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Although breast surgeons can request frozen section biopsies to evaluate margin status in breast-conserving surgery (BCS), specimen imaging is also a useful assessment tool. Intraoperative digital specimen mammography (IDSM) has recently been introduced in Korea. To estimate the clinical role of IDSM, this study compared the clinicopathologic factors of patients whose specimen was assessed with IDSM with those assessed using conventional specimen mammography (CSM).From October to December 2021, 78 breast cancer patients who underwent BCS were included in this study. The obtained specimens were assessed using IDSM (n = 44) and CSM (n = 34). Clinicopathologic factors included margin involvement status in specimen mammography and the results of frozen section biopsies. The radiation dose emitted from the specimen after mammography was measured using a portable device.There were no significant differences in clinicopathological factors between the two groups, except the type of surgery for axillary lymph nodes. The closest distance from the margin to tumor was longer in the CSM group than in the IDSM group, although the difference was not statistically significant (p = 0.894). Margin involvement was accurately detected using IDSM due to the absence of compression (p 0.001). In addition, the sensitivity and accuracy of IDSM were higher, and the false-negative rate was lower.Both specimen mammography methods were highly accurate in evaluating the margin involvement status. However, the margin status could be examined more precisely using IDSM because the specimen was not compressed to perform the examination. Because the IDSM system was installed in the operating room, it not only shortened performing routes but also reduced the operating time by providing immediate results.

Background Immediate breast reconstruction after mastectomy can be challenging in some patients for medical or oncological reasons. Delayed two-stage tissue expander/implant breast reconstruction is a reliable option for these patients. However, data regarding surgical techniques, outcomes, and complication rates are limited. This study reports our experience using the two-stage tissue expander/implant procedure for delayed breast reconstruction.Methods This retrospective study included 32 patients (34 breasts) who underwent delayed two-stage tissue expander/implant breast reconstruction at our institution from January 2018 to July 2022. We summarized the techniques used in the procedure and evaluated the 1-year postoperative outcomes and complication rates.Results The mean time from mastectomy to expander insertion was 210±25 days, and 8.2±2.3 additional expansions were required prior to the implant insertion. The mean time of tissue expansion was 187±15 days, and the mean volume of expansion was 495±31 mL. No major complications occurred that required reoperation, and the patients were highly satisfied with the surgical results.Conclusions Although delayed two-stage tissue expander/implant breast reconstruction resulted in satisfactory outcomes, consensus regarding the operative technique is still needed. Two-stage tissue expander/implant breast reconstruction is a safe and effective option for delayed breast reconstruction.

Background. A combination of the reduction mammoplasty technique and breast reconstruction allows surgeons to lift ptotic breasts through local flaps and skin reduction during surgery for breast cancer. This study presents a reliable course for the combination of partial and skin or nipple-sparing mastectomy with reduction-reconstruction surgery. Methods. Fifty-seven patients underwent a partial mastectomy before reduction mammoplasty of both breasts during the same time period between 2014 and 2021 at our institution and thirteen patients underwent skin or nipple-sparing mastectomy, breast reconstruction with an extended latissimus dorsi flap or silicone implant, and aesthetic reduction mammoplasty of the contralateral breast during the same time period. Additional photos were obtained preoperatively, immediately after the operation, and at one, three, six, and twelve months postoperatively. Patient satisfaction was evaluated preoperatively and postoperatively and postoperative complications were noted. Results. Among the patients who underwent a partial mastectomy, the mean age was 45.18 ± 11.05 years, the mean body mass index (BMI) was 26.74 ± 3.53 kg/m2, and the mean preoperative right and left breast volumes were 663.85 (±28.12) cc and 664.34 (±37.13) cc, respectively, and the mean excised mass weight was 177.74 (±213.93) g. Among the patients who underwent a skin-sparing mastectomy, the mean age was 51.62 ± 8.96 years, the mean BMI was 26.91 ± 4.34 kg/m2, and the mean preoperative right and left breast volumes were 624.17 (±98.52) cc and 562.31 (±80.81) cc, respectively, and the mean excised mass weight was 618.05 (±338.17) g. Four patients (5.3%) in the partial mastectomy group had fat necrosis. The mean patient satisfaction score was higher postoperatively in both groups. Conclusion. Patients with breast cancer and large and/or ptotic breasts can successfully undergo reduction mammoplasty for both breasts immediately following partial mastectomy and nipple or skin-sparing mastectomy.

Seroma is the most common complication after mastectomy and reconstruction surgery. Therefore, this study aimed to determine whether the topical application of tranexamic acid would be useful to reduce seromas in a rat mastectomy model.Forty-eight Sprague-Dawley rats were divided into four groups. After mastectomy and axillary lymph node dissection, 0.4 mL of normal saline was administered to group A in the dead space. In group B, 0.4 mL of a triamcinolone mixed solution was administered. In group C, 0.4 mL of a tranexamic acid (10 mg/kg) mixed solution was administered. In group D, 0.4 mL of a tranexamic acid (50 mg/kg) mixed solution was administered. Gross examination, assessment with micro-computed tomography (CT), quantitative analysis via aspiration, and histopathologic assessment were implemented 7 and 14 days postoperatively.No other complications such as wound infection and skin necrosis were observed. At postoperative week 1, groups B and C showed significantly lower seroma volume values on micro-CT (P 0.001 and P 0.05, respectively) and seroma volume values at aspiration (P 0.01 and P 0.001, respectively) than group A. According to histopathologic analysis, inflammation was observed more frequently in groups A and D than in the other groups, and angiogenesis was more active in groups B and C than in the other groups.Topical application of tranexamic acid was as effective as topical application of triamcinolone to prevent seroma formation. The stability of tranexamic acid was confirmed when the high dose of tranexamic acid was used.This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

The European Society for Radiotherapy and Oncology (ESTRO) recently defined delineation guidelines for the clinical target volume for postmastectomy radiation therapy (PMRT) after immediate implant-based reconstruction for early-stage breast cancer. We analyzed the three-dimensional location and pattern of local recurrence in accordance with the reconstruction type and ESTRO-target volume.This retrospective study involved patients who had undergone mastectomy with implant reconstruction between 2010 and 2019 and who had local recurrence as the first event. For mapping analysis, one subpectoral and one prepectoral implant patient were selected. All recurrence lesions were contoured and mapped in a representative case.A total of 1327 patients with breast cancer who underwent mastectomy and implant-based breast reconstruction were identified; 51 were enrolled with a total of 65 lesions. In subpectoral implant patients, 93% of recurrences were located in the ESTRO-target volume. No recurrence occurred in the implant pocket, but 7% of the recurrent tumors developed in the pectoralis major and deep thoracic muscle. In prepectoral implant patients, all recurrent tumors occurred within the ESTRO-target volume.The ESTRO-target volume in PMRT after reconstruction encompassed most local recurrences in patients who underwent mastectomy with immediate implant reconstruction. Our results support the application of the ESTRO Advisory Committee for Radiation Oncology Practice consensus guideline for target volume of PMRT after immediate implant-based reconstruction for early-stage breast cancer.

The pathogenic variant (PV) or likely pathogenic variant (LPV) BRCA1/2 gene is strongly associated with hereditary breast or ovarian cancer. Therefore, it is important to screen blood relatives to establish preventive modalities and surveillance. This study evaluated the feasibility of targeted cascade genetic testing for family members of BRCA1/2 gene PV or LPV carriers. We screened 18 families for BRCA1/2 gene status via the conventional cascade genetic test (n = 9) and targeted cascade genetic test (n = 9), which targeted the exon region wherein the index patient showed PV or LPV. The pedigree and clinicopathologic characteristics were reviewed and analyzed. All index patients were diagnosed with breast cancer, while the third family members were all healthy. In the conventional cascade test group, 3 index patients and 3 family members had the BRCA1/2 gene PV or LPV. In the targeted cascade test group, 5 family members had same type of BRCA1/2 gene PV or LPV as their index patients. Two families had an identical string of BRCA1/2 gene PV or LPV. Although the targeted cascade genetic test cannot completely characterize the BRCA1/2 gene, it is sufficient for determining its PV or LPV status. This limited genetic test can be used for family members of PV or LPV carriers.

Purpose: Currently, there are no molecular biomarkers for the early detection of breast cancer. This study focused on identifying surface proteins found on circulating extracellular vesicles (EVs) for detecting early-stage breast cancer.Experimental Design: Circulating EVs, isolated from the plasma of 10 patients with breast cancer (stages I and II) and 5 healthy controls, were analyzed using LC-MS/MS. Developmental endothelial locus-1 protein (Del-1) was selected as a candidate biomarker. Two different ELISAs were used to measure Del-1 in plasma samples from healthy controls (n = 81), patients with breast cancer (n = 269), breast cancer patients after surgical resection (n = 50), patients with benign breast tumors (n = 64), and patients with noncancerous diseases (n = 98) in two cohorts.Results: Plasma Del-1 levels were significantly higher (P < 0.0001) in patients with breast cancer than in all controls and returned to almost normal after tumor removal. The diagnostic accuracy of Del-1 was AUC, 0.961 [95% confidence interval (CI), 0.924–0.983], sensitivity of 94.70%, and specificity of 86.36% in test cohort and 0.968 (0.933–0.988), 92.31%, and 86.62% in validation cohort for early-stage breast cancer by one type of ELISA. Furthermore, Del-1 maintained diagnostic accuracy for patients with early-stage breast cancer using the other type of ELISA [0.946 (0.905–0.972), 90.90%, and 77.14% in the test cohort; 0.943 (0.900–0.971), 89.23%, and 80.99% in the validation cohort].Conclusions: Del-1 on circulating EVs is a promising marker to improve identification of patients with early-stage breast cancer and distinguish breast cancer from benign breast tumors and noncancerous diseases. Clin Cancer Res; 22(7); 1757–66. ©2015 AACR.

List of proteins identified EVs derived from the breast cancer cell line MDA-MB-231. For each protein, they show IPI accession number, protein description, Mascot score, and protein mass.

Supplemental Figure 1. Study design, including sample collection, discovery, test and validation. Supplemental Figure 2. Characterization of EVs isolated from human plasma and MDA-MB-231 cells. Supplemental Figure 3. Optimization of ELISA. Linearity of ELISA Method 1 (A) and ELISA Method 2 (B) for the quantification of Del-1 on EV in plasma. Supplemental Figure 4. CA 15-3 levels in plasma from patients with BC in test set. The black horizontal lines are means, and error bars are SEs. Healthy controls (HC). Supplemental Figure 5. The relationships among the number of circulating EVs, tumor sizes, and Del-1 or CD63 levels, in patients with breast cancer. Supplemental Figure 6. Correlation between Del-1 levels and the status of four types of receptors associated with BC in the test cohort. Supplemental Figure 7. Del-1 levels in plasma in the validation cohort using two types of ELISA.

List of proteins quantified between control and breast cancer. For each protein, they show IPI accession number, protein description, ratio from each patient, ,average and common protein in MDA-MB-231.

Background The latissimus dorsi (LD) muscle has a dominant pedicle with one thoracodorsal artery and receives sufficient blood by segmental circulation through several perforators. Thus, it is widely used in various reconstructive surgeries. We are reporting on the patterns of the thoracodorsal artery analyzed by chest computed tomography (CT) angiography. Methods We analyzed the preoperative chest CT angiography results of 350 patients scheduled to undergo LD flap breast reconstruction following complete mastectomy for breast cancer between October 2011 and October 2020. Results A total of 700 blood vessels were classified according to the Kyungpook National University Plastic Surgery-Thoracodorsal Artery (KNUPS-TDA) classification: 388 (185 right and 203 left), 126 (64 right and 62 left), 91 (49 right and 42 left), 57 (27 right and 30 left), and 38 (25 right and 13 left) vessels were classified as type I, type II, type III, type IV, and type V, respectively. Among 350 patients, 205 patients showed matching types for left and right vessels, whereas 145 patients showed mismatching types. For 205 patients with matching types, the distribution by type was 134, 30, 30, 7, and 4 patients with type I, type II, type III, type IV, and type V, respectively. For 145 patients with mismatching types, the distribution by different combinations was 48, 25, 28, 19, 2, 9, 7, 3, 1, and 3 patients with type I + type II, type I + type III, type I + type IV, type I + type V, type II + type III, type II + type IV, type II + type V, type III + type IV, type III + type V, and type IV + type V, respectively. Conclusion While there is some diversity in the vascular anatomical structures of the LD flap, the dominant vessel can be found in a similar location in almost all cases and no flap had absence of a dominant vessel. Therefore, in surgical procedures using the thoracodorsal artery as the pedicle, preoperative radiological confirmation is not absolutely necessary; however, due to variants, performing the surgery with an understanding of this aspect should lead to good outcomes.

Selaginellaceae plants are used in cosmetics to limit skin aging. This study is the first to investigate the anti-aging effects of

BACKGROUND: With recent advances in surgical techniques, minimally invasive methods for reconstructive breast surgery are being investigated. To enhance surgical proficiency through training and minimize predictable complications before human application, we conducted a preliminary experimental study of reconstructive breast surgery using a porcine model. METHODS: Between February and March 2019, four 3-month-old pigs underwent a bilateral mastectomy and immediate breast reconstruction with a latissimus dorsi (LD) flap or silicone implants. After performing the mastectomy by dissecting the pectoralis profundus in the subcutaneous plane, the pig was placed in the decubitus position, and ultrasound-guided marking was used to design the LD flap. The thoracodorsal artery was marked, and a 4-cm incision was made on the midaxillary line. An additional endoscopic incision was made in the inferior margin of the LD flap; a 2-hole approach was used for endoscopic LD flap elevation. In the silicone implant model, a silicone implant (Allergan, smooth, round type, 90 cc) was placed using a single incision (4–5 cm). RESULTS: Eight mastectomies followed by breast reconstruction with LD flap elevation or silicone implant models were performed on four pigs. Serious complications, such as active bleeding, did not occur. However, heat dispersion to the skin flap that became thinner by endoscopic dissection caused a second-degree burn in one pig. CONCLUSIONS: This preliminary study of endoscopic or robot-assisted minimally invasive reconstructive breast surgery demonstrates that a porcine training model is a highly valuable experimental model for surface anatomy verification, incision plan selection, instrument selection, operator proficiency enhancement, and complication prevention.

In the recent trend toward less aggressive approaches to breast reconstruction, minimally invasive harvesting of the latissimus dorsi (LD) flaps has long been a desirable goal. Endoscopically-assisted LD flap harvesting was reported as a method for minimizing scar formation and reducing donor-site morbidity. This study investigates the surgical outcomes of endoscopically-assisted immediate breast reconstruction with LD muscle flaps. This prospective study included 21 patients who underwent endoscopically-assisted breast reconstruction with LD muscle flap and 20 patients who underwent breast reconstruction with conventional harvesting LD musculocutaneous flap. In patients with nonexcised skin or possible primary closure, the reconstruction was performed with endoscopically-assisted LD muscle flaps using the single-port and CO2 gas insufflation technique. The patients were classified into groups according to the location of the defect and mastectomy type. Moreover, patient satisfaction was investigated 6 months after surgery. In patients who underwent endoscopically-assisted breast reconstruction with LD muscle flaps, the scar of the donor-site was vertical, and the size was 4 cm to be obscured when lowering the arms. In comparison with patients who underwent breast reconstruction with conventional LD flaps, those who underwent endoscopically-assisted breast reconstruction with LD muscle flaps showed shorter hospital stay and no difference in patient satisfaction. Endoscopically-assisted breast reconstruction with LD flaps showed no difference in patient satisfaction with good esthetic results compared with conventional LD flaps. The endoscopic LD muscle flap harvest technique using a single-port and CO2 insufflation technique can be very useful in breast reconstruction that does not require a skin paddle. 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 .

Background Complications of radiotherapy after implant-based reconstruction include capsular contracture development, seroma formation, and reoperation for implant removal or replacement. However, there is a lack of studies regarding aesthetic outcomes and complication rates following radiation therapy among patients undergoing latissimus dorsi (LD) flap-based reconstruction with implant insertion for volume shortage. The present study aimed to evaluate clinical and aesthetic outcomes of post-mastectomy radiation therapy (PMRT) among patients receiving both LD flap reconstruction and implant insertion. Methods This study comprised 66 patients who underwent mastectomy and breast reconstruction between March 2014 and July 2019. Patient demographics and outcomes were compared among patients who did and did not receive PMRT. Aesthetic outcomes were compared using gross photographs. The incidence of complications, including seroma formation, flap necrosis, nipple-areola complex necrosis, hematoma development, and capsular contractures, was compared between groups. Results No differences in aesthetic outcomes using gross photos during outpatient follow-up were observed between the radiation and control groups. No significant difference in the frequency of complications was observed between groups. Conclusions The use of implants and LD reconstruction are inevitable in a proportion of patients due to a lack of LD flap volume. For these patients, PMRT could be safe treatment option if the necessary precautions are implemented.

Purpose: This study investigated the effects of a serial home-based exercise program in the affected upper extremity immediately after latissimus dorsi (LD) flap reconstruction with mastectomy in order to improve the functional impairment and quality of life in breast cancer survivors. Methods: Patients with breast cancer scheduled for a mastectomy immediately followed by autologous LD flap reconstruction surgery were enrolled. Forty-five patients were included as an intervention group who received a serial home-based exercise program with stretching and strengthening for upper extremities preoperatively (T0), and 2 weeks (T1), 6 weeks (T2), and 3 months (T3) postoperatively. Thirty-five patients were included as the control group. We evaluated the range of movement in the shoulder at T0, T1, T2, T3, 6 months (T4), and 12 months (T5) postoperatively. We also evaluated the disability of the upper extremity using disabilities of the arm, shoulder, and hand (DASH) questionnaire and quality of life using the 36-Item Short-Form Health Survey (SF-36) at T0, T3, T4, and T5. Results: There were significant differences in interaction effects between time and shoulder flexion and internal and external rotation. Post hoc, the intervention group showed more improvement of movement in internal rotation at T2 and T5 and external rotation at T2, T3, and T4. Furthermore, there were significant differences in interaction effects between DASH scores and time in the two groups. Post hoc, there were significantly lower DASH scores at T3, T4, and T5 in the intervention group. There were significant differences in interaction effects of physical role functioning, vitality, and mental health scores of SF-36 and time in the two groups. Post hoc, physical role functioning scores at T3 and T4 and vitality and mental health scores at T3 were elevated in the intervention group. Conclusion: A serial home-based exercise after LD flap reconstruction is effective for the rehabilitation of the affected upper extremity and enhances the quality of life.

The surgical range of breast cancer that shows pathologic complete response (pCR) without change in microcalcifications after neoadjuvant chemotherapy (NAC) is controversial. This study examined whole breast specimens to evaluate the necessity of mastectomy in those cases. The viability of cancer cells around the residual microcalcification was assessed using prospectively collected breast samples to confirm the presence or absence of cancer cells. A total of 144 patients with breast cancer and diffuse microcalcifications were classified into the reduced mass with no change in residual microcalcification (RESMIN, n = 49) and non-RESMIN (n = 95) groups. Five specimens were prospectively evaluated to assess the presence of viable cancer cells around the microcalcification. Tumor responses to NAC were significantly better with high pCR rates in the RESMIN group (p = 0.005 and p = 0.002). The incidence of human epidermal growth factor receptor 2-positive and triple-negative breast cancers was significantly high in the RESMIN group (p = 0.007). Although five (10.2%) patients had locoregional recurrence in the RESMIN group, no local recurrence in the breast was reported. Although pCR was highly estimated, residual cancers, including ductal carcinoma in situ, remained in 80% cases. Therefore, given the weak scientific evidence available currently, complete removal of residual microcalcifications should be considered for oncologic safety.

AimWhile many studies reported the oncological outcomes of oncoplastic breast-conserving surgery (OBCS), there were inherent differences in the study population, surgeons’ expertise, and classifications of techniques used. There were also limited studies with long term follow up oncological outcomes beyond 5 years. This current study aimed to compare long-term oncological outcomes of ipsilateral breast tumor recurrence (IBTR) disease-free survival (DFS) and overall survival (OS) following conventional and oncoplastic breast-conserving surgery using volume displacement and replacement techniques.MethodsBetween 2009 and 2013, 539 consecutive patients who underwent breast conservation surgery including 174 oncoplastic and 376 conventional procedures were analysed. A systematic review of studies with at least five years of median follow up were performed to compare long term oncological outcomes.ResultsAt a median follow-up of 82.4 months, there were 23 (4.2%) locoregional recurrences, 17 (3.2%) metachronous contralateral breast cancer, 26 (4.8%) distant metastases, and 13 (2.4%) deaths. The hazard ratio of OBCS for IBTR, DFS and OS were 0.78 (95% confidence interval [CI] 0.21–2.94, p=0.78), 1.59 (95% CI, 0.88 to 2.87, p=0.12), and 2.1 (95% CI, 0.72 to 5.9, p=0.17) respectively. The 10-year IBTR-free, DFS and OS rate were 97.8%, 86.2%, and 95.7% respectively.ConclusionThere remained a dearth in well-balanced comparative studies with sufficient long-term follow-up, and our study reported long-term oncological outcomes for OBCS which were favourable of either VD or replacement techniques.

Polyurethane (PU), currently replacing existing synthetic materials worldwide, is a synthetic polymer derived from polyols, isocyanates, and a chain extender added by condensation reactions. PU wastes which are difficult to recycle, are commonly discarded in landfills and flow into ecosystems, thereby causing serious environmental problems. In recent years, insect-associated microbes have become a promising, eco-friendly strategy as an alternative to plastic recycling. This study aimed to evaluate the potential of

Hematomas represent one of the postoperative complications in patients undergoing reconstructive or aesthetic breast surgery with a silicone implant. Although there are few reports of intracapsular hematoma, those presenting late hematoma after reconstructive and aesthetic augmentation surgeries are rarer. This study reported two Asian patients with late hematoma after reconstruction and aesthetic breast surgery. A 54-year-old female patient underwent bilateral nipple-sparing mastectomy with immediate breast reconstruction using anatomically shaped textured implant for intraductal carcinoma in August 2019. Contralateral nipple-sparing mastectomy was performed for the BRCA gene mutation on the left breast, which was immediately reconstructed with an anatomically shaped textured implant. In a 1-year postoperative magnetic resonance imaging evaluation, an extracapsular hematoma was found on the right side, which was removed following the removal of both implants. Another case was a 63-year-old female patient who underwent augmentation of both breasts with smooth round implants and experienced right unilateral swelling and painless firmness about 30 years postoperatively. A preoperative magnetic resonance imaging evaluation showed both intracapsular and extracapsular ruptures on the right breast and a bulging implant herniation on the left breast. During the operation, hematoma, implants, and capsule were all removed. The excised capsule was sent for histological evaluation. Slightly dark colored blood was emptied before removing the semisolid-state intracapsular hematoma. In both cases, the patients responded well postoperatively and were discharged to their homes with no postsurgical complications, including seroma, or additional hematoma on the breasts. The etiology of late hematoma following breast augmentation or reconstruction has been poorly characterized. Further reports are needed to clearly establish the reasons for this increase in late hematoma formation.

Background The use of acellular dermal matrix in implant-based breast reconstruction immediately after mastectomy has attracted attention in recent years because it yields good outcomes. Herein, we analyzed the usefulness of meshed SurgiMend in direct-to-implant (DTI) breast reconstruction. Methods In this retrospective single-center analysis, 44 one-stage breast reconstructions using SurgiMend were performed in 42 patients from May 2016 to December 2017. The implant was inserted into the subpectoral plane and SurgiMend was applied to the inferolateral part that lacked tissues to wrap the silicone implant. In 19 patients (20 breasts), fenestration was performed with SurgiMend, while in the remaining 23 patients (24 breasts), SurgiMend that was meshed at a ratio of 1:1.5 was used. We analyzed the frequency of complications. Patient satisfaction was compared and analyzed using a five-item questionnaire (shape, texture, symmetry, pain, and overall outcome). Results The average age of the patients was 43.2 years, and their mean body mass index was 21.1 kg/m2. The average follow-up period was 24.0 months. In the control (fenestrated SurgiMend) and experimental (meshed SurgiMend) groups, major seroma occurred in five of the 20 breasts (25.0%) and two of the 24 breasts (8.3%), respectively. Minor complications were resolved with conservative treatment. The patient satisfaction score for shape, texture, symmetry, pain, and overall satisfaction was 4.3, 4.1, 4.7, 4.5, and 4.4, respectively. Conclusions Applying meshed SurgiMend in DTI breast reconstruction is a useful surgical technique.

Background: Glucose metabolism in cancer cells produces various glycolytic metabolites, which can affect cancer progression and treatment outcome. Herein we evaluated the association of glucose transporters and enzymes involved in glucose metabolism with clinic-pathological factors and outcomes in breast cancer patients who underwent neoadjuvant chemotherapy(NAC). Methods: We selected 7 target transporters and enzymes(GLUT1, hexokinase 2, lactate dehydrogenase, MCT1, MCT4, IGF1RA, and IGF1RB) involved in glucose metabolism. Their tumoral expressions were scored both quantitively and qualitatively based on tissue microarrays and immunohistochemistry as previously described (Pinheiro et al, 2010) and then evaluated in relationships with pretreatment clinical/pathological characteristics and treatment outcomes including findings of 18F-FDG PET/CT,pathologic complete response(pCR), and relapse in breast cancer(stage IIA-IIIC) patients who underwent anthracycline or taxane-based NAC. Results: Of the 236 enrolled patients, 145(61.4%), 44(18.6%), and 47(19.9%) were luminal, HER2-enriched, and TNBC subtypes. Pathologic CR was determined 50(21.2%) and 57(24.2%) relapses, 42(17.8%) distant relapses, and 28 deaths were observed during median follow-up duration of 64.0 (32.3-114.9) months. The expression rates of the target molecules were 76.0, 31.1, 42.1, 54.9, 67.9, 78.4, and 49.8% for GLUT1, hexokinase 2 (HK2), lactate dehydrogenase(LD), MCT1, MCT4, IGF1RA, and IGF1RB, respectively. Among target molecules in glucose metabolism, LD was significantly associated with pCR(OR=0.251; p-=0.016) and distant disease-free survival (HR= 2.29; P=0.019). Plus, LD expression shows a trend for a high SUVmax of primary tumor 18F-FDG PET/CT(OR=1.797 P=0.060). Conclusion: Tumoral expression of lactate dehydrogenase can be considered as a predictive marker for pCR to NAC and plus prognostic marker for survival in patients with breast cancer. Citation Format: In Hee Lee, Soo Jung Lee, Jeeyeon Lee, Ho Yong Park, Jin Hyang Jung, Nora Jee-Young Park, Ji-Young Park, Yee Soo Chae, Byeongju Kang. LDH as a surrogate marker for both pCR and survival in breast cancer patient [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 2146.

Background After skin-sparing mastectomy, direct-to-implant breast reconstruction is divided into a subpectoral and prepectoral techniques. However, there is still lack of studies that have compared the functional recovery after reconstruction based on the two techniques. Therefore, this study was conducted as a prospective comparison of the functional recovery and quality of life between the two techniques. Methods Patients who had undergone mastectomy for breast cancer were grouped based on whether the approach during direct-to-implant reconstruction was subpectoral or prepectoral. Functional outcomes were evaluated pre-operatively, 2 weeks, 1, 3, and 6 months post-operation. The evaluation included range of motion of the shoulder, maximal muscle power of the shoulder, pain intensity (measured by the visual analogue scale), disability of the upper extremity (measured by the Disabilities of the Arm, Shoulder and Hand questionnaire), quality of life (measured by the 36-Item Short-Form Health Survey), and mood status [measured by the hospital anxiety and depression scale (HADS)]. Repeated-measures analysis of variance was performed to evaluate changes in functional assessments. Results In the subpectoral/prepectoral groups, the average age, body mass index (BMI), preoperative breast volume, and implant volume were 45.5/45.1 years, 22.6/22.7 kg/m2 , 244.5/206.0 cm3 , and 258.6/ 234.8 cm3 , respectively. There were no significant differences in functional assessments between the two groups before the operation. There were significant differences in visual analogue scale, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and time interaction effects between the two groups. In post-hoc analysis, the prepectoral group exhibited lower visual analogue scale and DASH scores than those in the subpectoral group at 2 weeks post-operation. Conclusions The prepectoral group showed favorable recovery of pain intensity and disability of the upper arm at the early phase post-operation. Both groups functionally recovered at 6 months post-operation. Therefore, the prepectoral technique can be considered as a useful alternative technique, compared to the classic subpectoral technique.

Breast-conserving surgery (BCS) has been reported to have better survival rates when compared with total mastectomy (TM) in early breast cancer. We evaluated the long-term outcomes of Korean women with early breast cancer who underwent either BCS plus radiotherapy (RT) or TM. In this population-based study, we evaluated 45,770 patients from the Korean Breast Cancer Registry (KBCR) who were diagnosed with early breast cancer, and divided them into the BCS + RT and TM groups. To minimize bias caused by factors other than the surgical method, we used exact match pairing of prognostic factors. We compared the 10-year overall survival (OS) and breast cancer-specific survival (BCSS) before and after exact matching. As the KBCR is a multicenter, online-based registry program, we used the Asan Medical Center (AMC) database, a single-center database, to validate the results from the KBCR database. In both the KBCR and AMC cohorts, the BCS + RT group showed better OS and BCSS than the TM group, before and after exact matching. For the KBCR cohort after exact matching, the hazard ratios for OS and BCSS were 1.541 (95% confidence interval [CI] 1.392–1.707, p

Background Several studies have discussed various methods of prepectoral direct-to-implant (DTI) breast reconstruction using an acellular dermal matrix (ADM) prosthesis to achieve full coverage. However, methods for anterior coverage have rarely been reported. In this study, prepectoral DTI breast reconstruction with complete anterior implant coverage was performed using a square piece of ADM. This study aimed to introduce our prepectoral DTI technique and determine its functional and cosmetic outcomes as well as compare them with those of existing subpectoral DTI techniques. Methods This prospective comparative study focused on 29 patients (35 breasts) and 34 patients (35 breasts) who underwent breast reconstruction via subpectoral implant insertion (control group) and anterior coverage prepectoral implant insertion (anterior coverage group), respectively. Postoperative complications were noted, and breast symmetry was evaluated using the Vectra H2 three-dimensional scanner. The modified Kyungpook National University Hospital Breast-Q (KNUH Breast-Q) scale was used to assess the patient’s subjective satisfaction with the reconstruction and postoperative quality of life. Results No remarkable differences in terms of complications (seroma, skin necrosis, nipple–areola complex necrosis, hematoma, capsular contracture, and infection) were noted in both groups. Compared with controls, considerably better results were observed among those in the anterior coverage group in terms of the mean drain removal period. Furthermore, those in the anterior coverage group showed greater symmetry on three-dimensional scans than the controls; however, this was not statistically significant. Subjective satisfaction and postoperative quality of life measured using the KNUH Breast-Q scale were not significantly different between both groups. Conclusions Considering its stability, faster recovery time, and cosmetic benefit, prepectoral breast reconstruction with anterior implant coverage using a single, large ADM is a good choice to perform breast reconstruction with implant insertion in patients who have undergone mastectomy. Level of evidence: II.