Search Results (67)

Background: Lysosomal-associated membrane protein 1 (LAMP1), typically localized to the lysosomal membrane, is increasingly implicated as a marker of cancer aggressiveness and metastasis when expressed on the cell surface. This study aimed to develop a LAMP1-targeted antibody-based PET tracer and assess its efficacy in mouse models of human breast and colon adenocarcinoma. Methods: To determine the source of LAMP1 expression, we utilized human single-cell RNA sequencing and spatial transcriptomics, complemented by in-house flow cytometry on xenografted mouse models. Tissue microarrays of multiple epithelial cancers and normal tissue were stained for LAMP-1, and staining was quantified. An anti-LAMP1 monoclonal antibody was conjugated with desferrioxamine (DFO) and labeled with zirconium-89 (⁸⁹Zr). Human triple-negative breast cancer (MDA-MB-231) and colon cancer (Caco-2) cell lines were implanted in nude mice. PET/CT imaging was conducted at 24, 72, and 168 h post-intravenous injection of ⁸⁹Zr-DFO-anti-LAMP1 and ⁸⁹Zr-DFO-IgG (negative control), followed by organ-specific biodistribution analyses at the final imaging time point. Results: Integrated single-cell and spatial RNA sequencing demonstrated that LAMP1 expression was localized to myeloid-derived suppressor cells (MDSCs) and cancer-associated fibroblasts (CAFs) in addition to the cancer cells. Tissue microarray showed significantly higher staining for LAMP-1 in tumor tissue compared to normal tissue (3986 ± 2635 vs. 1299 ± 1291, p < 0.001). Additionally, xenograft models showed a significantly higher contribution of cancer cells than the immune cells to cell surface LAMP1 expression. In vivo, PET imaging with ⁸⁹Zr-DFO-anti-LAMP1 PET/CT revealed detectable tumor uptake as early as 24 h post-injection. The ⁸⁹Zr-DFO-anti-LAMP1 tracer demonstrated significantly higher uptake than the control ⁸⁹Zr-DFO-IgG in both models across all time points (MDA-MB-231 SUV_max at 168 h: 12.9 ± 5.7 vs. 4.4 ± 2.4, p = 0.003; Caco-2 SUV_max at 168 h: 8.53 ± 3.03 vs. 3.38 ± 1.25, p < 0.01). Conclusions: Imaging of cell surface LAMP-1 in breast and colon adenocarcinoma is feasible by immuno-PET. LAMP-1 imaging can be expanded to adenocarcinomas of other origins, such as prostate and pancreas. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Objectives: The current study underscores the potential role of miRNAs, specifically miR-3173 and miR-155, as promising biomarkers for breast and ovarian cancers (BC and OC). The primary objective was to evaluate the expression levels of these miRNAs in cancer patients compared to healthy individuals, assess their diagnostic accuracy, and explore their associations with cancer progression and prognosis. Methods: This study involved 60 participants, comprising 30 patients diagnosed with primary BC and 30 patients with epithelial ovarian cancer (EOC). Tumor tissue samples were obtained from all patients for molecular analysis. For control comparisons, adjacent non-tumorous tissues from both groups were utilized. miR-3173 and miR-155 expression levels were measured using real-time PCR (qPCR). The diagnostic accuracy of both miRNAs was evaluated through receiver operating characteristic (ROC) curve analysis, calculating sensitivity and specificity for distinguishing cancer cases from healthy controls. Additionally, the association of miR-155 with metastasis was explored, and miR-3173’s correlation with poor progression-free survival in BC patients was assessed using Kaplan–Meier survival curve analysis. Results: Both miRNAs were found to be significantly upregulated in cancer patients compared to healthy individuals, with miR-155 exhibiting high sensitivity and specificity for distinguishing BC and OC cases. Notably, miR-155 is associated with metastasis, which aligns with previous research, suggesting its role as an oncogene in epithelial OC. Meanwhile, the elevated expression of miR-3173 correlates with poor progression-free survival in BC patients, marking it as a potential prognostic marker. However, these results highlight the complexity of miRNA expression in cancer progression, as miR-3173 showed varied associations with different types of cancer. Despite these challenges, the ROC curve analysis for both miRNAs is promising with high sensitivity and specificity for both BC and OC. Conclusion: The study findings are particularly significant in the context of early diagnosis and monitoring cancer progression, yet further investigations involving larger cohorts and diverse populations are needed to validate these results. Future studies should focus on expanding sample sizes, refining the understanding of miRNA roles in tumor progression, and exploring their potential as therapeutic targets. These advancements could significantly enhance personalized treatment strategies for breast and ovarian cancer, improving patient outcomes. Full article

Background: Implant-based breast reconstruction (IBBR) is a widely adopted technique following mastectomy in breast cancer patients. However, the impact of chemotherapy type and duration on the development of capsular contracture remains unclear. Methods: This nationwide, retrospective, cohort study used Health Insurance Review and Assessment Service data to identify breast cancer patients who received chemotherapy and underwent immediate IBBR between January 2015 and December 2018. Follow-up continued until January 2024, with a median follow-up of 5.2 years. A total of 4303 patients (direct-to-implant [DTI], n = 2083; tissue expander insertion [TEI], n = 2220) were included. Results: Chemotherapy type and duration were not significantly associated with capsular contracture risk in either the DTI or TEI groups. In the DTI cohort, no significant difference in contracture incidence was found between neoadjuvant and adjuvant chemotherapy before or after matching (p = 0.056 and p = 0.121, respectively). In the TEI cohort, an initially significant difference (p = 0.019) was no longer observed after matching (p = 0.213). Similarly, chemotherapy duration (≤12 weeks vs. >12 weeks) did not impact contracture risk in either cohort. Multivariate analysis identified age, radiotherapy, lymphedema, and axillary lymph node dissection (ALND) as independent risk factors for contracture (p < 0.005). Comorbidities, such as diabetes and autoimmune diseases, also showed no significant association with contracture risk. Conclusions: These findings suggest that chemotherapy decisions should not be guided by contracture concerns. Instead, optimizing reconstruction outcomes should focus on modifiable factors, such as radiotherapy, lymphedema, and ALND. Full article

Background: Nipple-sparing mastectomy (NSM), given demonstrated oncologic safety, is widely used for both therapeutic and prophylactic mastectomy. The popularity of NSM has spurred advancements by breast and plastic surgeons, liberalizing the indications for NSM and improving patient and aesthetic reconstructive outcomes. This review explores these developments and establishes up-to-date surgical tenets for successful NSM and reconstruction. Methods: A comprehensive literature review was conducted using the PubMed, Google Scholar, and Cochrane Library databases, focusing on peer-reviewed studies published up to 2024. Articles were selected based on relevance, quantity, and documentation of clinical outcomes and patient satisfaction. Results: NSM is utilized frequently for both invasive breast cancers and prophylactic mastectomy, with expanded criteria for candidacy by breast surgeons. Staged procedures such as adjunct reduction, mastopexy, or nipple delay allow patients with larger or ptotic breasts to undergo NSM with comparable outcomes. Long-term outcome studies have identified important risk factors for complications, including smoking history, higher mastectomy weight, certain medical comorbidities, and suboptimal mastectomy flaps. Evolutions in reconstructive decision making in direct-to-implant and staged tissue expander placement have improved aesthetic results while accounting for poor mastectomy flap quality or adjuvant therapy. Long-term outcomes show NSM remains safe and has comparable rates of local recurrence. Patient-reported outcomes demonstrate satisfaction with NSM, especially in sexual and psychological wellbeing metrics. Conclusions: NSM has been demonstrated to be safe in long-term oncologic outcomes. Its widespread popularity over the past ten years has helped identify methods to improve upon surgical and aesthetic outcomes, including decision-making in reconstruction; considerations for challenging patient-related characteristics such as macromastia, ptosis, and NAC asymmetry; and novel advances in areas such as neurotization. Full article

Existing convolutional neural network (CNN) methods primarily depend on first-order feature modeling, which makes it challenging to effectively capture higher-order features in breast cancer histopathological images. Additionally, due to the limitations of the receptive field, CNNs have difficulty capturing long-range dependencies, thereby limiting the integration of global information. To address this, inspired by the strengths of high-order statistical features and extended receptive fields in visual tasks, this study proposes a novel high-order receptive field network (HoRFNet). Specifically, HoRFNet expands the receptive field and improves the model’s contextual awareness of pathological tissue structures by introducing a multi-branch convolutional structure with convolution kernels of varying sizes, along with dilated convolution layers. Additionally, HoRFNet integrates a matrix power normalization strategy in the covariance pooling module to model the global interactions between convolutional features, thereby improving the higher-order representation of complex textures and structural relationships in tissue images. The BreakHis dataset shows that HoRFNet achieves an image level classification accuracy of 99.50% and a patient level classification accuracy of 99.23%, significantly outperforming existing methods and demonstrating its effectiveness. Full article

Background: Breast cancer, irrespective of gender, stands as the most prevalent cancer globally, with an annual estimate of 2.3 million new cases. Surgical intervention, including therapeutic mastectomy (excluding prophylactic procedures), is performed on approximately 28% of patients, necessitating subsequent breast reconstruction. Although implant-based breast reconstruction (IBBR) is frequently employed due to its relative ease compared to autologous methods, it presents a notable risk for complications at mid-term such as peri-prosthetic infections. These complications can lead to implant loss and the eventual compromise of the mastectomy pocket. To address these complications, negative pressure wound therapy with instillation and dwell (NPWTi-d) emerges as a promising rescue intervention, known for its capacity to significantly reduce bacterial load and potentially salvage compromised soft tissues. However, the evidence supporting its effectiveness in infected pockets after mastectomy is currently insufficient. This study aims at investigating the efficacy of NPWTi-d in the management of peri-prosthetic mastectomy pocket infection. Methods: A thorough literature search has been concluded through PubMed, Web of Science, and Cochrane databases up until 18th March 2025 on evaluating NPWTi-d’s ability to manage peri-prosthetic infections and preserve mastectomy pockets for subsequent reconstruction. Furthermore, a meta-analysis on the salvage rate of the mastectomy pocket was carried out, while for other outcomes, a descriptive analysis was applied. Results: Nine studies (n = 230 patients) were included, investigating whether the us NPWTi-d was successful in treating peri-prosthetic infection and preserving the mastectomy pocket for subsequent reconstruction by expander or implant. The pooled salvage rate of the implant-based BR due to the use of NPWTi-d was 86.1% (95%CI: 80.6–91.6%). Preservation of the skin envelope avoided secondary reconstruction after a defined time interval, reducing number and complexity of surgeries and related costs. Conclusions: This innovative surgical approach should be considered in selected cases of infected implants after breast reconstruction in breast cancer centers. However, the actual low level of evidence is based on case series, and it is not possible to define generally accepted recommendations for the use of NPWTi-d to save the mastectomy pocket. Full article

Background/Objectives: Simultaneous vascularized lymph node transfer (VLNT) and breast reconstruction is a reconstructive option that potentially addresses two adverse consequences of breast cancer treatment in the same operation. This systematic review aims to analyze the quality of data and outcomes in the current literature. Methods: This systematic review was performed following PRISMA guidelines. A systematic search was conducted with Google Scholar and PubMed for studies with the simultaneous intervention of VLNT and breast reconstruction. The search terms were ((diep OR pap OR expander OR implant OR breast OR msTRAM OR TRAM) AND (“vascularized lymph node”)). Studies were included if they were original articles that discussed patients who underwent simultaneous VLNT and breast reconstruction. Additional sources were identified from bibliographies. Patient characteristics, types of treatment, reconstruction, and outcome measures were collected. This review was not registered. Results: A total of 1969 unique English literature search results led to the inclusion of 118 studies. Further analysis was performed on 42 non-review articles, documenting a total of 772 patients. The mean patient age was 51.6 years, the mean BMI was 28, and there was a mean follow-up of 23.8 months. Discrete breast reconstruction data were given for 494 patients with 492 autologous reconstructions and 2 tissue expander-to-implant reconstructions. The most common reconstructive approach was a deep inferior epigastric flap. The most common VLNT donor site was the superficial inferior epigastric nodes, followed by superficial circumflex iliac nodes. Indications for 646 patients were for treatment and 18 were for prevention, while 108 were not specified. The mean excess volume reduction in treatment studies was 39.5%. A total of 168 complications (21.8%) were reported, with donor site seromas being the most common. Additionally, four partial and three total flap failures were reported. Conclusions: VLNT can be safely combined with autologous breast reconstruction for the treatment or prevention of breast cancer-related lymphedema. Future research should standardize the approach for data collection and report patient outcomes for lymphedema and immediate lymphatic reconstruction. Full article

Background/Objectives: Combining autologous fat grafting with implant placement is meant to improve the quality of implant-based breast reconstruction. The present study explores the concept of multi-stage composite breast reconstruction with repeated sessions of autologous fat grafting to increase mastectomy flap thickness and provide better pre-pectoral implant coverage. Methods: Twenty-five consecutive patients underwent bilateral multi-stage composite expander-to-implant breast reconstruction and reverse expansion from August 2020 to April 2024. Subcutaneous thickness of the mastectomy flap was evaluated in predefined regions of interests of the breast on standardized MR images at two timepoints (before the first fat grafting session, with the tissue expander fully inflated, and 3 months after implant placement). Furthermore, the incidence of complications requiring surgery and implant-related complications were evaluated. All values are expressed as mean ± standard deviation, accepting statistical significance for a p-value < 0.05. Results: Patients underwent an average of 2.5 ± 0.6 fat grafting sessions, with a fat injection volume of 170 ± 60 mL per breast per session. The mean duration of the reconstructive process from mastectomy to final implant placement was 12 ± 5 months and the mean follow-up was 17 ± 8 months. The overall thickness of both breasts amounted to 190% of baseline thickness and was significantly higher in the upper breast quadrants than in the lower quadrants (p < 0.05). Tissue thickness increase correlated well with the number of fat grafting sessions and was independent of the patient’s weight gain. Complications requiring surgery occurred in eight breasts during the reconstruction, with iatrogenic expander puncture being the most frequent (three cases, 6%). During follow-up, only one implant-related complication was observed (one case of bilateral rippling, 4%). No breast animation or symptomatic capsular contracture were observed. Conclusions: Multi-stage pre-pectoral composite expander-to-implant breast reconstruction using autologous fat grafting is an effective concept for breast reconstruction. Despite the need for multiple surgeries, the significant increase in subcutaneous tissue thickness, resulting in better soft tissue coverage, compensates for the longer reconstructive process. Full article

Background: Breast cancer is the most common cancer among women. The number of cases is increasing among young women, and consequently, breast reconstructions are performed more often. Postoperative complications, wound healing, and the quality of scars influence the final cosmetic outcomes. The aim of the study was to investigate the effect of using a negative-pressure therapy compared to a standard dressing on two postoperative wounds in the same woman, after bilateral tissue expander replacement surgery—when identical healing conditions occur. Methods: This study includes a single-center evaluation of the application of two different dressings during bilateral exchanges of tissue expanders with breast implants. The study included 22 patients with a history of breast cancer after bilateral mastectomy with two-stage reconstruction. During the second stage, a sNPWT was applied to one breast and a standard dressing to the other. Results: A statistically significant difference in skin elasticity in favor of sNPWT was visible after 7 days, while the greatest difference was visible in the evaluation after 6 months (mean of 0.806 vs. 0.607). A difference in temperature measurements was shown 7 days after the procedure. However, after 30 days, these measurements were similar. There was also a reduced incidence of postoperative complications as well as seroma accumulation in the breasts with negative pressure. Conclusions: The results indicate faster healing, better scar quality, and improved skin elasticity in breasts with sNPWT compared to the standard dressing. The number of postoperative complications were also reduced, which is especially important in high-risk patients. Full article

Background. In alloplastic breast reconstruction, the choice of implant positioning and the selection of periprosthetic devices is a critical and challenging decision. Surgeons must navigate between various biologic and synthetic meshes, including acellular dermal matrices (ADM). This study aimed to propose a simple selection tool for periprosthetic devices in prepectoral breast reconstruction. Methods. Patients scheduled for mastectomy followed by implant-based breast reconstruction between September 2019 and December 2023 were included. Preoperative risk assessments were performed using the Pre-Bra Score, and only those deemed suitable for prepectoral implant placement were selected. Mastectomy flap thickness was used as an independent criterion, and only cases with flap thicknesses less than 1 cm were included. Results. A total of 70 cases with an average flap thickness of 0.7 cm (range, 0.4–0.9 cm), as measured by preoperative contrast-enhanced spectral mammography (CESM), underwent prepectoral reconstruction with ADM covering the implant. Of these, 25 patients (35%) received direct-to-implant reconstruction, while 45 (65%) underwent two-stage reconstruction with a temporary tissue expander. Postoperative complications were recorded during a minimum follow-up period of 6 months. Over an average follow-up duration of 17.5 months (range 6–36 months), no major complications were observed. Minor complications occurred in seven patients: infection (1.28%), seroma (3.85%), and superficial skin necrosis (1.28%). Additionally, 21 patients (30%) experienced rippling, and secondary lipofilling was scheduled. Conclusions. The incidence of rippling was reduced by 40% through ADM in this patient subgroup, reducing the need for secondary aesthetic refinements. Full article

Background/Objectives: The rising incidence of breast cancer has led to more mastectomies and increased demand for reconstruction. While retropectoral reconstruction with expanders is common, it has complications like postoperative pain and animation deformity. Prepectoral reconstruction, aided by advancements in biological and synthetic meshes, offers a promising alternative. Methods: This study prospectively evaluated the “Prepectoral Breast Reconstruction Assessment Score” on 20 patients undergoing mastectomy at Policlinico Umberto I, Rome, from July 2022 to February 2024. Patients with scores between 5 and 8 were included. The procedure involved the use of ADM (Acellular Dermal Matrix) or titanium-coated polypropylene mesh, followed by postoperative expansions and final implant placement after six months. Results: The mean age of patients was 51.85 years, with a mean BMI of 24.145 kg/m². ADM was used in 15 cases and synthetic mesh in 5. Complications were one exposure of the expander, one superficial skin necrosis and one seroma. Statistical analysis showed a trend toward fewer complications with higher scores, though this was not statistically significant (p-value = 0.139). Conclusions: Prepectoral reconstruction with expanders is a viable option, offering benefits such as reduced operating time, better volume control, and a more natural breast contour compared to the retropectoral approach. Although the trend suggests fewer complications with higher assessment scores, further studies with larger samples are needed for confirmation. Full article

Micro-computed tomography (micro-CT) is a non-destructive imaging technique that offers highly detailed, 3D visualizations of a target specimen. In the context of breast cancer, micro-CT has emerged as a promising tool for analyzing microcalcifications (MCs), tiny calcium deposits that can indicate at an early stage the presence of cancer. This review aimed to explore the current applications of micro-CT in analyzing breast MCs (ex vivo, animal models, and phantoms) and to identify potential avenues in scientific research. We followed PRISMA guidelines for scoping reviews, yielding 18 studies that met our criteria. The studies varied in their purposes: feasibility and optimization of micro-CT for breast cancer imaging and MC analysis/diagnosis, comparison with other imaging modalities, development of micro-CT scanners and processing algorithms, enhancement of MC detection through contrast agents, etc. In conclusion, micro-CT offers superior image quality and detailed visualization of breast tissue (especially tumor masses and MCs), surpassing traditional methods like mammography and approaching the level of detail of histology. It holds great potential to enhance our understanding of MC characteristics and breast pathologies when used as a supplementary tool. Further research will solidify its role in clinical practice and potentially expand its applications in breast cancer studies. Full article

Background and Objectives: Breast cancer in patients with prior breast augmentation poses unique challenges for detection, diagnosis, and management. Mastectomy rates are increasing, and patients with prior augmentation often have a lower body mass index, making autologous techniques unsuitable. This study aims to assess the best reconstructive option in patients with a history of subglandular or dual-plane breast augmentation. Materials and methods: A prospective analysis was conducted on patients who underwent breast reconstruction after mastectomy. Patients with subglandular or dual-plane breast augmentation were included. Patients were divided into submuscular breast reconstruction (Group 2) or prepectoral breast reconstruction (Group 1) groups. Demographic and surgical data were collected. Results: A total of 47 patients were included, with 23 in Group 1 and 24 in Group 2. Complications occurred in 11 patients (23.4%), with significant differences between groups. The most common complication was seroma formation. Implant loss occurred in 4.3% of cases in Group 1, while no implant loss was observed in Group 2. Patient-reported satisfaction scores were similar between groups at 12 months postoperatively. Conclusions: Subpectoral breast reconstruction with a tissue expander seems a safer and effective technique for patients with prior breast augmentation. It resulted in fewer complications. This approach should be considered as an option for breast reconstruction after mastectomy in this cohort of patients. Full article

Background: Continuous research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has introduced a focus on surface texturizations and a shift towards smooth breast devices, yet outcomes comparing the complication profiles of differently textured tissue expanders (TEs) remain conflicting. The study aim was to compare the complication profile of a new nanotextured and MRI-compatible TE to micro- and macrotextured TEs and to identify possible predictors for complications. Methods: A retrospective analysis of women undergoing expander-based breast reconstruction after mastectomy between January 2016 and March 2022 was conducted. The primary endpoint was the development of capsular contracture. Possible predictors were analyzed in a mixed-effects model using the least absolute shrinkage and selection operator (LASSO). Moreover, a comparison of complications and an evaluation of predictors were carried out. Results: A total of 147 breasts, encompassing 82 nanotextured, 43 microtextured and 22 macrotextured TEs, were analyzed. Breasts with nanotextured TEs were less likely to develop capsular contracture overall (OR, 0.12; 95%CI 0.05–0.28, p < 0.001). Post-mastectomy radiotherapy (PMRT) was identified as a predictor for capsular contracture (OR, 4.67; 95%CI 1.86–11.71, p < 0.001). Breasts with nanotextured TEs showed a higher rate of seroma, but lower rates of malposition and pain. Predictors for developing postoperative complications included higher mastectomy weight (p = 0.008). Conclusions: Breasts with nanotextured TEs exhibited the lowest rate of capsular contracture compared to micro- and macrotextured TEs. Together with its MRI-compatibility and improved oncologic follow-up, the nanotextured TE seems to be a favorable device for expander-based breast reconstruction. Full article