Search Results (666)

Despite major advances in early breast cancer detection and therapeutic strategies, locoregional and distant recurrences, as well as the development of a second primary breast cancer, remain major clinical challenges. Current prognostic tools primarily rely on tumor-specific features, such as the histological grade, hormone receptor status, and proliferative index, and, more recently, on molecular signatures aimed at improving risk stratification and predicting recurrence. However, these approaches remain imperfect, and there is an urgent need to develop complementary strategies. Growing attention has been focused on the tumor microenvironment and the surrounding non-tumoral tissue, which may harbor clinically relevant molecular alterations. Emerging evidence suggests that DNA methylation changes can be detected in the adjacent and contralateral breast tissue and reflect early steps of carcinogenesis or predisposition to tumor development. This phenomenon, often referred to as field cancerization, raises new questions about the dynamics of cancer development. The aim of this work is to provide an integrative overview of DNA methylation alterations in normal breast tissue, including peritumoral and contralateral areas, and to examine their potential as predictive biomarkers of recurrence, based on the available data from tumoral tissue. In theory, these applications seem promising, but their role needs to be confirmed in large prospective trials, in order to overcome barriers to clinical implementation. The currently available evidence does not support a role for DNA methylation in the selection of locoregional and systemic treatment strategies, particularly with a view to reducing the rising number of uni- and bilateral mastectomies performed without any demonstrated survival benefit. Full article

Studies on the influence of radiotherapy on the structure, thermal properties, and thermo-oxidative decomposition of breast silicone implants were conducted. Additionally, the potential use of breast silicone implant waste as a component in layered composites was investigated. ATR-FTIR, DSC, and TG/DTG/FTIR analyses confirmed that radiation does not affect the structure, thermal properties, or oxidative decomposition behavior of the shell and gel layers of breast silicone implants. The conducted tests demonstrated the successful fabrication of composite materials using a PUM matrix and breast silicone implant waste. The presence of the PUM matrix in the manufactured composites influenced the crystallization and melting behavior of the silicone phase. Moreover, the incorporation of a silicone implant waste layer into the composites increased their thermal stability while decreasing the glass transition temperature, storage modulus and hardness compared to neat PUM. The type of implant waste layer used (shell or gel) in the preparation of the PUM composites did not significantly affect the melting and glass transition temperatures, thermal stability, or oxidative decomposition behavior of the newly developed materials. As demonstrated, new layered composite materials based on silicone implant waste (shell and gel), with properties valuable for practical applications, were successfully developed. Full article

Breast reconstruction represents an integral component of contemporary breast cancer management, with substantial impact on patients’ psychological well-being, body image, and overall quality of life. Given the profound symbolic and personal significance of the breast, mastectomy—whether total or partial—extends beyond oncologic resection and may result in considerable aesthetic, functional, and psychosocial consequences. For this reason, reconstructive planning should be incorporated into the initial multidisciplinary treatment strategy while ensuring that oncologic safety and adjuvant therapies are never compromised. Breast reconstruction may be achieved using autologous tissue, implant-based techniques, or a combination of both approaches. Each method carries specific advantages, limitations, and potential complications and must be tailored to the individual patient’s oncologic status, anatomy, and expectations. This article provides a historical overview of the evolution of breast cancer treatment and reconstructive techniques. It further examines the principles, benefits, and challenges associated with different reconstructive modalities, highlighting key considerations in clinical decision-making and long-term outcomes. Full article

Breast lymphedema is characterized by skin thickening/swelling of the breast and is common following partial mastectomy and radiation. Oncoplastic reduction performed during partial mastectomy removes additional breast tissue compared to partial mastectomy alone to optimize breast contour. Recent literature has suggested oncoplastic reduction in patients with macromastia undergoing breast-conservation surgery is protective of breast lymphedema, decreasing rates from 11% to 3%. The purpose of this study is to assess the rates of breast lymphedema after partial mastectomy and oncoplastic reduction and identify risk factors. A single-center retrospective study was performed of breast cancer patients following partial mastectomy and oncoplastic reduction (2018–2023). Patients underwent contralateral breast reduction for symmetry. Breast lymphedema was assessed. Demographics data and risk factors were evaluated. This study included 158 patients who underwent partial mastectomy and oncoplastic reduction. Breast lymphedema incidence was 3.2% (5/158). Including contralateral non-cancerous breast symmetry reduction, lymphedema occurred in 3.6% (5/140) of irradiated breasts and 0% (0/176) of non-irradiated breasts (p = 0.0164). Among irradiated breasts, skin necrosis occurred in 11.4% (16/140) compared to 4.5% (8/176) of non-irradiated breasts (p = 0.031). Breast lymphedema developed 207.4 ± 37.6 days postoperatively and 101.6 ± 15.9 days following adjuvant radiation. Mean follow-up was 639 days. Breast lymphedema incidence following partial mastectomy and oncoplastic reduction was 3.6% in this series and occurs 3–4 months after radiation. Radiation was the only significant risk factor for developing breast lymphedema. This largest series on breast lymphedema after oncoplastic reduction corroborates that oncoplastic reduction may be protective. Full article

Breast-conserving therapy, consisting of lumpectomy followed by adjuvant radiotherapy, is the standard of care for early-stage breast cancer, providing oncologic outcomes equivalent to mastectomy while preserving breast anatomy and quality of life. Radiotherapy remains a cornerstone of treatment across disease stages, significantly reducing local recurrence rates and improving long-term survival. Advances in radiotherapy techniques—including conventional fractionation, hypofractionation, tumor-bed boost delivery, and regional nodal irradiation—have optimized oncologic efficacy while inducing a broad spectrum of time-dependent morphological changes in breast tissue. Accurate imaging surveillance is therefore essential to distinguish expected post-radiotherapy changes from tumor recurrence and to avoid unnecessary diagnostic or therapeutic interventions. This review provides a comprehensive overview of contemporary breast radiotherapy protocols, their impact on post-treatment imaging appearances, and current recommendations for imaging surveillance. Characteristic findings across mammography, ultrasound, magnetic resonance imaging, and nuclear medicine modalities are discussed, with emphasis on their temporal evolution from acute inflammatory changes to chronic fibrosis, fat necrosis, and architectural distortion. Recognition of these imaging patterns, together with integration of radiotherapy-related parameters into image interpretation, is crucial for accurate diagnosis, early detection of recurrence, and informed clinical management of breast cancer survivors. Full article

Background: Pre-pectoral direct-to-implant breast reconstruction is increasingly adopted after mastectomy because it avoids pectoralis major dissection, reduces postoperative pain, and eliminates animation deformity. However, reconstruction in patients with large or markedly ptotic breasts remains challenging because of skin envelope management, nipple–areola complex (NAC) viability, and implant stability. This study evaluated batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction. Methods: We conducted a retrospective single-center study of consecutive patients who underwent batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane-coated implant reconstruction between November 2022 and January 2025. Demographic, oncologic, operative, postoperative, and BREAST-Q data were collected. Primary outcomes included complications, oncologic events, and 12-month patient-reported outcomes. Results: Thirteen patients underwent reconstruction, accounting for 18 breasts, with a mean follow-up of 12.85 months. Mean age was 54.5 ± 9.7 years, mean body mass index was 27.0 ± 3.4 kg/m², and mean Regnault ptosis grade was 3.46 ± 0.52. No seromas or oncologic recurrences were observed. One hematoma and one late infection requiring implant removal occurred. Superficial NAC/central flap epidermolysis developed in four patients and resolved conservatively; no full-thickness NAC necrosis occurred. BREAST-Q scores improved significantly in all domains at 12 months, including satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being (all p < 0.05). Conclusions: Batwing skin-reducing mastectomy with immediate pre-pectoral polyurethane implant reconstruction appears safe and reproducible in selected patients with advanced ptosis, with acceptable complication rates and significant improvement in patient-reported outcomes. Full article

Background/Objectives: Nipple-sparing mastectomy with immediate reconstruction is a preferred option for selected patients undergoing prophylactic or therapeutic mastectomy. Optimizing postoperative wound care is essential to support healing, preserve the nipple–areola complex, and prevent delays in oncologic treatments. This retrospective observational study aimed to evaluate the clinical outcomes associated with the use of the NovoX^® Cup medical device in post-NSM surgical wound management, assessing clinical–surgical outcomes and quality of life (QoL). Methods: We conducted a retrospective observational study on 54 patients who underwent NSM with immediate reconstruction at AOUI Verona between January 2025 and January 2026; Novox^® Cup was applied intraoperatively and changed every 48 h according to protocol. Surgeon-reported outcomes were assessed by the skin flap viability scale and the complications by Clavien–Dindo classification. Patient-reported outcomes were assessed via the Wound-QoL17 questionnaire at 7, 30, and 90 days. Clinical outcomes were supported by photographic documentation. Results: Mean age was 51.5 years; BMI averaged 23.9 kg/m². Local complications occurred in 30.4% of cases (infections 12%, dehiscence 10%, seromas 4%). Mean healing time was 15 days, with 87.4% of patients having drains removed by day 14. One patient required surgical revision, and one (1.8%) experienced delayed adjuvant therapy. Wound-QoL17 responses showed minimal discomfort and high satisfaction. Clinical evaluation revealed favorable wound appearance and preserved NAC perfusion within 48 h. Conclusions: Novox^® Cup appears effective in supporting wound healing and NAC preservation after NSM, with high patient satisfaction and minimal treatment delays. Its integration into postoperative care may enhance outcomes and maintain oncologic timelines. Full article

Background: Oncoplastic breast surgery aims to combine oncologic safety with optimal cosmetic outcomes. However, many established techniques require visible anterior breast incisions or substantial tissue rearrangement, which may compromise cosmetic results in selected patients. Posterior access to the breast through the retromammary space may allow tumor excision while preserving the anterior breast envelope. Methods: We report an early clinical experience with Posterior Approach Partial Mastectomy (MAPP), a breast-conserving technique that accesses the lesion through a concealed inframammary or lateral breast crease incision. This single-center retrospective case series included consecutive patients undergoing excision using this approach. Patient selection, surgical technique, and early outcomes—including margin status, complications, and need for re-excision—were evaluated. Results: Eight patients underwent breast-conserving excision using the MAPP technique. Six patients had malignant lesions (invasive ductal carcinoma with or without ductal carcinoma in situ or pure DCIS), while two benign lesions were included for technical completeness. Tumor size ranged from 9 to 78 mm. All malignant cases achieved negative surgical margins (R0), and no patient required re-excision. Posterior access was successfully achieved in all cases using concealed inframammary or lateral crease incisions. One patient experienced minor wound discharge that resolved with conservative management, and no major postoperative complications were observed. Follow-up ranged from 2 to 12 months. Conclusions: Posterior Approach Partial Mastectomy appears to be a feasible oncoplastic approach with encouraging early oncologic outcomes in carefully selected patients undergoing breast-conserving surgery. By preserving the anterior skin envelope and concealing the surgical incision, this technique may offer cosmetic advantages while maintaining oncologic adequacy. Larger studies with longer follow-up are needed to further define its role in oncoplastic breast surgery. Full article

This two-step design used the unilateral bench press to examine the effect of breast cancer surgery on upper-limb muscle activation under low and moderate fatigue conditions. First, we studied the proper method to normalize the activation values obtained during dynamic contractions. For that, the muscle activation was relativized to the maximal value obtained during (i) an isometric contraction (ISO_Norm), and the concentric phase of the (ii) repetition maximum load (1RM_Norm), and (iii) the first three repetitions of an 80% 1RM set (Max80%_Norm). The normalization method with the lowest inter-subject variability was further used to compare the muscle activation of the affected and non-affected sides of twelve women who underwent unilateral breast surgery (eight mastectomies and four lumpectomies). Both sides were tested using dynamic sets at 60 and 80% of their 1RM until reaching 40% velocity loss (VL). Repetitions completed at each %1RM were then divided into two groups: low fatigue (first half of repetitions) and moderate fatigue (second half of repetitions). On results, the ISO_Norm and the Max80%_Norm showed the highest (mean CV = 32.9%) and lowest (mean CV = 12.9%) inter-subject variability, respectively. The affected side showed higher activation for the deltoid and triceps (Δ = 6.9 to 15.9%) but lower for the pectoralis (Δ = −5.7 to −13.2%) against 60% 1RM. These differences were lower and without a consistent trend against 80% 1RM. Between-side comparisons were not significant for either 60% 1RM (p > 0.270) or 80% 1RM (p > 0.500). Although these results should be interpreted with caution due to the small and heterogeneous sample, our analyses did not reveal meaningful differences in upper-limb muscle activation following breast cancer surgery. Full article

Background: Implant-based breast reconstruction (IBBR) is the most widely used reconstructive strategy after mastectomy, but postoperative infection remains a major complication because it may require reoperation, implant explantation, and reconstructive failure. This study evaluated the incidence, determinants, and clinical burden of infection in a large single-center cohort. Materials and Methods: This retrospective observational study included 1537 reconstructed breasts undergoing post-mastectomy implant-based breast reconstruction. The unit of analysis was the reconstructed breast. Infection was defined clinically by erythema, pain, swelling, or secretion requiring antibiotic treatment, without requiring microbiological confirmation or formal surgical-site-infection criteria; this pragmatic definition reflects the retrospective nature of the study and should be considered when comparing results across studies. Univariate analyses were performed using chi-square, Fisher’s exact, or Mann–Whitney U tests, as appropriate. Independent predictors were assessed by multivariate binomial logistic regression. Results: Postoperative infection occurred in 66 of 1525 reconstructed breasts (4.3%). Among infected breasts, 54 cases (81.8%) required surgery, whereas 12 (18.2%) were managed conservatively. Implant explantation was performed in 82 of 1525 reconstructions (5.4%), and infection accounted for 39 of 74 explantations with available indication data (52.7%). In multivariate analysis, longer operative time remained independently associated with infection (OR 1.005 per minute, 95% CI 1.001–1.010; p = 0.010; corresponding to OR 1.38, 95% CI 1.08–1.77, per 60 min increment). Prepectoral reconstruction was also associated with a higher risk of infection compared with retropectoral reconstruction (OR 2.31, 95% CI 1.03–5.16; p = 0.042). Additional analyses showed that prepectoral reconstruction was more frequently associated with bilateral procedures, nipple-sparing mastectomy, and longer operative time. In unilateral reconstructions, the association between prepectoral reconstruction and infection persisted. Conclusions: Infection after implant-based breast reconstruction remains a clinically relevant source of morbidity and frequently requires further surgery. Longer operative time emerged as the most consistent independent factor associated with infection in the overall cohort. Prepectoral reconstruction was also associated with infection, although this finding should be interpreted cautiously in light of reconstructive context and case selection. Full article

Background/Objectives: Radiotherapy following mastectomy induces persistent structural alterations in the chest wall, including fibrosis, extracellular matrix disorganization, and vascular changes that compromise reconstructive outcomes. Although autologous fat grafting is widely used to improve tissue quality in irradiated breasts, direct human histological evidence remains limited. The aim of this prospective pilot study was to evaluate intra-patient histological remodeling in irradiated postmastectomy breast tissue before and 4 months after autologous fat grafting using paired core needle biopsies. This study should be considered a hypothesis-generating histological pilot study. Methods: Five female patients with prior mastectomy and adjuvant radiotherapy underwent Tru-Cut core needle biopsy of irradiated chest wall tissue before lipofilling and at approximately four months (range between 3 and 12 months) post-procedure. Specimens were processed using formalin fixation, paraffin embedding, and hematoxylin and eosin staining. Histological assessment focused on collagen density, stromal organization, vascular structures, inflammatory infiltrate, and adipocyte integration. Comparative intra-patient analysis was performed descriptively. Results: Baseline biopsies demonstrated consistent post-radiation alterations, including collagen compaction, stromal disorganization, perivascular fibrosis, and variable inflammatory infiltrate. Post-lipofilling specimens showed heterogeneous remodeling characterized by focal collagen fiber insertion between adipocytes, areas of immature connective tissue formation, and variable preservation of adipose architecture. The extent and pattern of remodeling differed among patients. Inflammatory activity decreased or remained mild in most cases. Conclusions: Autologous fat grafting in irradiated postmastectomy tissue is associated with measurable histological remodeling. Structural adaptation appears heterogeneous and patient-specific, suggesting a dynamic multi-stage process rather than uniform regeneration. Further studies incorporating quantitative and molecular analyses are required to clarify the mechanisms underlying these changes. Full article

Acellular dermal matrix (ADM) is commonly used for breast reconstruction with the proposed benefit of stabilizing the implant pocket and enhancing breast shape. However, some reports highlight safety concerns regarding ADM use. This study evaluates short and long-term unplanned return to the operating room (OR) for immediate implant-based reconstruction with or without ADM. Females who underwent primary mastectomy with direct to implant reconstruction for breast cancer or risk reduction (2010–2020) were identified using an integrated healthcare system’s EHR. Multivariable Poisson regression was conducted to evaluate return to OR outcomes at early (<1 year), intermediate (1–2 years), and long term (≥2 years) periods for ADM versus without. The cohort included 2886 patients, 69.8% with ADM. Overall, no differences were observed for OR returns for ADM compared to none. For unilateral procedures, a lower rate of return to OR was observed at 0–1 year (IRR = 0.74, 95% CI = 0.58–0.95) and >2 years (IRR = 0.52, 95% CI = 0.29–0.94). The lack of overall difference suggests ADM usage did not impact risk of complications nor improve surgical outcomes. For unilateral cases, ADM is associated with lower rates of return to OR at a higher cost to the healthcare system. Surgeons may use their discretion whether ADM is appropriate for breast reconstruction. Full article

Breast-conserving therapy (BCT), consisting of lumpectomy followed by adjuvant radiation, provides oncologic outcomes equivalent to mastectomy for many patients with breast cancer. As survivorship increases, the demand for aesthetic restoration after BCT has grown; however, reconstructive strategies in this setting remain less standardized than those following mastectomy. Reconstruction after BCT presents distinct challenges due to partial tissue loss, nonuniform radiation injury, progressive fibrosis, and wide variability in patient expectations and tolerance for revision surgery. Consequently, mastectomy-based reconstructive algorithms are often insufficient for guiding care in this population. This review synthesizes contemporary reconstructive options following BCT through a personalized medicine framework, emphasizing patient-specific risk factors that influence technique selection, timing, and long-term outcomes. Key determinants include radiation exposure, breast morphology, comorbid conditions, prior breast surgery, and psychosocial preferences. Oncoplastic volume displacement, implant-based augmentation, fat grafting, and autologous reconstruction each demonstrate distinct risk profiles in the post-BCT tissue environment and require individualized application. Timing of reconstruction and willingness to undergo staged procedures play a central role in outcome durability and patient satisfaction. Across reconstructive strategies, revision burden emerges as a clinically meaningful, patient-centered outcome that is not adequately captured by traditional short-term complication metrics. A risk-informed approach that integrates individualized risk assessment with transparent counseling and shared decision-making may improve alignment between reconstructive planning and patient goals. Personalized reconstruction after BCT requires moving beyond technique-driven paradigms toward flexible, longitudinal care pathways. Future efforts should focus on developing BCT-specific predictive models and incorporating patient-reported outcomes to advance personalized reconstructive care. Full article