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Introduction This study aims to analyze whether there is any patient- or treatment-related factor that can influence patients' body perception after mastectomy and autologous or implant-based breast reconstruction. Materials and methods This retrospective cohort study included patients who underwent immediate implant-based or DIEP flap breast reconstruction. Predictive factors analyzed included chemotherapy, radiotherapy, hormone therapy, body mass index, age, type of mastectomy, and follow-up length. The BREAST-Q was administered postoperatively almost 2 years from the last surgical procedure. Mean BREAST-Q scores were reported for the overall cohort and by modality for the postoperative period. A linear regression model was applied to all BREAST-Q scores with all predictor factors. Results In total, 325 patients were enrolled in this study (133 DIEP flap and 192 implant-based reconstructions). The DIEP flap reconstruction group with a previous nipple sparing mastectomy showed the highest scores. Patients with a longer follow-up were less satisfied than the ones with a shorter follow-up, which could be considered as an assessment of the outcome. No significant difference was reported between patients who underwent radiotherapy, chemotherapy or hormone therapy and those who did not. Furthermore, age and BMI had no influence on patient satisfaction. Conclusion This study is the first that groups a large number of patients and analyzes predictive factors of long-term satisfaction of patients undergoing breast reconstruction. This can be regarded as a pilot study to raise the awareness of everyone's clinical practice to predict the attitude that patients have after surgery and to prepare them in the best possible way. Level of evidence iv This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com .

Autologous fat grafting (AFG), defined as the re-implant to the breast of fat tissue from different body areas, has been firstly applied to esthetic plastic surgery and then has moved to reconstructive surgery, mainly used for scar correction and opposite breast altering. Nevertheless, due to the potentially unsafe stem-like properties of adipocytes at the tumoral bed level, no clear evidence of the procedure’s oncological safety has been clearly documented at present. We retrospectively collected data of early breast cancer (BC) patients from 17 Italian Breast Units and assessed differences in terms of locoregional recurrence rate (LRR) and locoregional recurrence-free survival (LRFS) between patients who underwent AFG and patients who did not. Differences were analyzed in the entire cohort of invasive tumors and in different subgroups, according to prognostic biological subtypes. With a median follow-up time of 60 months, LRR was 5.3% (n = 71) in the matched population, 3.9% (n = 18) in the AFG group, and 6.1% (n = 53) in the non-AFG group, suggesting non-inferiority of AFG (p = 0.084). Building Kaplan–Meier curves confirmed non-inferiority of the AFG procedure for LRFS (aHR 0.73, 95% CI 0.41–1.30, p = 0.291). The same effect, in terms of LRFS, was also documented among different biological subtypes (luminal-like group, aHR 0.76, 95% CI 0.34–1.68, p = 0.493; HER2 enriched-like, aHR 0.89, 95% CI 0.19–4.22, p = 0.882; and TNBC, aHR 0.61, 95% CI 0.12–2.98, p = 0.543). Our study confirms in a very large, multicenter cohort of early BC patients that, aside the well-known benefits on the esthetic result, AFG do not interfere negatively with cancer prognosis.

Heterologous breast reconstruction after mastectomy sometimes requires the management of the contralateral breast to achieve symmetric long lasting aesthetic results. Some techniques could be used for the symmetrization of contralateral breast with or without implants as breast augmentation, reduction mammoplasty, mastopexy, with T inverted, J, vertical, periareolar, semi-circular, or axillary scars. The aim of this study is to present the use of crescent mastopexy technique with implants in contralateral adjustment following monolateral breast reconstruction compared with a control group in which patients underwent other contralateral procedures. We used BREAST-Q to evaluate breast perception and patient’s satisfaction and surgeon-rated aesthetic outcomes were measured using the Kroll evaluation (a global and itemized aesthetic tool). A retrospective study was designed. We enrolled in the study 55 patients who had undergone breast reconstruction with implants and contralateral breast symmetrization procedure at our hospital between 2010 and 2016, and they answered to BREAST-Q postoperative module after almost 1 year from breast reconstruction. The study population consisted of 2 groups of women: patient underwent contralateral adjustment with crescent mastopexy and augmentation and patients underwent other contralateral procedures. Statistical analysis was performed using descriptive and summary statistics to identify a central tendency between the two groups, we applied Fisher’s exact test to the results to obtain answers 1 year after the last procedure for the two groups. This cross-sectional study compared two cohorts in which 55 women underwent monolateral mastectomy and breast reconstruction with contralateral adjustment, 15 of these underwent contralateral crescent mastopexy with augmentation, and 40 (control group) underwent contralateral breast adjustment with other mastopexy and augmentation technique (27 patients underwent T inverted mastopexy, 2 J mastopexy, 6 vertical scar mastopexy, 5 periareolar mastopexy). Nineteen patients suffered of co-morbidities (smoking, autoimmune disease, cardiological, neurological, and dismetabolic). All patients answered the postoperative BREAST-Q reconstruction module almost 1 year from last surgical procedure. In patients with a pseudoptosis or mild ptosis of the contralateral breast, crescent mastopexy could be a valid procedure with minimal scars, better symmetry, and global cosmetic results than other procedures. This is the first study which compares crescent mastopexy with augmentation with other mastopexy procedures. Level III: evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group. Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

Background In all branches of medicine, it is the surgeon's responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient. Methods An experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients' motivation and expectations, the degree of patient awareness regarding the planned operation, and the patients' perceptions of the purpose of the required consent for cosmetic surgery were all analyzed using Fisher's exact test. Results Candidates for abdominal wall surgery had significantly more preoperative psychological problems than their counterparts did (P=0.035). A significantly different percentage of patients under 40 years of age compared to those over 40 years of age searched for additional sources of information prior to the operation (P=0.046). Only 30% of patients with a lower educational background stated that the preoperative information had been adequate, whereas 92% of subjects with secondary schooling or a postsecondary degree felt that the information was sufficient (P=0.001). A statistically significant difference was also present between patients according to their educational background regarding expected improvements in their quality of life postoperatively (P=0.008). Conclusions This study suggests that patients require more attention in presurgical consultations and that clear communication should be prioritized to ensure that the surgeon understands the patient's expectations.

Linguistic validation is essential in translating patient-reported outcomes.

The anatomical description of the human body outlines its morphology, answering mainly the question of “how it works”. Therefore, a detailed layout is displayed on the anatomical board, where every element is analyzed thoroughly. A description of the body as such does not trace the real body: the unity of the corporeal reality is closely connected with the entirety of the person, whose body is in the necessary condition to be able to carry out actions which are peculiar to it. As the reality of the body is to be an acting body, then a description that captures the real physical entity in its fullness must go through the acts that the subject does with his own body, which is always living a symbolic, intentional and emotional at lifestyle. In this volume, we present the first version of the “philosophical” anatomy of the body, which outlines through a survey the intentional acts of humans, or the true reality of man and his body. From this new perspective, the unity and entirety of the body are highlighted: the body is what a person has to feed, what makes someone play sports and music, dance, pray, work, and what allows me to carry out all those actions which make someone feel realized as a person. This new conceptual approach brings us on a phenomenological level when describing this data, and thus the acts of the living body. A new perspective, from which the corporeality takes shape as a living entity, and not as a set of substance and accidents, or an aggregate of organs, or a transcendent spiritual unity.