Three-dimensional Simulation on Patient-reported Outcomes Following Oncoplastic and Reconstructive Surgery of the Breast: A Randomized Trial.

Background: Three-dimensional (3D) imaging using computer simulations is an evolving technology. There is a lack of strong data on the use of this technology for oncoplastic (OP) and reconstructive surgery. Methods: A prospective, randomized, single-center trial including breast cancer patients undergoing OP or mastectomy with immediate breast reconstruction with implant (IBR) enrolled from November 2019 to October 2021 at the Hospital Nossa Senhora das Graças, Breast Unit in Curitiba, Brazil. Both patients undergoing OP and those in the IBR group were randomized to undergo 3D imaging and simulation of postoperative results (intervention group) or 3D imaging without simulation (control group). All patients were invited to complete a patient-reported outcome (BREAST-Q) expectations module and breast reconstruction or reduction/mastopexy module before and 6 months after surgery. Results: A total of 96 patients were enrolled. Sixty-nine patients (45 OP and 24 IBR) completed the pre- and postoperative questionnaires and were randomized for the simulation. Women in the OP group had higher expectations for breast appearance when clothed than those in the IBR implant group (93.4 ± 16.3 versus 82.9 ± 26.5; P = 0.03). The intervention group was more satisfied with information than the control group (P = 0.021). Both patients who underwent OP and IBR believed that the 3D simulation helped them understand the surgical process (86.6% and 75%, respectively). Conclusions: Preoperative 3D simulation significantly improved patient's satisfaction with information and did not decrease postoperative satisfaction with the outcomes. The incorporation of preoperative 3D simulation may be a valuable tool in breast reconstruction.

Prepectoral Direct-to-Implant Breast Reconstruction without Placement of Acellular Dermal Matrix or Mesh after Nipple-Sparing Mastectomy.

BACKGROUND: The aim of this study was to report the results of prepectoral direct-to-implant reconstruction in nipple-sparing mastectomy without acellular dermal matrices or mesh. METHODS: A multicenter cohort of patients undergoing prophylactic or therapeutic nipple-sparing mastectomy was included from 2013 to 2020. All sizes and types of breasts were included, except those with previously failed reconstruction, previous radiotherapy with severe skin damage, locally advanced breast cancer, gigantomasty, severe degree of ptosis, tumors close to the nipple-areola complex (<1 cm on magnetic resonance imaging), or combined autologous-based reconstruction. RESULTS: A total of 280 immediate breast reconstructions were performed in 195 patients. The mean age was 45 years and 32.8 percent of patients were postmenopausal. The mean follow-up period was 16.5 (±17.43) months. Eighty-five patients (43.6 percent) underwent bilateral mastectomy; 116 mastectomies (41.4 percent) were prophylactic and 164 (58.6 percent) were therapeutic. Sixty-eight reconstructions (24 percent) had at least one acute complication, the most common being implant explantation (9.2 percent), which was more frequent in smokers. Late complications included rippling (grades 3 and 4) in seven cases (3.8 percent) and capsular contracture (Baker II through IV) in 29 cases (15.7 percent) [22 Baker II (11.9 percent), six Baker III (3.3 percent), and one Baker IV (0.5 percent)]. One implant rotation was observed. No deformity animation was observed. Cosmetic results were considered good or excellent in 87.3 percent of patients. CONCLUSIONS: Overall complications were similar to those reported in acellular dermal matrices, mesh, or subpectoral series, except for a higher explantation rate. This technique is safe and economically advantageous, as it is a one-stage technique without acellular dermal matrices and mesh. These are preliminary data and larger and comparative studies are needed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Breast cancer and pyoderma gangrenosum: a complication after conservative surgery and radiotherapy

Pyoderma gangrenosum (PG) is a rare, ulcerative, and painful neutrophilic dermatosis of unknown cause associated with systemic diseases and/or pathergy phenomenon in 30% of cases. We report the case of a breast cancer patient submitted to oncoplastic conservative surgery followed by adjuvant radiotherapy, with long-term progression to PG. It's rare and challeng ing nature reinforces the need for early diagnosis to increase treatment effectiveness and reduce morbidity.