envelope, a...

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 patient...

Breast reconstruction in previously irradiated patients represents a difficult challenge to the surgeon due to the higher rates of complication and reconstruction failure that occur in this group of patients, especially with implants. Flaps remain the primary option, although for some very well-selected patients, implants can achieve satisfactory r...

Data present here describe a comparative proteomic analysis among the malignant [primary breast tumor (PT) and axillary metastatic lymph nodes (LN)], and the non-tumor [contralateral (NCT) and adjacent (ANT)] breast tissues. Protein identification and quantification were performed through label-free mass spectrometry using a nano-liquid chromatogra...

Copy number alterations (CNAs) are a frequent feature in human breast cancer, and one of the hallmarks of genomic instability. The FOSL1, GSTP1 and CCND1 genes are located at 11q13, a cytoband commonly affected by CNA in breast cancer, with relevant function in progression and invasion. Our main goal was to analyze CNAs of these genes and determine...

Proteins play an essential role in the biological processes associated with cancer. Their altered expression levels can deregulate critical cellular pathways and interactive networks. In this study, the mass spectrometry-based label-free quantification followed by functional annotation was performed to investigate the most significant deregulated p...

Clinico-pathological information, classification, follow up and DNA copy number of 73 patients.

MicroRNAs (miRNAs) play an essential role in gene expression and affect the development of tumours, including breast cancer (BC). Polymorphisms in miRNA genes can affect the interaction of miRNAs with their target messenger RNA by interfering, creating or disrupting target sites. The single nucleotide polymorphism (SNP) rs2910164, located in the se...

This book demonstrates why oncoplastic and reconstructive surgery represents such an exciting tool for surgeons who undertake breast surgery. Fundamental principles and basic concepts are clearly outlined, and numerous techniques are presented by acknowledged experts from across the world. The emphasis is very much on a “how to do” approach, with d...

PurposeIndications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice an...

Breast cancer is a very heterogeneous disease. The intrinsic molecular subtypes can explain the intertumoral heterogeneity and the cancer stem cell (CSC) hypothesis can explain the intratumoral heterogeneity of this kind of tumor. CD44+/CD24- phenotype and ALDH1 expression are the major CSC markers described in invasive breast cancer. In the presen...

Introduction: According to the cancer stem-cell theory, tumors originate from a small population of cancer stem cells, which lose the mechanism of self-regulation and begin to differentiate and proliferate indefinitely. The CD44 ⁺ /CD24 ⁻ phenotype may be considered a stem-cell marker in breast cancer. Objective: To evaluate the correlation between...

Introduction: Nipple-sparing mastectomy (NSM) and preservation of the nipple-areola complex (NAC) represent a therapeutic option of breast cancer with a better aesthetic result, a positive impact on body image and more satisfaction than the reconstruction of the same. It is questioned the indication of radiotherapy when the NAC is maintained and it...

Epidemiologic and molecular studies have shown that breast cancer subtypes are distributed unevenly among racial/ethnic groups. The incidence of the triple-negative breast cancer (TNBC) subtype in particular, one of the most clinically aggressive breast cancer subtypes, affects around 20% of women from Latin America, 24-28% of African-Americans, 6-...

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 patient...

Oncoplastic surgery (OP) represents an important evolution in breast cancer treatment, allowing better aesthetic outcomes and lower risks of compromising margins and reoperations. It is both a new surgical method and technical refinement. Therefore, the emphasis is on immediate partial reconstruction, with the synergic combination of plastic surger...

Oncoplastic and reconstructive surgery is an important part of the treatment of breast cancer. In Brazil there is a specialization in Mastology since 1978, fully dedicated to manage all diseases of the breast. There are 2 years of specific residence training, after specialization in General Surgery or Gynecology. Incorporation of the reconstructive...

Background and objectives: To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014. Methods: Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolut...

Introduction: Breast cancer is the most cause of death, and approximately 90% of these deaths are due to metastases. Matrix metalloproteinase-2 (MMP-2) gelatinase activity is able to degrade a major constituent of the tumor microenvironment, type IV collagen. Two well-established proteins used as markers in clinical practice for breast cancer are t...

A cirurgia oncoplástica e reconstrutiva da mama é parte importante do tratamento do câncer de mama, porém, faltam profissionais bem treinados e dedicados. Objetivo: Avaliar a eficácia do Programa de Educação Continuada Teórico-Prática em Oncoplastia e Reconstrução Mamária da Sociedade Brasileira de Mastologia no Hospital Araújo Jorge (HAJ), em Goiâ...

A reconstrucao mamaria em pacientes previamente irradiadas e realizada na maioria das vezes com o uso de retalhos miocutâneos. Esta sempre foi considerada como uma contraindicacao re? lativa para o uso de expansores e proteses. Este foi o primeiro relato do uso do pericardio bovino em reconstrucao mamaria imediata com protese definitiva em paciente...

In breast cancer, lymph node (LN) metastasis is one of the strongest prognostic factors at diagnosis. Therefore the identification of molecular markers with metastatic potential that promote the development of LN metastasis is of critical clinical relevance. In this study, we evaluated the copy number status of the FOSL1, GSTP1, NTSR1, FADD and CCN...

Breast cancer is the second most common cancer worldwide and the first among women. Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are the two major histological subtypes, and the clinical and molecular differences between them justify the search for new markers to distinguish them. As proteomic analysis allows for a powerful...

A biopsia do linfonodo sentinela (LS) e o procedimento padrao para as pacientes com axila clinicamente negativa. O seu exame intraoperatorio ainda gera dificuldades na sua abordagem. Assim, o objetivo deste estudo foi avaliar a eficacia desse exame no câncer de mama. Foram avaliadas 342 pacientes que foram operadas na Unidade de Mama do Hospital No...

Over time, variations of mastectomy came up and started allowing the oncological safety and the possibility of an immediate breast reconstruction. Nipple sparing mastectomy (NSM) procedures have strongly increased in frequency and have become one of the best alternatives to treat breast cancer, also improving overall aesthetic outcomes and the achi...

Background: Although there are many reports on different techniques in breast reconstruction, there are few data regarding immediate breast reconstruction with definitive form-stable anatomical implants in terms of aesthetics and quality-of-life outcomes. Methods: Ninety-four patients underwent mastectomy with immediate breast reconstruction usi...

MTAP is a ubiquitously expressed gene important for adenine and methionine salvage. The gene is located at 9p21, a chromosome region often deleted in breast carcinomas, similar to CDKN2A, a recognized tumor suppressor gene. Several research groups have shown that MTAP acts as a tumor suppressor, and some therapeutic approaches were proposed based o...

MTAP MS-PCR at breast cancer cell lines. M, methylated; U, unmethymated. (PPTX)

Effect of MTAP downregulation on the proliferation and the invasiveness of MDA-MB-435 cells. A. Western-blotting of MTAP, CDKN2A and β-Tubulin proteins at 48 and 72 hours from transfection with scramble siRNA and MTAP esiRNA. B. Proliferation of cells untransfected, transfected with scramble siRNA and transfected with MTAP esiRNA expressed as value...

RT-qPCR and MS-PCR primers. Primers sequences are in the sense 5’- 3’. m, methylated; u, unmethylated. (DOCX)

To the Editor: The results of the clinical trial reported by Chagpar et al. (Aug. 6 issue)(1) may be broadly applied to help both surgeons and patients avoid positive margins and reoperation after partial mastectomy for breast cancer. However, in this study, both the original resection of margins and the additional resection of circumferential marg...

Apesar do grande número de publicações em cirurgia oncoplástica e reconstrutiva da mama, diversas questões permanecem controversas. Assim, o objetivo desta Reunião de Consenso, foi desenvolver um guia prático de recomendações baseadas nas melhores evidências disponíveis na literatura. Método: Os painelistas foram os membros da Comissão de Cirurgia...

Background/aim: Breast cancer is the most common type of cancer among women worldwide, and about 57,000 new cases are expected for the Brazilian population in 2015. Elucidation of protein expression and modification is essential for the biological understanding, early diagnosis and therapeutics of breast cancer. The main objectives of the study ar...