Search Results (226)

Background/Objectives: Appetite-regulating hormones are bioactive components of human milk. We tested the associations of leptin and adiponectin with infant growth and eating behaviors to age 6 months. Methods: In a cohort of 70 healthy, full-term infants and their mothers, human milk adiponectin and leptin were assayed at age 2 months (m). At infant ages 2, 4, and 6 m, infant anthropometry was obtained, mothers reported feeding frequency, duration, and breastfeeding intensity and completed the Baby Eating Behavior Questionnaire (Enjoyment of Food, Food Responsiveness, and General Appetite), and infant sucking vigor using an artificial nipple (burst duration and sucking frequency) was measured. Mothers reported demographics, gestational diabetes and pre-pregnancy body mass index (BMI), gestational age, and infant birthweight. Multivariate models evaluated predictors of leptin and adiponectin, and associations of leptin and adiponectin with infant growth and eating behaviors. Results: Human milk leptin was predicted by maternal BMI (β = 0.02) and breastfeeding intensity (β = −0.32). Regarding infant growth, infant weight-for-age and weight-for-length z-scores at 6 m were predicted by leptin (β = 0.91 and β = 1.22, respectively) and adiponectin (β = 0.01 and β = 0.01, respectively). Regarding infant eating behaviors, feeding duration at 2 m and feeding frequency at 4 m were predicted by adiponectin (β = 0.03 and β = −0.02, respectively). Conclusions: Human milk leptin and adiponectin may contribute to weight gain in early infancy, but the effect does not appear to be mediated substantially by infant eating behaviors. Further investigation into the metabolic programming of early infant weight gain is warranted. 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: Ankyloglossia is a congenital anomaly characterized by restricted tongue mobility due to a short, thick, or tight lingual frenulum. Methods: This narrative review synthesizes current concepts on etiology, clinical presentation, diagnostic approaches, functional implications, and management for ankyloglossia in newborns. Results: Ankyloglossia can compromise breastfeeding dynamics, manifesting as suboptimal latch, maternal nipple pain, and inefficient milk transfer, and may influence orofacial function if unrecognized. Because anatomical appearance alone does not reliably predict function, evaluation should prioritize structured functional assessments over purely morphological descriptors. Management should be individualized and stepwise, beginning with lactation support and positioning strategies, and progressing to frenotomy when clear functional limitation persists. In appropriately selected cases, timely intervention can improve feeding efficiency and caregiver comfort while minimizing disruptions to early bonding and nutrition. Post-procedure follow-up is important to confirm functional gains and address residual feeding mechanics. Conclusions: A coordinated, multidisciplinary approach aligns diagnosis and treatment with the infant’s functional needs and family goals, promoting safe, effective, and patient-centered care. Full article

Background/Objectives: With increasing survival rates following oncologic mastectomies, loss of breast sensation can negatively impact a patient’s quality of life. Methods: PubMed, Embase, and Web of Science were searched in April 2025 for studies reporting sensory outcomes after neurotized breast reconstruction. Eligible studies included patients undergoing autologous or implant-based reconstruction with any neurotization technique. Forty studies were included, and outcomes involved objective sensory testing (e.g., Semmes-Weinstein monofilaments, pressure-specified sensory devices, and thermal thresholds) and patient-reported quality of life (e.g., BREAST-Q). Results: Neurotization consistently accelerated and improved recovery of tactile, thermal, and protective sensation compared with non-neurotized controls, particularly in DIEP and TRAM flaps. Direct coaptation was most frequently employed, while nerve allografts, conduits, and autologous grafts offered effective alternatives when direct repair was not feasible. Implant-based reconstructions using allografts also demonstrated significant improvements in the nipple–areola complex and breast skin sensation. Across studies, earlier and more uniform sensory return was reported, with improved sensation often associated with high patient satisfaction and quality of life. Conclusions: The preponderance of observational evidence suggests that nerve coaptation, whether by direct suture, conduit, allograft, or autograft, represents a promising adjunct to breast reconstruction in both autologous and implant-based reconstruction. However, many studies were retrospective in design, had small sample sizes, and lacked randomization. Full article

Background: Immediate prepectoral implant-based breast reconstruction (IBR) following skin-reducing mastectomy (SRM) preserves the pectoralis major muscle, improving recovery and aesthetics. A dual-layer technique combining porcine-derived acellular dermal matrix (ADM) with an inferior autologous dermal sling may enhance implant support, vascularization, and lower-pole stability, particularly in patients with macromastia or ptosis. Methods: This retrospective single-center study included 20 patients (24 breasts) who underwent SRM with immediate prepectoral IBR using the dual-layer technique between January 2023 and May 2025. Demographic, oncologic, and perioperative data were collected prospectively. Complications were classified by severity, and patient-reported outcomes were evaluated using the BREAST-Q scale preoperatively and at 1, 3, 6, and 12 months postoperatively. Statistical analysis included paired t-tests, Shapiro–Wilk tests, and effect size estimation (Cohen’s dz). Results: Mean age was 42 ± 6.3 years and BMI 26.1 ± 3.2 kg/m². Mean mastectomy specimen weight was 432.5 ± 120.8 g, and implant volume 375 ± 60 cc. No reconstruction failures or infections occurred. Early complications were reported in 20.8% of breasts, including superficial nipple–areola complex epidermolysis (8.3%), seroma (4.2%), and hematoma (4.2%), all managed conservatively. At 12 months, BREAST-Q scores improved significantly: satisfaction with breasts increased from 63 ± 8 to 89 ± 11 (p < 0.001); psychosocial well-being from 60 ± 10 to 81 ± 11 (p < 0.001); and physical well-being from 62 ± 7 to 82 ± 10 (p < 0.001). Conclusions: Dual-layer prepectoral reconstruction using porcine ADM and autologous dermal sling is safe, provides durable implant stability, and significantly improves patient satisfaction and quality of life following SRM. Full article

Background and Objectives: The aim of this retrospective cohort study was to determine the frequency of early-stage nipple necrosis and wound complications in patients undergoing unilateral skin-sparing mastectomy (SSM) and direct implant-based reconstruction and describe the conservative/advanced wound care approaches used for these complications. Materials and Methods: A retrospective review was made of the medical records of 84 patients who underwent same-session unilateral SSM and implant-based reconstruction in the Surgical Oncology Clinic between November 2019 and February 2024. Statistical analyses were performed using the Shapiro–Wilk test, Mann–Whitney U-test, and Chi-square/Fisher tests. Results: The mean age of the patients was 43.51 ± 6.5 years, 35.7% of the patients received neoadjuvant chemotherapy, and smoking prevalence was 7.1%. Wound complications developed in 16.7% of the patients, distributed as follows: wound dehiscence 6%, NAC necrosis 8.4%, infection 1.2%, and hematoma 1.2%. Interventions due to complications were performed at rates of 2.4% for areola excision, 2.4% for debridement, and 2.4% for implant excision. The only variable significantly associated with complication development was excision volume, which was higher in the complication group (p = 0.033). Logistic regression analysis showed that a one-unit increase in excision volume was associated with a statistically significant increase in the likelihood of complication development (O.R = 1.002; 95% CI: 1.000–1.004; p = 0.019). No significant association was found between age, height/weight, neoadjuvant therapy, smoking, breast side, pathology subtype, axillary approach, and the development of complications (p > 0.05). Advanced wound management was provided in 10 of the 14 cases (71.4%) that developed complications. Conclusions: Excision volume was found to be the only variable associated with wound complication development after implant-based reconstruction following unilateral SSM. Most complications were managed successfully with advanced wound care, minimizing the need for re-operation. For patients undergoing high-volume excision, risk-based early multidisciplinary, close follow-up is recommended. Full article

Background/Objectives: We investigated the feasibility of ductoscopy in diagnosis and management of patients presenting with clinically pathological nipple discharge (PND). Methods: Mammary ductoscopy was performed on 57 breasts with PND in 54 patients for diagnostic and therapeutic purposes. Ductoscopic abnormalities included ductal irregularities, presence of erythematous patches, or presence of intraductal papillomas, whereas duct ectasia or presence of dense fluid was considered a benign finding. Results: Age older than 40 and any pathology in ultrasound or ductoscopy were significantly associated with a decision of surgery. Surgical procedures included central duct excisions (n = 16) or specific duct excisions (n = 14) guided by either ultrasound (USG) or ductoscopy. Presence of an abnormal finding on ductoscopy was significantly associated with a specific lesion yield for PND in 18 patients, such as ductal carcinoma in situ with/without papillary cancer (n = 2, 11.1%), or intraductal papilloma/papillomatosis (n = 15, 83.3%) or periductal mastitis (n = 1, 5.6%) (specific lesion for PND; ductoscopic abnormality: 83.3% (15/18) vs. ductoscopic benign findings: 16.7% (2/12); p = 0.001) in patients undergoing surgical intervention. However, pathological findings in other imaging modalities including USG, magnetic resonance imaging (MRI) or mammogram were not associated with specific lesion yield for PND. The cancer detection rate in surgically excised lesions (n = 30) was 6.7% (n = 2). Overall, nipple discharge ceased in three patients who were conservatively observed after benign findings on ductoscopy at a median of 58 months (IQR, 39–77). Conclusions: The use of ductoscopy facilitated surgical decision-making in patients with PND, helping to distinguish patients requiring surgical excision from those suitable for conservative follow-up. In this cohort, ductoscopy findings were frequently associated with specific lesions, including mostly intraductal papilloma, explaining nipple discharge in patients selected for surgery. Full article

Background/Objectives: Prophylactic mastectomy can significantly reduce the risk of breast cancer in patients carrying gene mutations such as BRCA1 and BRCA2. Patients who opt for breast removal are offered tailored reconstructive options based on their medical history and prior treatments, and in these often young patients with limited autologous tissue reserves, implant-based reconstruction is frequently the option of choice. Complication rates of these procedures are relatively high and account for up to 30%. Subcutaneous mastectomy with primary implant reconstruction carries risks such as hematoma, seroma, skin necrosis, necrosis of the nipple–areola complex, and wound healing issues, which may necessitate revision surgery. This university-center retrospective analysis aims to improve outcomes by identifying patient- and surgery-related risk factors associated with postoperative complications in allogenic breast reconstruction following subcutaneous mastectomy. Methods: We analyzed 61 female patients and 122 breasts who underwent primary implant-based reconstruction after skin- or nipple-sparing subcutaneous mastectomy over three years between January 2021 and December 2023. Demographic and surgical variables were systematically collected and analyzed. Results: The mean patient age was 41.5 ± 10.3 years. A total of 13% of patients were active smokers, and 1.6% had diabetes mellitus. Overall, skin flap necrosis occurred in 27.9% of patients (22.1% of breasts), wound healing disorders in 19.7% of patients, wound infections in 9.8%, and revision surgery in 18.0%. A history of pregnancy was associated with skin flap necrosis (OR 10.07, 95% CI 1.79–190.06; p = 0.032); however, this finding must be interpreted with caution due to limited statistical power and model instability. Conclusions: This investigation revealed clinically relevant patterns suggesting potential risk factors for wound healing disorders and skin necrosis. Prospective studies are planned to further substantiate these findings and to help reduce overall complication rates associated with the procedure. Full article

Background/Objectives: Autologous fat grafting (AFG) is widely used in breast reconstruction; however, graft retention remains unpredictable due to recipient-bed variability. Photoacoustic imaging (PAI) is a contrast-free, noninvasive modality enabling visualization of vascular structures in detail. This study used PAI to visualize and quantitatively assess neovascularization and vascular structure in breasts reconstructed with AFG. Methods: In this retrospective, cross-sectional study, data from eight patients who underwent PAI of both reconstructed and contralateral breasts at least three months after their final AFG procedure for total breast reconstruction were used. Excluding the nipple–areola complex and skin markings, four 3 × 3 cm regions of interest (one per quadrant) were selected in the periareolar region. Vascular density in terms of depth from the skin surface was analyzed in five cases with adequate contact between the device and the skin. Visible vessel diameters within the regions of interest were manually measured and categorized as small, medium, or large to assess distribution patterns. Results: PAI successfully enabled visualization of vascular structures on the reconstructed side in all cases, even at depths greater than 10 mm. In five cases, vascular density in the superficial layer (0–2.5 mm) was higher on the reconstructed side than on the contralateral side. A longer postoperative interval was associated with a higher proportion of small vessels and fewer large vessels. Conclusions: PAI enabled noninvasive visualization of vascular structures consistent with neovascularization on the reconstructed side after AFG. Temporal changes in vessel diameter distribution suggest ongoing vascular remodeling, supporting the potential utility of PAI in assessing vascular structural changes in grafted tissue over time. Full article

This study synthesizes the evidence on effective interventions for the prevention of breastfeeding-related nipple-areolar injuries. A systematic review was performed and guided by the evidence synthesis manual of the Joan Briggs Institute, carried out in six databases, with only intervention studies. Interventions with a positive outcome for the prevention of nipple-areolar lesions were considered effective. Methodological quality was assessed by the Grading of Recommendations Assessment, Development and Evaluation. The final sample of 14 articles found the following to be effective strategies: educational practices (simulations and demonstrations of the breastfeeding technique, with a qualified professional or by video) and the use of peppermint (aqueous solution or gel), extra virgin olive oil, honey, guaiazulene ointment, and venix caseosa. Each intervention was used in specific situations and ways, which should be considered for use in clinical practice. The interventions discussed can help prevent nipple-areolar lesions and breastfeeding difficulties, encouraging breastfeeding. Full article

Canine mammary tumours often present as multiple synchronous nodules, necessitating decisions regarding staging intensity and surgical planning prior to histology. We developed two preoperative nodule-level prediction models using only the medical history and physical examination of client-owned bitches with mammary disease, which were staged using the WHO-modified TNM system with a M0 classification (no distant metastasis) at the time of presentation. This retrospective study analysed 286 surgically excised mammary nodules from 92 dogs managed under a standardised mammary oncology protocol; those with inflammatory mammary carcinoma or distant metastasis were excluded. The outcomes were (i) malignant versus benign/non-neoplastic histology (for all nodules) and (ii) intermediate/high histologic grade (II–III versus I) among carcinomas. Separate multivariable Firth penalised logistic regression models accounted for within-dog clustering with dog-level bootstrap internal validation. Multiple imputation was used in a sensitivity analysis for missingness in the detection-to-surgery interval. Malignancy was confirmed in 87/286 (30.4%) of the nodules (86 carcinomas), including 35/87 (40.2%) that measured less than 1 cm. Among complete cases (153 nodules), malignancy was associated with age at neutering, maximum tumour diameter, owner-reported rapid growth and a detection-to-surgery interval of more than 3.5 months (an exploratory ROC-derived threshold) with good discrimination (area under the curve (AUC) 0.805; optimism-corrected 0.799) and acceptable calibration. Among carcinomas (83 specimen), previous mammary tumours, bloody nipple discharge and fewer synchronous nodules were associated with intermediate/high malignancy grade (AUC 0.859). Sensitivity analyses yielded directionally consistent estimates. Routinely available clinical information may provide interpretable preoperative risk stratification to support staging and surgical planning, pending external validation. Full article

Reconstruction of the nipple is the final step of breast reconstruction following skin-sparing mastectomy (SSM) and plays a critical role in restoring breast symmetry and aesthetic completeness. Various nipple reconstruction techniques have been described, including split transplantation of normal nipples and flap-based procedures; however, long-term maintenance of nipple projection and volume remains challenging due to postoperative tissue loss. This study evaluates the clinical outcomes of a previously described long V-Y flap technique, focusing on its ability to mitigate postoperative nipple projection and volume loss. A retrospective analysis was performed on 27 patients who underwent nipple reconstruction using the long V-Y flap following SSM with tissue expander–implant reconstruction. Nipple projection and volume were measured immediately after surgery and at follow-up beyond six months, and volume loss rates were calculated. Outcomes were compared descriptively with projection loss rates reported for other commonly used flap techniques in the literature. The mean nipple volume loss was 34.23%, and the mean projection loss was 32.79%, while nipple width remained largely unchanged over time. These values were numerically lower than those reported for skate, star, bell, and arrow flaps in prior studies. The long V-Y flap appears to be a practical and reliable option for nipple reconstruction after SSM, particularly for larger nipples, with favorable short- to mid-term maintenance of projection and volume. Full article

Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures—one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons. Full article

Background/Objectives: Nipple-sparing mastectomy (NSM) is a surgical procedure that significantly improves postoperative cosmetic outcomes and quality of life (QOL) while ensuring oncological safety. However, ischemic necrosis of the nipple–areolar complex (NAC), resulting from impaired blood flow, remains a serious complication, particularly in patients with risk factors. To mitigate this ischemic risk, the Nipple Delay (ND) procedure, which applies the principle of surgical delay, has been proposed. The objective of this study was to retrospectively review cases in which the ND procedure was performed prior to NSM with immediate autologous breast reconstruction and to evaluate the safety and clinical utility of this technique in preventing NAC necrosis. Methods: This study included 30 breasts from 30 patients who underwent the ND procedure prior to NSM with autologous reconstruction at our institution. ND was performed under local anesthesia two weeks before NSM. The skin around the NAC was dissected from the underlying breast tissue. Results: The median age of the patients was 49 years, and the mean BMI was 22.7 kg/m². Risk factors for NAC necrosis included periareolar incision in 24 patients (80.0%), a BMI of 25 kg/m² or higher in 7 patients (23.3%), and a history of smoking in 8 patients (26.7%). No cases of full-thickness necrosis requiring NAC excision were observed (0%). Partial-thickness necrosis, which healed with conservative treatment, was observed in 6 patients (20.0%). No malignant involvement was detected in subareolar specimens. Conclusions: A staged approach using the ND procedure before NSM suggests effectiveness for preventing serious ischemic complications and safely expanding the indications for NSM, even in patients at high risk of NAC necrosis. Full article

Implant-based breast reconstruction (IBBR) remains the most common form of post-mastectomy reconstruction worldwide, offering patients a reliable and accessible option to restore breast contour. Advances in surgical technique, biomaterials, and implant technology have driven rapid evolution in the field, with the dual goals of improving aesthetic outcomes and minimizing patient morbidity. The prepectoral plane has been popularized due to the eliminated risk of animation deformity and reduced postoperative pain. Some concerns remain regarding mastectomy flap thickness and long-term oncologic and aesthetic outcomes. Concurrently, nipple-sparing mastectomy has improved aesthetic results and enabled surgeons to move beyond just restoring breast form and improve functional recovery as well, as demonstrated by surgical efforts aimed at restoring nipple–areolar complex (NAC) sensation. Adjunctive use of biologic matrices and synthetic meshes has broadened reconstructive options, while next-generation implants seek to further enhance outcomes. Balanced against these innovations are important oncologic and systemic safety concerns, including breast implant-related cancers and the ongoing debate over breast implant illness (BII). This review highlights eight current “hot topics” in implant-based breast reconstruction: (1) prepectoral reconstruction, (2) nipple-sparing mastectomy, (3) oncoplastic techniques, (4) nipple–areolar complex (NAC) neurotization, (5) biologic matrices and synthetic meshes, (6) next-generation implants, (7) optimizing aesthetic outcomes, and (8) implant-associated cancer and systemic concerns. Together, these areas define the current landscape of innovation, controversy, and future directions in implant-based reconstruction. Full article