Search Results (712)

Introduction: Breast milk is the best food for a growing infant during the first 6 months of life. The presence of trans fatty acids (TFAs) in breast milk can interfere with the synthesis of long-chain polyunsaturated fatty acids (LC-PUFAs), increasing the risk of developing, among other issues, asthma or atopic dermatitis. TFAs are not synthesised de novo in the human body. Their content in breast milk may be a good marker of short-term dietary intake of these compounds by breastfeeding mothers. However, the literature shows differences in the assessment of the relationship between dietary TFAs intake and TFAs content in breast milk. Furthermore, the decrease in the TFAs content in food observed recently seems to make it impossible to use Craig-Schmidt’s formula to estimate the TFAs content in the diet or in breast milk. The aim of this study was to confirm the possibility of using TFAs content in breast milk as a marker of their short-term intake within the breastfeeding mother’s diet, together with an attempt at preliminary quantitative determination of the relationship between these parameters. Materials: The study material was collected from a single breastfeeding mother and included 10 breast milk samples and 10 samples of daily food rations reconstructed based on the 24 h food consumption survey. Methods: The content of fatty acids, including TFAs, was determined by gas chromatography–mass spectrometry (GC-MS). Results: The TFAs content in the whole-day mother’s diet and in 100 mL of breast milk ranged from 0.11 to 0.54 g/day and from 0.02 to 0.07 g, respectively. A strong statistically significant (p < 0.05) positive correlation between these parameters was found. Equations for an exploratory linear relationship between the TFAs content in a breastfeeding mother’s diet and the concentration of these fatty acids in breast milk have been developed. Due to the small number of samples, these data should be interpreted very cautiously and validated in a larger cohort. Conclusions: This single-participant pilot study suggests that TFAs content in breast milk may be a marker of the dietary intake of these compounds from the previous day. It seems that the dietary habits of breastfeeding mothers of twins are a significant factor influencing the composition of breast milk and, consequently, the nutritional quality of breastfed infants. Full article

Langer’s axillary arch, also known as the axillopectoral muscle, represents a relatively uncommon anatomical variation of the axillary region. Although often asymptomatic, its presence may have important implications in surgical procedures involving the axilla, particularly during breast surgery, axillary lymph node dissection, and reconstructive procedures. Despite numerous anatomical and surgical reports describing this variation, the true prevalence of Langer’s axillary arch remains uncertain due to variability in study design and detection methods. Objective: The aim of this systematic review and meta-analysis was to evaluate the reported prevalence of Langer’s axillary arch and to assess methodological variability among anatomical and surgical studies. Methods: A systematic literature search was conducted in accordance with PRISMA guidelines using electronic databases including PubMed, Scopus, and Web of Science. Studies reporting original data on the presence or prevalence of Langer’s axillary arch in cadaveric or surgical populations were included. Data extraction included study characteristics, sample size, number of detected axillary arches, and reported prevalence. A random-effects meta-analysis was performed to estimate the pooled prevalence and to evaluate heterogeneity between studies. Results: The analysis included studies comprising both cadaveric anatomical investigations and surgical series. Considerable variability in reported prevalence was observed across studies. Cadaveric studies generally reported higher prevalence rates compared with surgical series, reflecting differences in detection methods. Meta-analytic synthesis demonstrated that Langer’s axillary arch represents a relatively uncommon but clinically relevant anatomical variation. Conclusions: Langer’s axillary arch should be recognized as an important anatomical variant of the axillary region. Awareness of this variation is essential for surgeons performing axillary procedures, as its presence may influence surgical exposure and lymph node identification. Further large-scale anatomical and clinical studies are needed to better define its prevalence and surgical implications. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for diabetes and weight loss, with many breast reconstruction candidates being prescribed these medications. However, perioperative risks remain unclear. This study evaluated the association between GLP-1RA use and postoperative complications in implant-based and autologous tissue breast reconstruction. Methods: A retrospective analysis of TriNetX identified patients undergoing implant-based or autologous tissue breast reconstruction. Preoperative GLP-1RA users were compared to matched controls. Patients were propensity score matched (1:1 and 1:3) for demographics and comorbidities including body-mass index and timing of reconstruction (delayed vs. immediate). Ninety-day outcomes were assessed using logistic regression. Results: Between 2014 and 2024, 57,987 patients were identified, of which 823 were GLP-1RA users. Of those users, 326 patients undergoing implant-based reconstruction and 51 patients undergoing autologous reconstruction were matched to controls. In implant-based cohorts, GLP-1RA use was associated with increased odds of implant failure (1:1 OR 1.70, 95% CI 1.18–2.45, p = 0.0046), wound healing complications (1:1 OR 1.90, p = 0.027), and higher readmission/ED utilization (1:1 OR 1.80, 95% CI 1.04–3.21, p = 0.040). No significant differences were observed for hematoma, seroma, or thromboembolism. In autologous reconstruction, GLP-1RA use was not associated with increased risks. Conclusions: GLP-1RA use is linked to higher rates of implant failure, wound healing complications, and readmission in implant-based breast reconstruction only. These findings highlight the need for risk stratification and counseling of GLP-1RA users undergoing implant-based procedures and for further research investigating the implications of perioperative use of these agents in plastic surgery. Full article

Freehand three-dimensional (3D) ultrasound enables cost-effective volumetric breast imaging, but accurate reconstruction requires reliable probe tracking during manual scanning. This study proposes a portable freehand 3D ultrasound framework using dual-rotary-encoder two-degree-of-freedom (2DoF) pose sensing to measure probe displacement and inclination during breast scanning. A slip-resistant roller mechanism and time-aware trajectory modeling were introduced to improve measurement robustness under practical scanning conditions. The framework was evaluated through robotic experiments and phantom-based volumetric reconstruction. Positional displacement experiments achieved root mean square errors (RMSEs) of 0.38 mm on dry surfaces and 0.81 mm under gel-coated conditions. Inclination sensing using the rotary encoder outperformed an inertial measurement unit (IMU), achieving an RMSE of 2.76° with improved temporal stability. Reconstruction experiments using a breast phantom with spherical inclusions demonstrated successful volumetric visualization across multiple scanning trajectories. Statistical analysis revealed significant effects of inclusion size and scanning trajectory on relative reconstruction error, as well as a significant interaction between the two factors. Larger inclusions generally exhibited lower relative errors, while the influence of scanning trajectory depended on the target size. These findings support the feasibility of the proposed reduced-dimensional mechanical pose sensing approach for reliable freehand 3D ultrasound reconstruction with reduced hardware complexity. Full article

Background/Objectives: Biological ageing is accompanied by progressive alterations in mitochondrial metabolism, microvascular function, and thermoregulation. These processes collectively influence tissue heat production and dissipation, reflecting integrated metabolic, vascular, and thermoregulatory activity measurable at the physiological level. Passive microwave radiometry (MWR) provides a non-invasive, radiation-free method for detecting deep-tissue bioenergy emissions, complementing surface infrared thermography. To evaluate a thermophysiological Bioenergetic Index (BEI), derived from deep-tissue microwave emission, surface temperature, and their spatial and deep–surface relationships, as a candidate age-referenced thermophysiological marker associated with chronological ageing. Methods: Breast thermophysiology measurements from 36,391 women aged 20–80 years were analysed using data collected during routine clinical assessments. Supervised machine-learning models were trained exclusively on thermal features, with chronological age used only as the prediction target. Model performance was assessed using mean absolute error (MAE), root mean square error (RMSE), and coefficient of determination (R²). In addition, data were aggregated into 5-year age bins to evaluate population-level ageing trajectories. Results: At the individual level, models predicted chronological age with MAE ≈ 3.5 years, RMSE ≈ 5.4 years, and R² ≈ 0.76. Aggregation into 5-year age bins revealed a robust nonlinear ageing trajectory characterised by midlife decline and late-life stabilisation. The increased correspondence at the grouped level reflects reconstruction of the population-level ageing trajectory rather than improved individual-level prediction accuracy, as averaging reduces inter-individual variability. Conclusions: These findings demonstrate a strong ageing-related signal in female breast thermophysiology and support thermophysiology as a candidate age-referenced physiological marker, pending longitudinal and outcome-based validation. The present analysis is cross-sectional and requires longitudinal validation before diagnostic or prognostic interpretation. Full article

Background: Multimodal breast ultrasound, including B-mode imaging, color Doppler flow imaging, and elastography, provides complementary information for lesion characterization. However, effectively integrating heterogeneous modalities remains challenging due to inconsistent feature distributions, limited cross-modal interaction, computational cost in existing methods, and sensitivity to noise and missing data. Methods: We presented an efficient Cross-Modal Interaction and Dynamic Fusion Network (CIDFNet) for multimodal breast ultrasound analysis. The framework integrates a multi-scale feature enhancement module to improve modality-specific representations, a cross-modal interaction module to enable early-stage feature exchange across modalities, and a dynamic fusion strategy to adaptively combine modality information based on feature reliability estimation. In addition, an invertible neural network is incorporated to reconstruct missing modality features during training. Results: Experiments on an internal dataset of 248 patients with 1532 images show that CIDFNet obtains an AUC of 85.69%, accuracy of 75.51%, recall of 50.00%, F1-score of 62.50%, and precision of 83.33%, while requiring 49.51 M parameters and 79.79 G FLOPs, respectively. Under a simplified Gaussian noise perturbation setting, performance degradation is observed. Conclusions: CIDFNet presents a framework for multimodal breast ultrasound analysis that reflects a trade-off between performance and computational efficiency. Full article

Objectives: This study evaluates the protocol-level image quality and quantitative diffusion metrics of a clinically implemented deep-learning–reconstructed readout-segmented echo-planar imaging protocol with water-excitation spectral fat saturation (DL-rs-EPI with WEXfs) compared with conventional rs-EPI using spectral attenuated inversion recovery (SPAIR) at 3 T. Methods: Overall, 80 patients underwent breast magnetic resonance imaging (MRI) with both conventional rs-EPI with SPAIR and DL-rs-EPI with WEXfs protocols (b-values: 0, 800, and 1200 s/mm²). ROI-based relative image-quality metrics, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and lesion contrast, were assessed at b = 800 and b = 1200 s/mm²; apparent diffusion coefficient (ADC) values were calculated using multi-b-value data. Fat suppression, background diffusion signal, lesion conspicuity, and artifact severity were qualitatively evaluated. A temperature-controlled diffusion phantom (CaliberMRI) was scanned; ADC values were compared with reference values at 24 °C. Results: DL-rs-EPI with WEXfs demonstrated higher ROI-based relative SNR estimates (b800: 5.79 vs. 5.28; b1200: 5.41 vs. 4.94; p < 0.001) and CNR estimates (b800: 3.35 vs. 3.12, p = 0.024; b1200: 3.67 vs. 3.37, p = 0.001), with unchanged lesion contrast. Tumor ADC values were comparable between protocols, whereas normal fibroglandular tissue ADC values were slightly higher, and ADC contrast increased with DL-rs-EPI with WEXfs. Phantom ADC values from both protocols closely matched reference values at 24 °C, without significant differences. DL-rs-EPI with WEXfs demonstrated more homogeneous fat suppression and reduced background diffusion signal, with comparable lesion conspicuity and artifact severity. Conclusions: The combined DL-rs-EPI with WEXfs protocol demonstrated improved qualitative and relative quantitative image quality while preserving tumor ADC measurements. As a protocol-level evaluation, these composite improvements support its clinical feasibility for high-quality breast DWI without implying the isolated effect of DL reconstruction alone. Full article

The deep inferior epigastric perforator (DIEP) flap holds its place as the gold standard approach for autologous tissue breast reconstruction given the strong durability, favorable donor site morbidity, and high patient satisfaction overall. With the reliability and safety of microsurgical reconstruction of the breasts being well-established over these last decades, the goals of DIEP flap reconstruction have expanded beyond flap survival toward optimization of aesthetic, patient-reported, and quality-of-life outcomes. Achieving ideal cosmesis requires thoughtful decision-making across the reconstructive continuum, including of radiation timing, mastectomy incision design, nipple–areolar complex management, reconstructive sequencing, flap shaping and inset, abdominal closure, neurotization, and the potential role of any revision or adjunctive procedures. Modern techniques including delayed-immediate reconstruction, nipple delay, free nipple grafting, fat grafting, and abdominal wall reinforcement have expanded the availability of personalized care in breast reconstruction. This narrative review integrates a targeted literature search with consensus-driven expert opinion informed by our senior authors’ extensive cumulative experience performing DIEP flap breast reconstruction. It discusses principles, technical strategies, and evolving evidence for optimizing aesthetic outcomes in DIEP flap breast reconstruction while preserving safety and minimizing morbidity. Full article

Background/Objectives: Accurate breast lesion segmentation using deep learning models requires precise understanding of both global contextual relevance and finer lesion structure details, which remains a challenge for existing convolutional and transformer-based approaches. This study aims to address these limitations by proposing a new segmentation model capable of improving context-aware dense segmentation tasks for ultrasound images. Method: We propose LTM-UNet, a novel segmentation method integrating transformer-based encoding with state-space-driven decoding in a U-Net-style framework. The architecture utilizes an efficient vision transformer encoder to extract multi-scale global representations. These features are refined through an attention-guided skip-fusion mechanism incorporating spatial-channel attention preserving finer spatial details and thereby minimizes the semantic gap between encoder and decoder features. Additionally, a direction-aware decoder based on a state-space model is introduced to efficiently capture long-range dependencies and enhance relevant feature reconstruction. Results: Extensive experiments on benchmark ultrasound medical imaging datasets demonstrate the effectiveness of the proposed method. The model achieves dice-score coefficients of 82.41% on the BUSI dataset and 86.62% on Dataset B (UDIAT), outperforming several existing segmentation approaches in both dice-score coefficient and Intersection-over-Union (IoU) metrics. Conclusions: The integration of efficient transformer-based global feature extraction, attention-enhanced feature fusion, and state-space-driven decoding enables LTM-UNet to effectively capture both structural details and contextual information, resulting in superior segmentation performance compared to existing methods. Full article

Background: Extrachromosomal DNA (ecDNA) amplification represents a distinct mechanism of genomic instability in cancer, increasingly recognized for its role in aggressive disease progression. This review examines how ecDNA drives tumour evolution and assesses its potential as both a prognostic marker and therapeutic target. Methods: The authors integrate findings from multiple detection platforms—including FISH, whole-genome sequencing, and specialized reconstruction algorithms—and present data across diverse cancer types; no preregistration is noted, and no animal studies are included. Results: ecDNA consists of circular, acentric DNA elements carrying high-copy oncogene amplifications (such as EGFR, MYC, MDM2, and CDK4). Unlike chromosomal DNA, ecDNA segregates unevenly during cell division, generating intratumoral heterogeneity, accelerating adaptation to selective pressures, and promoting resistance to therapy. Pan-cancer surveys summarized here reveal ecDNA in a significant subset of tumours, with particularly high frequencies in liposarcoma, glioblastoma, and HER2-positive breast cancer, and consistent associations with worse clinical outcomes. Conclusions: The authors conclude that ecDNA amplification serves as a credible adverse prognostic indicator and holds promise for refining risk stratification and guiding treatment strategies. However, they stress that clinical adoption remains constrained by the absence of standardized, scalable, and reproducible detection. Full article

Background/Objectives: Nipple–areolar complex (NAC) necrosis following nipple-sparing mastectomy (NSM) delays adjuvant therapy and compromises oncological outcomes. This retrospective propensity-matched cohort study compared continuous topical oxygen therapy (cTOT), hyperbaric oxygen therapy (HBOT), and standard care (SOC) in patients with NAC necrosis after NSM. Methods: Between January 2020 and August 2025, 213 patients with NAC necrosis after NSM at a single academic center met eligibility criteria (cTOT, n = 57; HBOT, n = 59; SOC, n = 97). Propensity score matching (1:1:1, 15 covariates, all standardized mean differences < 0.1) yielded 57 matched triplets (171 patients). The primary outcome was time to complete epithelialization, with restricted mean survival time (RMST) at 56 days designated as a co-primary metric. Results: cTOT was associated with the fastest healing (mean 30.5 ± 9.9 days vs. HBOT 36.4 ± 9.0, p = 0.007, vs. SOC 45.1 ± 10.6, p < 0.001). RMST analysis demonstrated a mean gain of 14.0 unhealed days (95% CI, 10.5–17.5) for cTOT versus SOC. Eight-week healing rates were 98.2% (cTOT), 96.5% (HBOT), and 87.7% (SOC). Multivariable Cox regression identified cTOT as an independent predictor of accelerated healing (HR 4.61; 95% CI, 2.99–7.11; p < 0.001), with results stable across incision-type and ptosis-grade sensitivity analyses. The treatment association was most pronounced in larger wounds (≥2.0 cm²; HR 6.85; p for interaction = 0.018). cTOT patients also reported significantly lower pain and higher satisfaction, with no device-related discontinuations (0/57). Conclusions: cTOT was associated with significantly accelerated NAC necrosis healing and, as a portable home-based therapy, may support oncological treatment timelines after NSM. The shorter time to adjuvant initiation observed for cTOT (continuous outcome) was not paralleled by a significant reduction in the >6-week delay endpoint, which requires confirmation in multicenter randomized trials. Full article

Breast cancer accounts for nearly one in four cancer diagnoses amongst women, with 36–50% of patients electing to undergo post-mastectomy breast reconstruction. Though immediate reconstruction has risen in popularity due to higher patient satisfaction scores, factors such as individual patient anatomy, patient preference, and adjuvant oncologic treatments may preclude this option for some patients. In such circumstances, a delayed approach to reconstruction offers a promising alternative, often offering comparable aesthetic results with lower rates of major complications. Autologous, implant-based, and hybrid reconstructive techniques may all be applied in a delayed setting at a time point clinically distinct from oncologic resection, with each technique carrying unique advantages and risks that must be evaluated in the context of patient-specific factors. By providing an overview of common complications associated with various delayed breast reconstruction modalities, this review seeks to synthesize the current approaches to prevention, management, and treatment of reconstructive obstacles and outcomes to foster shared decision-making, individualized surgical planning, and optimal reconstructive results. Full article

Background/Objectives: Deep inferior epigastric perforator (DIEP) flap reconstruction represents the gold standard for autologous breast reconstruction, while profunda artery perforator (PAP) flap reconstruction has developed as a reliable alternative, particularly in patients with low body mass index or inadequate abdominal tissue. Even though several comparative studies have evaluated surgical and patient-reported outcomes between PAP and DIEP flaps, evidence regarding reconstructive timing, oncologic safety, and interactions with adjuvant therapies remains scarce, especially for PAP reconstruction. Methods: A narrative review of the literature was conducted using PubMed. Studies assessing PAP and DIEP flap breast reconstruction were included, with particular focus on surgical outcomes, patient-reported outcomes, reconstructive timing (immediate or delayed reconstruction), oncologic safety, recurrence, and the effects of radiotherapy and chemotherapy. Comparative studies, cohort studies, systematic reviews, and meta-analyses were synthesized through a narrative review. Results: Twenty studies were included. Comparative evidence showed similar flap survival rates and overall patient satisfaction between the two methods, with flap success rates approaching 98–100%. PAP reconstruction was associated with increased donor-site wound complications and, in some studies, increased fat necrosis rates, while long-term patient-reported and aesthetic outcomes remained equivalent between techniques. In contrast to the relatively limited PAP literature, DIEP reconstruction has been widely studied in terms of reconstructive timing and oncologic safety. Current evidence indicates that immediate DIEP reconstruction does not increase the risk of flap loss, major complications, or recurrence in comparison with delayed reconstruction and might optimize early postoperative recovery and patient-reported outcomes. Nevertheless, none of the identified studies directly compared PAP and DIEP reconstruction with respect to immediate versus delayed timing, exposure to radiotherapy or chemotherapy, or long-term oncologic outcomes. Conclusions: PAP flap appears to represent a reliable alternative to DIEP flap reconstruction. However, major gaps in the literature persist involving PAP reconstruction in oncologic and timing-related settings. Future prospective multicenter studies that directly compare PAP and DIEP flaps according to reconstructive timing, exposure to adjuvant therapy, recurrence, and patient-reported outcomes are warranted to establish evidence-based reconstructive strategies for oncologic breast reconstruction. Full article

Simultaneous autologous breast reconstruction (ABR) and lymphatic surgery has emerged as a strategy to address breast cancer-related lymphedema (BCRL) while restoring breast contour within a single operative procedure. In light of the diversity of surgical strategies, we aimed to evaluate the current literature on combined ABR and lymphatic surgery, with particular focus on surgical techniques, clinical outcomes, complications, and patient-reported satisfaction. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251135446). Medline, Embase, CENTRAL, Web of Science, and PubMed were searched through 9 January 2026 Studies reporting outcomes of simultaneous ABR and lymphatic reconstruction were included. Data on surgical techniques, complications, changes in limb volume and cellulitis incidence, and patient-reported outcomes were extracted. Twenty-seven studies including 499 patients (mean follow-up 23 months) were analyzed. The most common approach was a chimeric deep inferior epigastric perforator (DIEP) flap with inguinal lymph nodes (459 patients), followed by ABR with a separate vascularized lymph node transfer and ABR with lymphovenous anastomosis. Most studies reported postoperative reductions in limb volume and cellulitis, with cellulitis reduction rates up to 100%. Patient-reported outcomes (LYMQOL, ULL-27, LYMPH-Q) showed improved quality of life. Complication rates were low, including 4% seroma and 1% flap loss after chimeric DIEP. Simultaneous ABR and lymphatic reconstruction is feasible and associated with improved clinical and patient-reported outcomes. However, heterogeneity limits comparison between the different surgical techniques, and prospective studies with standardized outcomes measurements are needed. Full article

Background: The use of conventional boluses in recurrent breast cancer often fails to conform to irregular surfaces, leading to air gaps and suboptimal dose distribution. We present a clinical experience involving a 3D-printed conformal bolus for a patient with gross recurrence and breast prosthesis invasion—a complex scenario where the treatment goal was surgical conversion. This report aims to generate hypotheses regarding the utility of customized boluses in facilitating the resection of initially unresectable tumors in the presence of reconstructive hardware. Case Presentation: A 58-year-old female with a history of breast cancer and prosthesis reconstruction presented with a rapid chest wall recurrence in 2018. The tumor invaded the overlying skin and the underlying prosthesis, rendering it unresectable. The patient received intensive salvage radiotherapy using Volumetric Modulated Arc Therapy (VMAT) with a dose-escalation regimen and a customized 1 cm 3D-printed bolus. While daily IGRT/CBCT and in vivo dosimetry were not available to definitively quantify the air gap reduction, the technical application of the bolus aimed to optimize surface dose coverage. Two months post-treatment, significant tumor regression was observed, allowing for the successful surgical removal of both the tumor and the prosthesis. Conclusions: To our knowledge, this case illustrates a specialized application of 3D-printed boluses in complex salvage scenarios. Following treatment, the patient experienced improved quality of life through pain reduction and reduced dressing frequency. Although the dramatic tumor response likely reflects the overall intensity of the radiotherapy regimen, our experience suggests that a 3D-printed bolus is a physically plausible tool to aid in achieving local control and facilitating surgical intervention. Further prospective studies are required to isolate the specific dosimetric advantages of this technology over conventional methods. Full article