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Purpose: In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting. Methods: In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain. Results: No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (p < 0.001) and mean fat volume (p = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (p < 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (p = 0.009 and p = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (p = 0.928 and p = 0.648, respectively). Conclusions: Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers. [ABSTRACT FROM AUTHOR]

Reduction mammoplasty is popular among people of various age groups, yet the impact of age on postoperative outcomes remains debated. The American College of Surgeons National Surgical Quality Improvement Program (2008–2021) was queried to identify adult female patients who underwent reduction mammoplasty. Patients were categorized into 10-year age brackets (i.e., 18–29, 30–39, 40–49, 50–59, 60–69, and >70 years). We compared age-dependent 30-day outcomes via confounder-adjusted multivariate analyses. 40,958 female patients (mean age: 41 ± 14 years and mean body mass index: 31 ± 6.1 kg/m²) were identified. Complications occurred in 6.4% (n = 2635) of cases, with 770 (1.9%) and 483 (1.2%) patients requiring reoperation and readmission, respectively. 1706 (4.2%) women experienced surgical complications, whereas medical complications were generally rare (n = 289; 0.7%). Compared with women aged 18–29 years, risks of any, surgical, and medical complications were higher for patients aged 30–39 years (OR: 1.22, p < 0.01; OR: 1.05, p = 0.51; OR: 1.84, p < 0.01), 40–49 years (OR: 1.34, p < 0.01; OR: 1.17, p = 0.04; OR: 1.54, p = 0.03), 50–59 years (OR: 1.45, p < 0.01; OR: 1.31, p < 0.01; OR: 1.78, p < 0.01), 60–69 years (OR: 1.38 years, p < 0.01; OR: 1.29, p = 0.01; OR: 1.71, p < 0.01), and >70 years (OR: 1.25, p = 0.18; OR: 1.01, p = 0.98; OR: 1.86, p = 0.14). Patients aged >30 years were also more likely to require readmissions and reoperations. Patient age significantly affects outcomes after reduction mammoplasty, with the lowest risk in patients aged <30 years. Importantly, the association between age and postoperative morbidity was not linear. These findings can help guide informed decisions, recognizing that while age is a factor, it is not the sole determinant of risk. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SLNB) is widely used in patients who receive neoadjuvant chemotherapy (NAC). Still, axillary lymph node dissection (ALND) is recommended for patients with any axillary residual disease after NAC. The necessity of ALND in patients with minimal axillary disease is unclear. We aim to investigate regional recurrence rates in patients with limited axillary residual disease after NAC underwent SLNB + image-tailored axillary surgery and adjuvant radiotherapy (RT). Methods: Patients with clinical stages were T1-3 and N1 at the time of diagnosis, clinically good or complete axillary response after NAC, and limited axillary residue (≤ 3 pathological lymph nodes) with favorable response to NAC in the final pathological examination were included in the study. All patients underwent SLNB + image-tailored axillary surgery. Peripheral lymphatic radiotherapy was applied, and no further surgery was performed in patients with compatible radiology and pathology results. Results: Our study, which evaluated 139 patients with a median age of 47 years, found that the median number of excised lymph nodes was 4. Notably, 46% of patients had between 1 and 3 lymph nodes excised, while 45% had between 4 and 6. Only 9% of patients had ≥ 7 lymph nodes. 83(60%) of the patients underwent breast-conserving surgery (BCS), and 56(40%) underwent mastectomy. The study's median follow-up period was 44 months. During this duration, one breast recurrence (0.7%), one supraclavicular recurrence (0.7%), and six systemic recurrences (4.3%) were observed. No axillary recurrence occurred within the follow-up period. Conclusions: Patients presenting with pathological-suspicious ≤ 3 lymph nodes on imaging and showing a good response to NAC can be considered suitable candidates for SLNB + image-tailored axillary surgery, followed by adjuvant RT instead of ALND. [ABSTRACT FROM AUTHOR]

Background/Purpose: Seroma is a common complication after axillary dissection in women with node-positive breast cancer. We aim to determine the effect of Cyanoacrylate on reducing seroma formation in patients undergoing axillary dissection. This a randomized clinical trial. Methods: This is a single-center, randomized, single-blinded, and two-arm parallel study. Women with node-positive breast cancer eligible for axillary dissection were enrolled. Patients with a Body Mass Index (BMI) greater than 35 kg/m2, those who underwent immediate breast reconstruction, and/or received neoadjuvant chemotherapy were excluded. Patients were randomized in a 1:1 ratio, and were stratified according to their age, BMI, tumor size, and operation type. The primary endpoint was the total seroma volume (the total drained volume and the total aspirated volume after drain removal). Data presented as mean and range when applicable. Results: 111 patients were randomized (Cyanoacrylate 57; control 54). 105 patients were analyzed. Sixty-nine patients underwent breast conserving surgery, and 36 underwent modified radical mastectomy. There was no difference in the total seroma volume between the Cyanoacrylate vs. control arms (1,304 (60-4,950) vs. 1,446 (100-5,223) ml, p=0.458). Wound infection, flap necrosis, number of manual aspirates, and hematoma formation were not statistically different between the two groups. Time to drain removal was shorter in the Cyanoacrylate arm (11.04(3-23) vs. 13.84(3-37) days, p=0.015). The use of Cyanoacrylate was not cost effective ($586.93 (550-748) vs. $29.63 (0-198), p<0.001). Higher seroma volume was correlated with modified radical mastectomy, older age, and BMI more than 30 kg/m². Conclusion: Cyanoacrylate did not reduce seroma formation and its use was not cost effective. [ABSTRACT FROM AUTHOR]

Background: Current trends in breast reconstruction demonstrate that a majority of reconstructive procedures are now favoring alloplastic or implant-based approaches. Recent research on alloplastic reconstruction indicates that it may be safely performed in a one-stage, direct-to-implant procedure after mastectomy. This study ultimately aims to evaluate how the rates of complications requiring readmission or unplanned surgery differ among patients who were discharged on the same day as their mastectomy followed by reconstruction compared to those admitted overnight following their procedures. Methods: Retrospective analysis of patients that underwent immediate alloplastic breast reconstruction between 2011 and 2021 at Emory University Hospitals was conducted. Patient demographic features, surgical technique (laterality, one vs. two-step reconstruction), and surgical outcomes (complication type, complication frequency) were considered. Results: Of 657 patients that underwent immediate alloplastic breast reconstruction, 559 (85%) patients were discharged following overnight admission, and 98 (15%) patients were discharged on the same day. Analysis of patient characteristics revealed no significant differences in age (p = 0.4937), BMI (p = 0.8607), hypertension (p = 0.7103), diabetes mellitus (p = 0.8271), or active tobacco use (p = 0.1818). Between same-day discharge and overnight admission cohorts, there was no significant difference in rates of overall complications (p = 0.2517), major complications (p = 0.8222), or minor complications (p = 0.3908). Complications included rates of hematoma (p > 0.9999), seroma (p > 0.9999), major (p = 0.7923) and minor (p > 0.9999) infection, major (p > 0.9999) and minor delayed wound healing (p = 0.7034, and implant/expander loss (p = 0.4768). Conclusions: This study presents evidence that same-day discharge following mastectomy and breast reconstruction is a safe option, associated with statistically comparable rates of complication as overnight discharges. However, patient education in the preoperative period is critical to its successful implementation and realization of healthcare savings. Level of Evidence: Level III, risk / prognostic study. [ABSTRACT FROM AUTHOR]

Background: This pilot prospective study aimed to evaluate ultrasound-guided cryoablation of breast cancer (BC) by assessing: (i) technical efficacy as the presence of necrosis in surgical specimens and rate of complete tumor ablation; (ii) safety as incidence and severity of complications; and (iii) patients' satisfaction using a dedicated questionnaire. In addition, (iv) we tested the capability of magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM) to predict cryoablation efficacy. Methods: From 07/2022 to 01/2023, we enrolled 20 patients with early-stage BC scheduled for breast surgery. Ten of them, with a cryo-feasible cancer location, were sent to cryoablation (cryo-group) and ten to routine surgical practice (control group). Both groups underwent surgery and were asked to answer a satisfaction questionnaire. Results: Of eleven patients screened for cryoablation, only one refused to be treated at another hospital (acceptance rate 10/11, 91%). Surgery was quadrantectomy in 19 cases and mastectomy in 1. In the cryo-group, the procedure was completed and steatonecrosis was observed in 10/10 cases, with complete tumor ablation in nine of them. The post-procedural status was evaluated with MRI in five patients, with CEM in four patients, and with ultrasound in one patient who refused MRI and CEM. MRI or CEM correctly predicted complete cryoablation in eight patients and incomplete cryoablation in one patient. Patients in both groups did not have serious complications and responded positively to satisfaction questionnaires. Conclusion: Ultrasound-guided cryoablation of early-stage BC is well accepted by patients, effective, and safe. MRI and CEM were able to predict the procedure's technical efficacy. Trial registration: https://clinicaltrials.gov/study/NCT05727813 updated February 14, 2023. Relevance statement: Our pilot study showed that ultrasound-guided cryoablation is a promising nonsurgical alternative for treating early-stage BC. Key Points: Ultrasound-guided cryoablation was effective and safe in early BC patients. The procedure was well-tolerated, with low morbidity and high patient satisfaction. MRI and CEM predicted cryoablation efficacy, in accordance with histopathologic findings. Cryoablation can be considered a potential alternative to surgery in selected patients. [ABSTRACT FROM AUTHOR]

Background: Tumescent local anesthesia (TLA) is widely used in esthetic surgery due to its ability to reduce complications, eliminate the need for general anesthesia, provide effective pain control, and shorten hospitalization times. Methods: This study evaluates the use of TLA in 80 patients who underwent augmentation mastopexy between 2010 and 2022. A tumescent solution containing 500 mg lidocaine, 672 mg sodium bicarbonate, and 1 mg epinephrine in 1000 mL of saline was infiltrated, with an average of 300 mL per breast. The surgical technique involved creating a subpectoral pocket for textured round implants (250–400 cc), followed by careful hemostasis. Results: No patients required conversion to general anesthesia, and there were no signs of toxicity or major complications. Minor complications included wound dehiscence (6.2%), hematoma (2.5%), and capsular contracture (2.5%). Pain management satisfaction at 3 months post-surgery was rated as "outstanding" by 12.5% of patients, "excellent" by 67.5%, and "good" by 20%. The longest follow-up was 6 years, with no implant ruptures except one (1.2%). Conclusions: While the study did not include a control group or statistical analysis, the findings suggest that TLA is a safe and effective alternative to general anesthesia for augmentation mastopexy, providing excellent pain control and a low rate of complications. [ABSTRACT FROM AUTHOR]

Background: The population aged ≥90 years is increasing worldwide, yet nearly 50% of elderly breast cancer (BC) patients receive suboptimal treatments, resulting in high rates of BC-related mortality. We analyzed clinical and survival outcomes of nonagenarian BC patients to identify effective treatment strategies. Methods: This single-institution retrospective cohort study analyzed patients aged ≥90 years diagnosed with stage I–III BC between 2007 and 2018. Patients were categorized into three treatment groups: traditional surgery (TS), performed according to local guidelines; current-standard surgery (CS), defined as breast surgery without axillary surgery (in concordance with 2016 Choosing Wisely guidelines) and/or cavity shaving; and non-surgical treatment (NS). Clinicopathological features were recorded and recurrence rates and survival outcomes were analyzed. Results: We collected data from 113 nonagenarians with a median age of 93 years (range 90–99). Among these patients, 43/113 (38.1%) underwent TS, 34/113 (30.1%) underwent CS, and 36/113 (31.9%) underwent NS. The overall recurrence rate among surgical patients was 10.4%, while the disease progression rate in the NS group was 22.2%. Overall survival was significantly longer in surgical patients compared with NS patients (p = 0.04). BC-related mortality was significantly higher in the NS group than in the TS and CS groups (25.0% vs. 0% vs. 7.1%, respectively; p = 0.01). There were no significant differences in overall survival and disease-free survival between the TS and CS groups (p = 0.6 and p = 0.8, respectively), although the TS group experienced a significantly higher overall postoperative complication rate (p < 0.001). Conclusions: Individualized treatment planning is essential for nonagenarian BC patients. Surgery, whenever feasible, remains the treatment of choice, with CS emerging as the best option for the majority of patients. [ABSTRACT FROM AUTHOR]

Introduction: Medicare significantly influences reimbursement rates, setting a standard that impacts private insurance policies. Despite declining rates in various specialties, the magnitude of these trends has not been examined in breast surgery. This study examines Medicare reimbursement trends for breast surgery operations. Methods: Data for 10 breast operations from 2003 to 2023 were collected from the Medicare Physician Fee Look-Up Tool and yearly reimbursement was computed using the conversion factor. The year-to-year percentage change in reimbursement was calculated, and the overall median change was compared with the consumer price index (CPI) for inflation evaluation. All data were adjusted to 2023 United States dollars. The compound annual growth rate (CAGR) was calculated using inflation-adjusted data. Results: Over the study period, reimbursement for the 10 breast operations had a mean unadjusted percentage increase of + 25.17%, while the CPI increased by 69.15% (p < 0.001). However, after adjustment, overall reimbursement decreased by − 20.70%. Only two operations (lumpectomy and simple mastectomy) saw increased inflation-adjusted Medicare reimbursement (+ 0.37% and + 3.58%, respectively). The CAGR was − 1.54% overall but remained positive for the same two operations (+ 0.02% and + 0.18%, respectively). Based on these findings, breast surgeons were estimated to be reimbursed $107,605,444 less in 2023 than if rates had kept pace with inflation over the past decade. Conclusion: Inflation-adjusted Medicare reimbursement rates for breast surgeries have declined from 2003 to 2023. This downward trend may strain resources, potentially leading to compromises in care quality. Surgeons, administrators, and policymakers must take proactive measures to address these issues and ensure the ongoing accessibility and quality of breast surgery. [ABSTRACT FROM AUTHOR]

Background Patients and Methods Results Conclusion Seroma is the most common complication after breast surgery. Some studies showed that tranexamic acid (TA) can be used in breast surgery to reduce seroma formation and drain volume. We studied the effect of intra‐operative and postoperative topical TA on the duration of drain and volume of seroma in patients undergoing axillary lymph node dissection (ALND) for breast cancer.Breast cancer patients planned for ALND were enrolled in the study between July 2020 and July 2021. Patients were randomized into three groups where one group (n = 50) received a single intraoperative dose of diluted topical TA, the second group, in addition, received daily postoperative doses till day 5 through the suction drain, and the third group (n = 50) did not receive any dose. Chi‐square tests and ANOVA were used to analyze the primary outcomes—the total volume of drain fluid and total drain duration, and secondary outcomes—daily drain output till postoperative‐day‐5, wound infection, and seroma rates.Patients receiving multiple doses of topical TA had a decreasing trend in total drain volume, although this was not statistically significant (1597 vs. 1763 vs. 1773 mL: p = 0.269). There was no significant change in the duration of the postoperative drain (21.6 vs. 19.2 vs. 19.55 days: p = 0.54). There was no statistically significant difference in complications between the groups.There is no significant reduction in drain duration, total drain volume, or the rate of complications with the use of single or multiple doses of topical TA. [ABSTRACT FROM AUTHOR]

Accurate preoperative and intra-operative localization of occult breast lesions is important. We aimed to compare the clinical efficacy of body surface mapping plus wire-guided localization (BWL) and body surface mapping plus methylene blue-guided localization (BML) in occult breast lesions. Patient samples were obtained from the Xuzhou Central Hospital from 01 January 2018 to 31 December 2020. A total of 315 patients with a single occult breast lesion were included, comprising 225 cases in the BWL group and 90 cases in the BML group, were eligible for this study. We found that the average localization time in the BWL group was significantly greater than in the BML group (2.9 min vs. 1.6 min), while no significant difference was observed in the degree of pain, which was mild, between the two groups (average score, 1.3 vs. 1.5, respectively). The localization success rate and surgical resection rate were 100% in both groups. In addition, no significant difference was observed between the BWL group and BML group in terms of the average time of surgery (8.5 min vs. 9.8 min), the subjective difficulty of surgery, which was easy in both groups (average score, 2.1 vs. 2.4), and the average volume of surgical specimens (1.8 mL vs. 2.4 mL). Further, in the follow-up 3 months after surgery, the resection rate of lesions was 100%, and both groups demonstrated similar cosmetic effect scores. These findings indicated that both BWL and BML have the advantages of accurate localization, high resection rate, few adverse reactions, and excellent cosmetic effects in patients with occult breast lesions. Although both localization methods might be suitable for hospitals in remote areas, our results indicated that BML might be relatively simpler and more economical. [ABSTRACT FROM AUTHOR]

Background: For high‑risk patients, adding a third antiemetic drug to dual postoperative nausea and vomiting (PONV) prophylaxis is controversial. Given the established antiemetic properties of midazolam, this study compared the combination of low‑dose dexamethasone‑ondansetron and midazolam with high‑dose dexamethasone‑ondansetron. Methods: A total of 300 female patients scheduled for breast surgery were recruited and randomly assigned to two groups. The DO group received dexamethasone 8 mg and ondansetron 4 mg, whereas the DOM group received dexamethasone 4 mg, ondansetron 4 mg, and midazolam 0.04 mg/kg. The primary outcome was the incidence of PONV within 24 h. Secondary outcomes were PONV severity, antiemetic requirement, blood glucose levels, satisfaction and sedation scores, time to eye opening and extubation, pain outcome, and sore throat. Results: Primary outcome analysis included 298 patients. Incidence of PONV within the first 24 h after surgery occurred in 52 of 150 (35%) patients in the DO group and 33 of 148 (22%) patients in the DOM group (adjusted risk ratio, 0.63; 95% confidence interval, 0.45–0.88; P = 0.007). The antiemetic requirement was significantly greater in the DO group compared with the DOM group (P = 0.034). However, a significantly higher sedation level and longer time for eye‑opening and extubation were observed in the DOM group (P < 0.05). Conclusion: Compared to high‑dose dexamethasone and ondansetron alone, midazolam combined with low‑dose dexamethasone and ondansetron decreased the incidence of PONV in patients undergoing breast surgery; however, it increased the sedation level in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most frequently diagnosed type of cancer among women and an important cause of premature death among women. The goal of oncoplastic surgery in women with early-stage breast cancer is to remove breast cancer with negative histological margins and preserve the breast contour. We aimed in our study to assess the oncologic and cosmetic outcomes of applying different types of volume displacement techniques of oncoplastic surgery in the early stages of breast cancer. Methods: This study included (30) patients who had undergone various types of volume displacement techniques of breast oncoplastic surgery in the early stages of breast cancer. This study was conducted at Zagazig University Hospitals, Nasser's Institute Hospital for Research and Treatment, And the National Cancer Institute in Cairo. Patients were evaluated for oncologic and cosmetic outcomes. Results: In our study, the pathologist in our multidisciplinary team affirmed that none of the patients had any tumor recurrence demonstrating that we had performed a safe oncoplastic technique from the oncological perspective. None of our cases have had a poor or ugly score in our study. We achieved an excellent cosmetic outcome for relatively large mass excisions with 90% of the cases in excellent and very good score groups with a mean cosmetic outcome score of 4.53. Conclusions: Breast oncoplastic surgical techniques were as safe as modified radical mastectomy in oncologic control but with more adequate cosmetic outcomes. [ABSTRACT FROM AUTHOR]

Minimally invasive interventional surgery is commonly used for diagnosing and treating breast cancer, but the high fluidity and deformability of breast tissue reduce intervention accuracy. This study proposes a bionic breast interventional robot that mimics the scorpion's predation process, actively manipulating tissue deformation to control target displacement and enhance accuracy. The robot's structure is designed using a modular method, and its kinematics and workspace are analyzed and solved. To address the nonlinear breast tissue deformation problem, a hierarchical tissue method is proposed to simplify the three-dimensional problem into a two-dimensional one. A two-dimensional tissue deformation solver is established based on the minimum energy method for quick resolution. The problem is treated as quasi-static, deriving the displacement relationship between external manipulation points and internal tissue targets. The method of active manipulation of tissue deformation is simulated using MATLAB (2019-b) software to verify the feasibility of the method. Results show maximum errors of 1.7 mm for prostheses and 2.5 mm for in vitro tissues in the X and Y directions. This method improves intervention accuracy in breast surgery and offers a new solution for breast cancer diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: The incidence of reduction mammoplasty has been steadily increasing over recent decades. Surgical site infections (SSIs) represent a common yet preventable complication across surgical disciplines. Studies across various surgical specialties have indicated a seasonal influence on SSIs, primarily correlated with higher temperatures and humidity. However, there remains a scarcity of clear data regarding the seasonal effects on complications specifically in breast surgery. Methods: We conducted a retrospective review encompassing all patients who underwent primary bilateral reduction mammoplasties at our institution between 1 June 2016, and 1 September 2019. The data collected included patient demographics, surgical details, and postoperative complications. The rates of SSIs and wound healing disturbances (WHDs) were correlated with local meteorological data at the time of surgery. Results: A total of 808 patients (1616 breasts) met the inclusion criteria. The mean age was 41 ± 14.8 years, with a mean BMI of 28.9 ± 5.2 kg/m2 and a mean follow-up duration of 8.9 ± 9.8 months. Nineteen cases (2.35%) of surgical site infections and 77 cases (9.52%) of wound healing disturbances were reported. No statistically significant increase in the risk of SSIs (p = 0.928) or WHDs (p = 0.078) was observed during the warmer months of the year. Although no specific risk factors were identified for surgical site infections, both resection weight (p < 0.001) and diabetes mellitus (p = 0.001) demonstrated increased risks for wound healing disturbances. Conclusions: While seasonal temperature variations have been shown to impact SSIs and WHDs in body contouring procedures, our findings suggest that breast reduction surgery may not be similarly affected. [ABSTRACT FROM AUTHOR]

Simple Summary: Axillary management in breast cancer has undergone significant changes over the past decades, especially with the introduction of neoadjuvant chemotherapy (NACT). NACT aims to shrink tumors before surgery, allowing for less invasive axillary approaches such as sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). These techniques help reduce the need for axillary lymph node dissection (ALND), which is associated with higher risks of complications like lymphedema. However, patient selection for these procedures depends on factors such as tumor biology, response to NACT, and the extent of nodal disease. This review discusses the latest evidence supporting de-escalation strategies in axillary surgery and highlights ongoing research that aims to further refine the selection criteria for these approaches. Multidisciplinary collaboration remains key to implementing personalized treatments that optimize patient outcomes while minimizing surgical morbidity. Background. In breast cancer (BC) patients, axillary management has undergone major improvements over the last few years, and efforts to identify the optimal strategy for the management of axillary surgery are still ongoing. Methods. In current clinical practice, women with clinically node-positive (cN+) BC usually receive neoadjuvant chemotherapy (NACT) with the aim of reducing the extent of primary disease and, thus, allowing for axillary-conservative surgery. Remarkably, after NACT, up to one out of three patients achieves an axillary pathologic complete response, which, in turn, is associated with a more favorable prognosis than residual axillary disease. However, NACT is not without drawbacks, as NACT-associated inflammation can damage lymphatic vessels. Furthermore, varying degrees of response may occur in the axillary lymph nodes, increasing the false negative rate for sentinel biopsy. Results. At present, there is no consensus on the optimal approach in patients with cN+ BC undergoing NACT, although multidisciplinary management seems to be recommended. Conclusions. This narrative review provides a comprehensive overview of axillary management in cN+ BC patients undergoing NACT. It uses a multidisciplinary approach that encompasses the oncological management perspectives, as well as surgical and chemotherapeutic viewpoints. [ABSTRACT FROM AUTHOR]

Objective: The Sentinel Node vs. Observation After Axillary Ultra-Sound (SOUND) trial reported that omission of axillary surgery was not inferior to sentinel lymph node biopsy (SLNB) in those with cT1 breast cancer and negative preoperative axillary ultrasound. The aim of our study was to evaluate the clinical characteristics of early breast cancer patients undergoing breast conserving surgery (BCS) at our institution in order to investigate the exportability of SOUND criteria to our patient population. Materials and Methods: We retrospectively reviewed patients with cT1N0 breast cancer undergoing BCS and adjuvant radiotherapy according to the SOUND trial criteria. Comparison was made between the eligible group of our cohort and the SLNB arm of the SOUND trial. Results: The proportion of younger patients was higher in our eligible cohort (37.7% vs. 17.5%, p = 0.002). Postmenopausal patients were more prevalent in the SOUND trial (79.4% vs. 56.6%, p = 0.004). On final pathology, tumours were more likely to be upgraded to T2 in our group (26.4% vs. 4.4%, p = 0.001). Patients in our cohort were more likely to receive adjuvant chemotherapy (37.7% vs. 20.1%, p = 0.002). Conclusion: The clinicopathological differences between our cohort and the SOUND trial population could be attributed to aggressive tumours in Bahrain compared to Western countries. Our study may influence others to investigate the applicability of the SOUND trial in clinical practice. Nevertheless, it is a study that should generate multidisciplinary discussion in the de-escalation of axillary surgery. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to examine the hypothesis that the opioid consumption of patients who receive a rhomboid intercostal block (RIB) or a pectoral nerve (PECS) block after unilateral modified radical mastectomy (MRM) surgery is less than that of patients who receive local anesthetic infiltration. Methods: Eighty-one female patients aged 18–70 years who underwent unilateral MRM surgery with general anesthesia were randomly allocated to three groups. The first group received an RIB with 30 ml of 0.25% bupivacaine on completion of the surgery, and the second received a PECS block with the same volume and concentration of local anesthetic. In the third (control) group, local infiltration was applied to the wound site with 30 ml of 0.25% bupivacaine at the end of the surgery. The patients' total tramadol consumption, quality of recovery (QoR), postoperative pain scores, and sleep quality were evaluated in the first 24 h postoperatively. Results: Both the RIB (58.3 ± 22.8 mg) and PECS (68.3 ± 21.2 mg) groups had significantly lower tramadol consumption compared to the control group (92.5 ± 25.6 mg) (p < 0.001 and p = 0.002, respectively). Higher QoR scores were observed in the RIB and PECS groups than the control group at 6 h post-surgery. The lowest pain values were observed in the RIB group. The sleep quality of the patients in the RIB and PECS groups was better than that of the control group (p < 0.001). Conclusion: Compared to local anesthetic infiltration, the RIB and PECS blocks applied as part of multimodal analgesia in MRM surgery reduced opioid consumption in the first 24 h and improved the quality of recovery in the early period. [ABSTRACT FROM AUTHOR]

Background: Due to the declining mortality rates of breast carcinoma and the rising incidence of risk-reducing mastectomies, enhancing the quality of life after breast reconstructions has become an increasingly important goal. The advantages of lightweight breast implants (B-Lite®) may significantly contribute to achieving this objective. This study aims to investigate whether lightweight implants are suitable for patients undergoing breast reconstruction and could improve the quality of life in comparison to conventional implants. Methods: In this study, we retrospectively analyzed 48 patients (38 implants in each group) who underwent implant-based breast reconstruction with either B-Lite® or conventional breast implants between 2019 and 2022 at the University Center for Plastic Surgery in Regensburg. As part of the postoperative follow-up, a clinical examination and a survey using the Breast-Q® questionnaire were conducted to evaluate the postoperative quality of life. Results: The implants used were similar in weight and shape. On average, the B-Lite® implants had a higher implant volume and patients in this group had a slightly higher BMI. Patients who received B-Lite® implants showed a significantly better result regarding the sensation of sensitivity in the surgical area and the scar formation also appeared to be more favorable. However, patients with B-Lite® implants perceived their implants as more uncomfortable than those with conventional breast implants. In other terms concerning quality of life, both groups appeared similar. Conclusion: In summary, there are confounding factors that could influence the outcome of some aspects in this study, which could not be avoided due to the retrospective study design and the temporary suspension of B-Lite implants. Nevertheless, as the first of its kind, this study demonstrated that B-Lite implants could also be suitable for usage in breast reconstructions, thus providing an important foundation for further prospective studies to build upon. [ABSTRACT FROM AUTHOR]

Introduction: Oncoplastic breast surgery includes volume replacement as well as volume displacement. Autologous tissue is the preferred approach for volume replacement and includes chest wall perforator flaps (CWPF). Although described more than a decade ago, CWPFs have not been adopted widely in clinical practice till recently. We report the largest single-centre institutional data on CWPFs. Patients and methods: The study includes all patients who underwent breast conservation surgery (BCS) using CWPFs from January 2015 to December 2022. Data were retrieved from the institutional electronic record and Redcap database. The analysis was done using SPSS 23 and STATA 14. Results: 150 patients were included in the study. The mean age was 48.8 years (SD 10.4), and the body mass index was (26.6 kg/m2, SD 4.3). >50% of patients had breasts with small cup sizes (A&B) and mild ptosis (Non-ptotic and Grade 1 ptosis). 44.7% of patients underwent lateral intercostal artery perforator flap (LICAP), anterior intercostal artery perforator flap in 31.3%, lateral thoracic perforator flap (LTAP) in 12%, LICAP + LTAP in 11.3% and thoracodorsal artery perforator flap in 1%. Post-operatively, haematoma was seen in 1.3%, complete flap necrosis in 1.3%, seroma in 7%, wound dehiscence in 12%, and positive margin in 6.7%. 92 patients responded to the satisfaction assessment, of which >90% were happy with the surgical scars, comfortable going out in a public place, satisfied with the symmetry of the breast, and no one chose mastectomy in hindsight. The 5-year predicted disease free survival and overall survival were 86.4% and 94.7%, respectively. Conclusion: BCS with CWPF is an excellent option for reconstruction in small to mediumsized breasts. It is associated with minimal morbidity and comparable patient-reported cosmetic and survival outcomes. [ABSTRACT FROM AUTHOR]

Autologous fat transfer (AFT) is increasingly adopted as another total breast reconstruction option. The aim of this study was to investigate the efficacy of prolonged antibiotic treatment on the onset of surgical site infections (SSIs) in patients treated with AFT for total breast reconstruction. This retrospective cohort study was conducted on patients who received AFT for total breast reconstruction, with antibiotic prophylaxis during their (multiple) AFT procedure(s) from 9 December 2020 to 10 October 2023. Patients were divided into 2 groups according to their prophylactic antibiotic regimen. The primary outcome was analyzed, including the cumulative incidence, the relative risk (RR), the absolute risk reduction (ARR), and the number needed to treat (NNT). For the secondary outcome, a multilevel logistic regression analysis was performed. Seven hundred sixty-five surgeries in 205 patients were analyzed. Six hundred twenty-four surgeries on 168 patients had perioperative antibiotic prophylaxis in combination with postoperative antibiotic prophylaxis administered (group 1). One hundred forty-one surgeries on 37 patients had only perioperative antibiotic prophylaxis administered (group 2). The RR was 0.68 (95% confidence interval [CI]; 0.14–3.31) of a SSI when receiving peri- and postoperative antibiotic prophylaxis in comparison with treatment with only perioperative prophylaxis. The ARR was 0.46% (95% CI; −1.40 to 2.32) with a NNT of 219 patients. Prolonged antibiotic prophylaxis is ineffective for patients who receive total breast reconstruction with AFT. This study showed no statistically significant difference in SSIs of the reconstructed breast after receiving prolonged antibiotic treatment in comparison with single-shot perioperative antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Dermatomyositis is a rare autoimmune disease characterized by muscle weakness and skin rashes. Management typically involves high-dose cortisone treatment, which raises concerns about the feasibility and safety of aesthetic surgeries for affected individuals. This case report presents a successful outcome of an aesthetic surgery conducted on a dermatomyositis patient undergoing high-dose cortisone therapy. The patient, a 39-year-old female with a history of juvenile dermatomyositis, expressed a desire for aesthetic improvement, first in the periocular area and then in terms of the appearance of her breasts. Despite the challenges posed by the underlying condition and ongoing corticosteroid treatment, the patient underwent elective aesthetic surgeries with meticulous perioperative care and close collaboration between the surgical, anesthetic, and rheumatology teams. The successful outcome of the procedures enhanced the patient's self-esteem and quality of life. This case underscores the importance of individualized treatment planning, interdisciplinary collaboration, and careful perioperative management for achieving favorable aesthetic outcomes for patients with dermatomyositis undergoing corticosteroid therapy for more than 20 years. Further research and awareness are warranted to guide the safe performance of aesthetic surgeries on this unique patient population. [ABSTRACT FROM AUTHOR]

Recent studies have reported a higher than expected risk of ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) and a single dose of electron beam intra‐operative radiotherapy (IORT). This finding was the rationale to perform a retrospective single center cohort study evaluating the oncologic results of consecutive patients treated with BCS and IORT. Women were eligible if they had clinical low‐risk (N0, ≤2 cm unifocal, Bloom and Richardson grade 1–2), estrogen receptor‐positive and human‐epidermal‐growth‐factor‐receptor‐2‐negative breast cancer. Prior to BCS, pN0 status was determined by sentinel lymph node biopsy. Data on oncologic follow‐up were analyzed. Between 2012 and 2019, 306 consecutive patients were treated and analyzed, with a median age of 67 (50–86) years at diagnosis. Median follow‐up was 60 (8–120) months. Five‐year cumulative risk of IBTR was 13.4% (95% confidence interval [CI] 9.4–17.4). True in field recurrence was present in 3.9% of the patients. In 4.6% of the patients, the IBRT was classified as a local recurrence due to seeding of tumor cells in the cutis or subcutis most likely related to percutaneous biopsy. In 2.9% of the patients, the IBRT was a new outfield primary tumor. Three patients had a regional lymph node recurrence and two had distant metastases as first event. One breast cancer‐related death was observed. Estimated 5‐year overall survival was 89.8% (95% CI 86.0–93.6). In conclusion, although some of IBTR cases could have been prevented by adaptations in biopsy techniques and patient selection, BCS followed by IORT was associated with a substantial risk of IBTR. [ABSTRACT FROM AUTHOR]

Aims & Objectives: The primary aim of this paper is to determine whether smart glasses or head-mounted displays improve efficiency in a procedural or theatre setting without compromising the quality of the procedure performed. Additionally, this paper aims to qualitatively explore applications in surgical education, whilst on-call, consulting and patient observation. Design: This paper is a systematic review of the literature available on the topic of smart glasses or head-mounted displays in surgical or procedural settings. Methods: A search of Pubmed, Cochrane and the Wiley Online Library was performed in accordance with the PRISMA guidelines. Procedural times and adverse outcomes were compared between the smart glass and non-smart glass groups in each of the quantitative studies. A literature review of studies, including those not satisfying the primary aim was conducted and is included in this paper. Results: 32 studies were identified that complied with the inclusion criteria of this paper. 8 of these studies focused on procedural times and adverse outcomes, with and without smart glass usage. Procedural time was reduced when smart glass technology was used, without an increase in adverse patient outcomes. Conclusions: Surgeons should consider whether the relatively short reduction in procedural time is worth the high cost, privacy issues, battery complaints and user discomfort involved with these devices. There are promising applications of this technology in the areas of surgical education and consultation. However, more trials are necessary to assess the value of using smart glasses in these settings. [ABSTRACT FROM AUTHOR]

Background Anxiety disorders, both with and without comorbid depression, are widespread globally. In this study we investigate the intersection of anxiety, depression, and self-reported breast implant illness (BII) in females undergoing aesthetic breast surgery. Objectives The objective of our research was to enhance understanding about mental health history, psychotropic medication use, and its relation to BII symptoms. Methods A cohort of 240 consecutive female patients undergoing elective breast surgery was studied. In the study we categorized patients by groups based on the presence of self-reported BII symptoms and the type of breast surgery performed. Mental health history, psychotropic medication use, and time spent in treatment for mental illness were scrutinized. Statistical analyses were conducted, including multiple regression analysis. Results Results revealed that patients with self-reported BII symptoms often had a preexisting anxiety/depression disorder treated medically before obtaining breast implants, and this disorder predicted the occurrence of BII symptoms. These patients tended to be diagnosed with anxiety and depression at a younger age, initiate medication therapy earlier, take more medications for their condition, and spend more time in therapy compared with others undergoing elective breast surgery. Conclusions Implications of this study highlight the need for comprehensive counseling between plastic surgeons and patients with self-reported BII symptoms. Understanding the role of anxiety/depression in the pathogenesis of self-reported BII is crucial, and collaboration with psychiatrists and other mental health professionals can ensure improved supportive care. The findings contribute to a better understanding of the psychological aspects surrounding breast implant surgery and self-reported BII and emphasize the importance of preoperative mental health assessments in appropriate patient selection for elective breast surgery. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Background. Breast cancer is an important cause of cancer‐related death in women worldwide and represents the second most frequent cause of brain metastases after lung cancer. The aim of this study was to determine the characteristics and outcomes of triple‐negative breast cancer (TNBC) patients with brain metastasis (BM). Methods. We retrospectively reviewed a cohort of patients diagnosed with TNBC at the "Instituto Nacional de Enfermedades Neoplasicas" (period 2000–2014) to evaluate patients who developed BM. Survival rates were assessed by the Kaplan–Meier method, and prognostic factors were identified with the Cox regression analysis. Results. Of a total of 2007 TNBC patients, 193 (9.62%) developed BM. Of these, 169 stages I–III patients with a median age of 45 years (range:21–78) were included. The stage in this cohort was 4 (2.4%) clinical stage (CS) I, 23 (13.6%) with CS II and 142 (84.0%) with CS III. Most of these patients presented ECOG ≥2 (68.6%). The most common symptom was headache (74.0%), followed by nausea‐vomiting (46.7%). Imaging showed that 80 patients (53.0%) had ≥1 metastatic brain lesion. Regarding the treatment of BM in this cohort, 132 patients (84.6%) received radiotherapy (RT), 2 (1.5%) surgery, and 6 (4.5%) surgery plus RT. The overall survival (OS) rate of BM was 59.8%, 37.3%, and 15.0% at 3, 6, and 12 months, respectively. A multivariate analysis showed RT to be the only factor with a positive impact on the OS of BM (hazard ratio (HR) = 0.48, 95% confidence interval (CI):0.30‐0.77, and p = 0.002), while ECOG ≥2 was associated with a worse OS (HR = 1.69, 95%CI:1.15–2.48, and p = 0.007). Conclusion. Despite the poor prognosis of TNBC patients who develop BM, RT showed a benefit in OS rates, while ECOG ≥2 was the only prognostic factor associated with a worse OS. These results may be useful for multidisciplinary teams for treatment planning in patients with TNBC and BM. [ABSTRACT FROM AUTHOR]

Introduction: The inframammary fold (IMF) is a critical structure in breast aesthetics and is affected by various types of breast surgery. The ideal IMF has a semi-elliptical shape, which may become attenuated with age and descends in macromastia. The aim of this study was to analyse the IMF and retain/restore its shape with sutures. Methods: A retrospective study was conducted on breast surgeries performed over a four-year period (2019–2022). The morphometry of the IMF was evaluated preoperatively while the patients were standing. In cases where the IMF was symmetrical, sutures were used to reinforce it during surgery. When the loss of the semi-elliptical shape was clinically indicated, the IMF was mobilized, repositioned, and then sutured into place. Results: The study included 56 patients: 43 undergoing immediate breast reconstruction, and 13 undergoing bilateral breast reductions. In over two thirds of the patients, the lateral IMF was inferiorly displaced compared to the medial IMF. Conclusion: It is recommended to reinforce the IMF in all patients undergoing breast surgery. Where the IMF has an elliptical shape preoperatively, it is reinforced. Where IMF is inferiorly displaced, mobilization and superior advancement of the IMF, followed by suture reinforcement, are necessary. This approach results in a well-defined IMF with improved breast aesthetics. 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/00266. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference. Methods: This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18–80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved. Results: Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed. Conclusion: The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the methodological and reporting quality of systematic reviews (SR) of randomized controlled trials on esthetics and reconstructive breast surgery.Meta‐research study with a broad search strategy was developed to retrieve all relevant systematic reviews. We evaluated the methodological and reporting guidance adopted by these reviews and assessed their adequacy to items from AMSTAR‐2 (methodological quality) and PRISMA 2020 (reporting quality). The protocol of this study was prospectively published in: https://osf.io/preprints/osf/ucpgd.After the selection process, 15 SR were included; eight (60%) referred the use of a methodological guide and five (33.3%) invertedly referred PRISMA as the methodological guide. Reporting guidelines were referred by none of the included systematic review. The median adequacy to PRISMA‐2020 items was 42.9% (Q1 – 38.1%/Q3 – 95.2%) and to AMSTAR‐2 items was 33.3% (Q1 – 23.3%/Q3 – 93.3%) which reflects overall low reporting and methodological quality of included SR. The overall confidence in the results using AMSTAR‐2 framework was critically low in 73.3% of included SR. Although a small number of SR were included, a high correlation between the methodological and reporting quality was observed (Spearmean rho = 0.96, 95% bias‐corrected confidence interval = 0.84 to 0.99).Methodological and reposting quality of SR of randomized clinical trials on esthetic or reconstructive breast surgery is poor. Half of the authors referred to the use of valid guidance to plan and conduct their reviews and none of them referred the use of a guidance for reporting their results. [ABSTRACT FROM AUTHOR]

In this study, the necessity of radiotherapy (RT) for hormone receptor-negative older breast cancer patients after breast-conserving surgery (BCS) was investigated. The data of hormone receptor-negative invasive breast cancer patients who underwent BCS were extracted from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. All patients were separated into two groups, namely, the RT group and the no radiotherapy (No RT) group. The 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates were compared between the No RT and RT groups after propensity score matching (PSM). The nomograms for predicting the survival of patients were constructed from variables identified by univariate or multivariate Cox regression analysis. A total of 2504 patients were enrolled in the training cohort, and 630 patients were included in the validation cohort. After PSM, 738 patients were enrolled in the No RT group and RT group. We noted that RT can improve survival in hormone receptor-negative older breast cancer patients who undergo BCS. Based on the results of multivariate Cox analysis, age, race, tumour grade, receipt of RT and chemotherapy, pathological T stage, N status, M status and HER2 status were linked to OS and CSS for these patients, and nomograms for predicting OS and CSS were constructed and validated. Moreover, RT improved OS and CSS in hormone receptor-negative older breast cancer patients who underwent BCS. In addition, the proposed nomograms more accurately predicted OS and CSS for hormone receptor-negative older breast cancer patients after BCS. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Changes to the tumour bed following oncoplastic breast surgery complicate the administration of adjuvant radiotherapy. Consensus guidelines have called for improved interdisciplinary communication to aid adjuvant boost radiotherapy. We propose a framework of tumour bed classification following oncoplastic surgery to enhance understanding and communication between the multidisciplinary breast cancer team and facilitate effective and more precise delivery of adjuvant boost radiotherapy.A classification system was devised by grouping oncoplastic procedures based on skin incision, tissue mobilization, tumour bed distortion, seroma formation and flap reconstruction. The system is supplemented by a colour‐coded pictorial guide to tumour bed rearrangement with common oncoplastic procedures.A 5‐tier framework was developed. Representative images were produced to describe tumour bed alterations.The proposed framework (OPSURGE) improves the identification of the primary tumour bed after initial breast‐conserving surgery, which is imperative to both the surgeon in planning re‐excision and the radiation oncologist in planning boost radiotherapy. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the risk and timing of postoperative bleeding complications following breast-conserving surgery (BCS), with or without axillary surgery, especially in relation to perioperative management of antithrombotic medications. Methods: Data from all patients who underwent BCS for breast cancer between 2010 and 2022 at a single university hospital were collected. Medical records were reviewed for reoperations, unplanned admissions, and patient characteristics. Results: In total, 4712 breast-conserving surgeries and 3631 axillary surgeries were performed on 3838 patients. The risk of any bleeding complication was 1.1% (40/3571) in breast-conserving surgery, 0.3% (9/2847) in sentinel lymph node biopsy, and 0.5% (4/779) in axillary lymph node dissection. Upon arrival for treatment, 645 (17%) patients were taking antithrombotic medications. The risk of bleeding complications was not elevated in patients whose medication was discontinued at least a day before the surgery (OR 0.84, p = 0.76); but it was almost four-fold (OR 3.61, p = 0.026) in patients whose antithrombotic medication was continued. However, the absolute risk for bleeding complication was low in these patients as well (2.0%, 15/751). The majority of bleeding complications (85%, 47/55) occurred within 24 h after the surgery. Conclusion: The risk for bleeding complications was elevated, but still low, after BCS with or without axillary surgery, when antithrombotic medications were continued through the surgical period. Discontinuing antithrombotic medications is not obligatory in these patients. [ABSTRACT FROM AUTHOR]

Introduction: An increasing number of breast cancer patients undergo breast-conserving surgery (BCS), but multiple ipsilateral breast cancer (MIBC) is still considered a relative contraindication for breast conservation. This study provides an update on trends in the surgical management for MIBC over a 10-year period. Methods: Nationwide data from the Netherlands Cancer Registration of all patients diagnosed with breast cancer between 2011 and 2021 were analysed. The primary outcomes of this study were the incidence of MIBC and the trend in breast surgery type among patients between 2011 and 2021. Secondary outcomes were the positive resection margin rates in patients treated with BCS, the proportion of patients requiring re-excision and overall survival. Results: In total, 114 433 patients (83%) with unifocal breast cancer and 23 932 patients (17%) with MIBC were identified. The incidence of MIBC was stable (17%) over the years. Overall BCS rates, both primary and after neoadjuvant chemotherapy, increased in MIBC from 29% in 2011 to 41% in 2021. Re-excision was performed in 1348 patients (n = 8455, 16%). The 5-year OS estimate for patients with MIBC treated with BCS was 93%. The pathological complete response (pCR) in MIBC patients treated with neoadjuvant chemotherapy followed by mastectomy was 23%. Conclusion: The breast conservation rate in MIBC has increased over the last decade. In addition, 23% of MIBC patients treated with neoadjuvant chemotherapy followed by mastectomy achieved a pCR. This suggests increasing opportunities for even more BCS in MIBC. Breast-conserving surgery rates in multiple ipsilateral breast cancer (MIBC) have increased over the last decade with excellent overall survival. Of patients with MIBC treated with neoadjuvant chemotherapy followed by mastectomy, 23% had a pathological complete response. This suggests that further de-escalation and optimization of the surgical approach in MIBC should continue. [ABSTRACT FROM AUTHOR]

Radiation-induced morphea (RIM) is a progressive and irreversible scleroderma encountered after breast radiation therapy. This condition is often underdiagnosed, with confounding differentials including post-radiation fibrosis, infection, inflammatory breast cancer, and cancer recurrence, amongst others. Treatment paradigms differ, and early diagnosis of RIM is essential in preventing further fibrosis and improving quality of life. First-line therapy includes immunosuppressive therapy; surgical management is infrequently described in the literature. Here, we report one of the few reports of completion mastectomy for RIM with postoperative outcomes described. This is a case of a patient who was treated with completion mastectomy with delayed wound closure after developing debilitating RIM status post right breast lumpectomy with radiation for invasive ductal carcinoma. [ABSTRACT FROM AUTHOR]

Background: Invasive lobular carcinoma (ILC) is challenging to stage accurately using mammography (MG) and ultrasound (US) with undiagnosed ipsilateral and contralateral cancer resulting in poor patient outcomes including return to surgery. Our institution employs routine staging breast MRI in ILC for this reason. However, increased time for further imaging/biopsies contributes to patient anxiety and potentially delays definite management. We aimed to quantify the frequency of staging MRI‐detected additional lesions requiring biopsy or follow‐up, the added cancer detection rate and MRI prompted change in surgical management. Methods: An observational study on staging breast MRI for newly diagnosed ILC at a tertiary Western Australian hospital from January 2019 to August 2022. Standardized 3T MRI protocol was performed, double read by unblinded fellowship‐trained radiologists. Histopathology from biopsy, surgery, or first annual surveillance was the reference standard for additional MRI‐detected lesions. Results: One hundred ten MRI studies demonstrated 49 (45%) patients had at least one additional clinically significant MRI‐detected lesion. Thirty‐one patients had an additional ipsilateral lesion detected, of which 18 (58%) proved malignant; 14 (45%) multifocal and 4 (13%) multicentric ILC. Additional work‐up of MRI‐detected lesions averaged a 9‐day delay to definitive surgery compared to patients with a negative or definitively benign MRI. MRI changed surgical planning in 11 of 110 cases from breast conservation surgery (BCS) to mastectomy and there were two contralateral cancers diagnosed. BCS reoperation rate was 11%. Conclusion: Staging MRI for ILC identifies clinically significant lesions in nearly half of patients, predominantly ipsilateral multifocal disease, without significant delay to definitive surgery. [ABSTRACT FROM AUTHOR]

Choosing Wisely (CW) recommends women age ≥70 y with cT1-2cN0 ER+/HER2-invasive breast cancer (BC) should forgo routine axillary staging with sentinel lymph node biopsy (SLN) at the time of breast surgery. Despite this longstanding recommendation, acceptance of SLN omission has not been widely adopted. Genomic assays, such as MammaPrint (MP), may supplement the decision to apply CW. We hypothesized that having MP on BC core needle biopsy (CNB) meeting CW could provide additional information to aid in decision-making about the need for axillary staging with SLN. A retrospective single-institution review was conducted for women with BC meeting CW criteria, who also had MP performed on CNB from 2020 to 2021. Categorical characteristics were compared using the chi-square test. Continuous variables were compared using the Mann–Whitney U -test. MP was available on CNB for 238 BC meeting CW criteria: 70% low risk and 30% high risk. Axillary staging was performed in 195 (82%). Eighty-one percent were pathologically node-negative and 19% were pathologically node-positive. The MP score did not correlate with pathologic nodal stage (P = 0.52). The rate of high nodal burden (pN2) was extremely low (n = 1, 0.5%). The only significant correlation with pathological node positivity was older age (P = 0.03). Appropriately, high-risk MP was strongly associated with increased recurrence risk (n = 4, P = 0.008). Having MP on CNB does not provide clinically meaningful information about the pN stage and does not further refine which BC patients within CW could benefit from escalation to SLN or delineate a group more likely to be pathologically node-negative. • Choosing Wisely (CW) criteria appropriately select breast cancer patients with a low burden of axillary nodal disease who benefit from de-escalation of axillary staging. • pN + breast cancer in this CW cohort had even distribution of MammaPrint scores on core needle biopsy from ultra-low risk to ultra-high risk. • MammaPrint should not be used to further refine CW guidelines to determine a group that still benefits from axillary staging because of higher nodal positivity rates. [ABSTRACT FROM AUTHOR]

For patients with complete breast resection, conventional contrast-enhanced T1-weighted imaging (CE-T1WI) with frequency-selective spectral attenuated inversion recovery (SPAIR) provides limited fat suppression on the postoperative side due to the uneven skin surface, inhomogeneous tissue environment, and frequency-selective feature of the SPAIR scheme, leading to difficulties in precise diagnosis. This study aimed to investigate the image quality and performance of the Dixon method compared with SPAIR in breast high-resolution CE-T1WI for mastectomy patients. Sixty female patients who had not performed any breast surgeries were randomly selected retrospectively as the control group. Postmastectomy female patients were enrolled to undergone high-resolution CE-T1WI with SPAIR and Dixon breast scans. Subjective scores were rated using a 5-point scale. Objective parameters, including contrast-to-noise ratio (CNR), edge sharpness, and signal uniformity were measured and calculated. The Wilcoxon rank-sum test and Kappa statistic were used. A total of 114 consecutive postmastectomy patients were included. Subjective scores of T1WI-SPAIR in the control group were all significantly better than those with SPAIR on the postoperative side of mastectomy patients (P < 0.01). Dixon outperformed SPAIR with significantly better subjective scores in regards to uniformity and degree of fat-suppression, anatomical structures depiction, lesion conspicuity, and axillary visibility (p < 0.05) in both post- and non-operative sides and bilateral axillary areas through the paired comparison. The objective parameters of Dixon were significantly better than those of SPAIR. The Dixon method provided better image uniformity and higher fat suppression efficiency, and showed significant advantages in delineating the anatomical structures, with better axillary and lesion visibilities, especially on the completely removed breast side. [ABSTRACT FROM AUTHOR]

Postoperative sleep disturbance (PSD) is prevalent in perioperative patients，and has significant impact on postoperative recovery and prognosis. The aim of this study was to investigate the effect of desflurane maintenance on postoperative sleep quality, in order to optimize patients' perioperative sleep management. A total of 118 patients undergoing elective breast surgery were randomized to receive either desflurane-based volatile anesthesia (desflurane group) or propofol-based total intravenous anesthesia (propofol group) for anesthesia maintenance. The primary outcome was the quality of sleep, which was assessed by the Pittsburgh Sleep Quality Index (PSQI) on 3 days after operation (POD3). Secondary outcomes were PSQI on postoperative day 7 (POD7) and 30 (POD30), and postoperative anxiety, depression, and pain score, as well as objective sleep parameters including total sleep time (TST), WASO (Wakefulness after sleep onset), REM (Rapid eye movement) and NREM (Non-rapid Eye Movement) measured by Fitbit Charge 2TM during the initial 3 postoperative days. The global PSQI scores on POD3 in the desflurane group was non-inferior to that in the propofol group [mean (SD) 8.47 (3.46) vs. 7.65 (3.16); mean difference (95 % CI) 0.82 (−0.43, 2.07); p < 0.001 for non-inferiority]. There were no significant differences in PSQI scores on POD3 and POD7. In addition, the score of anxiety, depression, and pain on the 3rd, 7th, and 30th day after surgery have no significant differences between the propofol and the desflurane group, respectively. The postoperative NREM was higher in the desflurane group than that in the propofol group. The effects of desflurane-based volatile anesthesia maintenance on postoperative sleep quality is not inferior to that of propofol-based total intravenous anesthesia, and these two drugs may have different effects on the sleep structure. ClinicalTrials.gov Identifier: NCT04805775. • General anesthetics can cause postoperative sleep disturbance in patients after surgery. • The relationship between desflurane and postoperative sleep disturbance is still unknown. • The effects of desflurane on postoperative sleep quality is not inferior to propofol. [ABSTRACT FROM AUTHOR]

La fasciite nécrosante est une infection rapidement progressive des tissus mous s'étendant de la peau au fascia et entraînant des nécroses étendues. Il s'agit d'une complication très rare mais grave avec une mortalité variant de 10 à 15 %. La prise en charge optimale relève d'un diagnostic précoce suivi d'un traitement associant antibiothérapie et parage chirurgical large dans les plus brefs délais. La localisation au niveau du sein est peu fréquente. Bien qu'il s'agisse le plus souvent de fasciites nécrosantes mammaires primaires, plusieurs cas de fasciites nécrosantes ont été rapportés dans les suites postopératoires d'une chirurgie mammaire. Nous présentons le cas d'une fasciite nécrosante du sein survenu après un geste de mastectomie par voie sous-mammaire avec reconstruction immédiate par implant prépectoral en silicone, ayant abouti à une défaillance multiviscérale suivi du décès de la patiente malgré une prise en charge médicochirurgicale intrahospitalière optimale. Il s'agit du premier cas survenu après une reconstruction mammaire immédiate. Necrotizing fasciitis is a rapidly progressive soft tissue infection extending from the skin to the fascia, resulting in extensive necrosis. It is a very rare but serious complication, with mortality ranging from 10 to 15%. Optimal management involves early diagnosis followed by treatment combining antibiotic therapy and wide surgical removal as soon as possible. Localisation in the breast is uncommon. Although most cases are primary necrotizing fasciitis of the breast, several cases of necrotizing fasciitis have been reported in the post-operative aftermath of breast surgery. We present a case of necrotizing fasciitis of the breast following submammary mastectomy with immediate reconstruction using a pre-pectoral silicone implant, which resulted in multiple organ failure and the death of the patient despite optimal medical and surgical management. This is the first case to occur after immediate breast reconstruction. [ABSTRACT FROM AUTHOR]

Background/Aim: This study examined the influence of preoperative MRI on the choice of implant volume in patients undergoing subcutaneous mastectomy with immediate breast reconstruction. It was postulated that preoperative MRI scans can adequately estimate glandular tissue, which in turn correlates with implant size. Patients and Methods: Preoperative and postoperative MRI scans were used in oncological and prophylactical subcutaneous mastectomy scenarios in 67 cases at the Department of Gynaecology, Breast Cancer Center, University of Cologne, Germany. The preoperative MRI was used to estimate the resected tissue and the postoperative MRI was used to scan for residual glandular tissue. In addition, a correlation found by Malter et al. in 2021 was evaluated with the available data. Results: Preoperative MRIs result in an adequate estimation of resected tissue. This in turn correlates with implant volume. The correlation by Malter et al. also holds when estimating implant volume. The likelihood of residual gland was low if the preoperatively estimate volume was removed. Conclusion: Our results indicate that the use of preoperative and postoperative MRI scans for subcutaneous mastectomies is advantageous. We suggest a routine estimation of glandular tissue, especially for small breasts. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review article is an update on the state of surgical options in the treatment of breast cancer. We seek to provide readers with the best practices for oncologically safe and cosmetically superior breast surgery. Recent Findings: This article reviews the latest technologies for partial mastectomy, advances in and oncologic safety of mastectomy including skin and nipple sparing techniques, and a review of oncoplastic breast surgery techniques. Summary: Our goal is to inform all surgeons who treat patients with breast cancer that many options remain available for the surgical treatment of breast cancer. [ABSTRACT FROM AUTHOR]

Background Different types of abdominoplasties have been developed to address individual patient characteristics. However, an analysis of complication rates and risk factors for different types of abdominoplasties has yet to be reported. Objectives The aim of this study was to evaluate the complication rates and risks associated with each type of abdominoplasty. Methods Utilizing the CosmetAssure database, patients undergoing an abdominoplasty from 2015 to 2022 were identified. Demographic factors and major complications were recorded and analyzed with a chi-square test or analysis of variance. A logistic regression was performed to identify the risk for developing complications associated with each type of abdominoplasty. Results A total of 55,596 patients underwent an abdominoplasty procedure by any method. The overall complication rate was 2.1%. There was a significant difference in the overall complication rates of all 7 types of abdominoplasties (P <.05), with fleur-de-lis abdominoplasty having the highest complication rate. The year of surgery, being underweight or morbidly obese, having diabetes, and being male placed patients at a significantly higher risk for developing a postoperative complication. Over 15,000 patients (27.2%) had concurrent procedures related to breast surgery, other body contouring, liposuction, or facial surgery. When accounting for various risk factors in a regression model, there was no significant added risk for major complications after a combination procedure with an abdominoplasty compared to abdominoplasty alone. Conclusions Among the different types of abdominoplasties, a fleur-de-lis abdominoplasty has the highest complication rate. Concurrent cosmetic procedures with an abdominoplasty showed no added risk for major complications when compared to abdominoplasty alone. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Abstract Background Sentinel lymph node biopsy (SLNB) is widely used in patients who receive neoadjuvant chemotherapy (NAC). Still, axillary lymph node dissection (ALND) is recommended for patients with any axillary residual disease after NAC. The necessity of ALND in patients with minimal axillary disease is unclear. We aim to investigate regional recurrence rates in patients with limited axillary residual disease after NAC underwent SLNB + image-tailored axillary surgery and adjuvant radiotherapy (RT). Methods Patients with clinical stages were T1-3 and N1 at the time of diagnosis, clinically good or complete axillary response after NAC, and limited axillary residue (≤ 3 pathological lymph nodes) with favorable response to NAC in the final pathological examination were included in the study. All patients underwent SLNB + image-tailored axillary surgery. Peripheral lymphatic radiotherapy was applied, and no further surgery was performed in patients with compatible radiology and pathology results. Results Our study, which evaluated 139 patients with a median age of 47 years, found that the median number of excised lymph nodes was 4. Notably, 46% of patients had between 1 and 3 lymph nodes excised, while 45% had between 4 and 6. Only 9% of patients had ≥ 7 lymph nodes. 83(60%) of the patients underwent breast-conserving surgery (BCS), and 56(40%) underwent mastectomy. The study’s median follow-up period was 44 months. During this duration, one breast recurrence (0.7%), one supraclavicular recurrence (0.7%), and six systemic recurrences (4.3%) were observed. No axillary recurrence occurred within the follow-up period. Conclusions Patients presenting with pathological-suspicious ≤ 3 lymph nodes on imaging and showing a good response to NAC can be considered suitable candidates for SLNB + image-tailored axillary surgery, followed by adjuvant RT instead of ALND.

Abstract Introduction Breast cancer is the most prevalent cancer among women, often necessitating surgical intervention. While surgeries like lumpectomy can be performed under local anesthesia, more extensive procedures typically require general anesthesia. Awake breast cancer surgery has emerged as an alternative due to risks associated with general anesthesia and patient preference. Methods This prospective observational study, conducted from July 2022 to July 2023, evaluated the effectiveness of ultrasound-guided fascial plane blocks for awake breast surgery. Patients aged 18–80 years undergoing unilateral breast surgery were included, following ethical committee approval and written informed consent. Exclusion criteria were prior breast surgery, coagulopathies, infections, allergies to local anesthetics, psychiatric disorders, body mass index over 40 kg/m², and chest deformities. The combination of interpectoral, pecto-serratus, and deep serratus plane blocks was used as the primary anesthetic method, with a superficial parasternal block added in cases where complete cutaneous coverage was not achieved. Results Seventeen patients were enrolled. The primary outcome, sufficient surgical anesthesia without deep sedation, was achieved in 15 patients. The combination of the aforementioned blocks proved effective, with an average surgery duration of 59.66 min, and propofol requirements averaging 1.77 mg/kg/hour. Most patients reported high satisfaction levels, and no early or late block-related complications were observed. Conclusion The combination of fascial plane blocks is a viable option for awake breast cancer surgery, potentially eliminating the need for more invasive anesthesia techniques. Further studies are necessary to confirm these findings in larger, homogeneous patient groups.

Background and Aims: General anaesthesia (GA) is the preferred modality for breast surgeries; however, neuraxial anaesthesia can be performed in cases where GA poses a significant risk. We hypothesise that neuraxial blockade is a safe and effective alternative to GA in short-duration breast surgeries. Methods: This randomised study included 30 patients of the American Society of Anesthesiologists physical status I and II, who were scheduled for elective breast surgeries of a duration of less than 90 min. Group I received thoracic spinal anaesthesia, while in Group II, standardised GA was administered. The primary outcome was the time to the first rescue analgesic, and the secondary outcomes were time to recovery, patient satisfaction and the cost incurred. Results: The demographic characteristics of both groups were comparable (P > 0.05). The time to first rescue analgesic in Group I was more than in Group II (P = 0.001). Patient satisfaction score was superior in Group I compared to Group II (P = 0.002). The average cost was lower in Group I compared to Group II (P = 0.002). Recovery was quicker in Group I than in Group II (P = 0.001). There were no significant haemodynamic disturbances or major complications in either group. Conclusion: Thoracic spinal anaesthesia is an excellent alternative to GA in terms of analgesic efficacy, patient satisfaction, recovery and cost-effectiveness for short-duration breast surgeries.

Radiation-induced morphea (RIM) is a progressive and irreversible scleroderma encountered after breast radiation therapy. This condition is often underdiagnosed, with confounding differentials including post-radiation fibrosis, infection, inflammatory breast cancer, and cancer recurrence, amongst others. Treatment paradigms differ, and early diagnosis of RIM is essential in preventing further fibrosis and improving quality of life. First-line therapy includes immunosuppressive therapy; surgical management is infrequently described in the literature. Here, we report one of the few reports of completion mastectomy for RIM with postoperative outcomes described. This is a case of a patient who was treated with completion mastectomy with delayed wound closure after developing debilitating RIM status post right breast lumpectomy with radiation for invasive ductal carcinoma.

Introduction: Mastectomy skin flap (MSF) necrosis remains a significant complication in breast reconstruction. This study aims to identify a correlation between the qualitative and quantitative analysis of the MSF perfusion grade and the skin necrosis rate 1 month after surgery using indocyanine green angiography (ICGA), focusing on lag time and perfusion metrics. Methods: Consecutive women scheduled for nipple/skin-sparing/skin-reducing mastectomy between May 2020 and October 2022 were prospectively enrolled. Patients were divided into Group 1 in the absence of superficial and full-thickness necrosis (SN; FTN) and Group 2 in the presence of both. Demographic data, lag time T1 (time between ICG injection and the initial perfusion of the least perfused MSF area), ICG-Q1, and ICG-Q% (absolute and relative perfusion values of the least vascularized area) were collected. Results: 76 breasts were considered. FTN was reported in 8 breasts (10.5%) and SN in 4 (5.2%). The 2 groups statistically differ in T1 (Group2 > Group1), ICG-Q1, and ICG-Q% (Group1 > Group2) (P < 0.05). T1 longer than 170 seconds, body mass index, previous chemo/radiotherapy, arterial hypertension, breast weight, type of surgery, and ICG quantitative values can help in predicting MSF necrosis. Conclusions: MSF qualitative and quantitative perfusion evaluation can be helpful to prevent MSF necrosis. However, it should be considered together with the patient's characteristics, the type of surgery, and T1. In this way, it is possible to predict the risk of MSF necrosis and plan the best reconstructive strategy. [ABSTRACT FROM AUTHOR]

Objective: Determining the presence of metastasis in the axillary lymph nodes using preoperative data in breast cancer has been studied previously. Formulas and nomogram programs that calculate the relationship between parameters and axillary lymph node metastases are presented. It is controversial whether current calculations give the same accuracy across all ethnic groups. We aimed to validate the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram results for the prediction of sentinel lymph node (SLN) metastasis in patients with breast cancer in Turkey. Method: The clinical records, pathology results, and surgery reports of 400 patients who underwent surgery were examined. Sensitivity, specificity, positive and negative predicated values, and area under the curve (AUC) values were calculated using a nomogram developed by the MSKCC. Results: Frozen section results of SLN examination of the patients were positive in 101 of the 400 patients. The relationship between nomogram calculation and sentinel positivity was evaluated using the receiver operating characteristic curve (ROC); AUC 0,699, p

Abstract Background Surgery is the primary treatment for benign breast disease and causes some disruption to the normal physiology of the breast, even when this disruption is localised, it remains unclear whether it affects women’s ability to breastfeed. There are only a few studies describing the experience of breastfeeding in women who have undergone benign breast disease (BBD) surgery. Methods We retrospectively analysed data from patients aged 20–40 years in Guangdong, China, who underwent breast lumpectomy for BBD in our department between 01 January 2013 and 30 June 2019, with a follow-up date of 01 February 2022. Patients were included who had a history of childbirth between the time of surgery and the follow-up date. By collecting general information about this group of patients and information about breastfeeding after surgery, we described the breastfeeding outcomes of women of a fertile age who had previously undergone surgery for benign breast disease. Results With a median follow-up of 5.9 years, a total of 333 patients met the inclusion criteria. From the breastfeeding data of the first child born postoperatively, the mean duration of ‘exclusive breastfeeding’ was 5.1 months, and the mean duration of ‘any breastfeeding’ was 8.8 months. The rate of ‘ever breastfeeding’ is 91.0%, which is lower than the national average of 93.7%, while the exclusive breastfeeding rate at six months was 40.8%, was higher than the 29.2% national average. The any breastfeeding rate at 12 months was 30.0%, which was well below the 66.5% national average. The common reason for early breastfeeding cessation was insufficient breast milk. A total of 29.0% of patients who had ever breastfed after surgery voluntarily reduced the frequency and duration of breastfeeding on the operated breast because of the surgery. Conclusions There are some impacts of BBD surgery on breastfeeding and some may be psychological. Institutions should provide more facilities for mothers who have undergone breast surgery to help them breastfeed, such as conducting community education on breastfeeding after breast surgery, training professional postoperative lactation consultants in hospitals, and extending maternity leave. Families should encourage mothers to breastfeed with both breasts instead of only the non-operated breast.