Macroareolar Changes following Periareolar Mastopexy: A Postoperative Assessment

Objectives: The position and configuration of the nipple-areolar complex (NAC) have a high impact on satisfaction (objective and subjective) after breast-conserving therapy (BCT). The aim of this study is to objectively measure the changes in the NAC after breast conservation surgery by the use of the 3D whole body scanner and compare its results with the outcome reported by the patients. This will support further patients and help physicians to tailor their technique prior to breast-conserving surgery. Methods: In a unicentric pilot project 6 months after BET with periareolar mastopexy and adjuvant radiation between 2019 and 2022, 38 women were studied. The mean age was 56.3 ±11.6 and BMI was 24.6 ± 4.5 kg/m². Objective 3D parameters were collected using the Vectra Whole Body Surface Imaging System (WB360) based on breast and NAC dimensions. In addition, the patients received the BCT module and the mastopexy module items about satisfaction with the NAC from the BREAST Q questionnaire. Results: In a group of 38 women, BCT with periareolar mastopexy and irradiation showed a small but significant change in NAC position and shape (see Table 1). This small change is matched by the high satisfaction with the nipple and areola surveyed in the BREAST-Q questionnaire. More than 66% of the women were rather satisfied or very satisfied. The BREAST-Q results from the Items about satisfaction with the nipple and areola are shown in Table 2. However, 34% of participants reported being somewhat dissatisfied to very dissatisfied with the symmetry of placement. This could be due to a significant cumulative small change in nipple-sternal notch distance and nipple-midline distance. No significant difference was found when measuring the nipple-inframammary fold distance (p=0.649). The absolute difference was of 0.13 ± 1.22 mm. The change in breast diameter was of 0.55 ± 1.54 mm (relative 2,75 ± 7.95%). There was also no significance (p=0.042). This indicates that after BCT, the nipple-inframammary fold distance and breast diameter did not change significantly. Breast volume decreases insignificantly by 49.2 ± 136.1 cc (relative 12,96 ± 33.51) on the operated side (p=0.009). In particular, a difference in vertical diameter of the NAC of -4,79 mm (14,27%) was observed between the non-operated and the operated breast (p=0.005 by Wilcoxon-test). The BREAST-Q BCT Module consists of 8 domains. The higher the score, the higher the satisfaction with the questioned item. In our sample of 38 women, satisfaction with the surgeon(s) was highest (BREAST-Q score of 83,97 ± 19,12). The mean Q score for satisfaction with "psychosocial well-being" is 67,47 ± 22,03. For the item "sexual well-being", only 35 women answered sufficient questions and the mean Q score was 54,42 ± 16,43. “Satisfaction with breast” had a Q-score of 61,03 ± 19,36. The questions about "physical well-being" had a mean of 70,11 ± 16,69. The Q-score for “satisfaction with medical team”, “with office staff”, and “with information” can be seen in Table 3. Conclusions: In a nutshell, the conclusion of this study is that the Vectra XT 3D-Imaging is a useful tool to assess the cosmetic outcome in terms of NAC position and shape. Hence, it is a helpful tool to support the planning of the surgery and may have a positive impact on the outcome. Postoperatively, there was only a slight change in the NAC dimension and position compared with intraoperative planning. The 3D Surface Analysis is most useful in assessing the quality of reconstruction after BCT and additionally the NAC is therefore an important factor for patient satisfaction. Results of a multicenter study are pending. Table 1: Descriptive statistic and Wilcoxon-test Results from the measures from the Breast and from NAC Dimension and Position (n=38) The 3D Measures from the Breast and from NAC Dimension and Position Table 2: Results from the BREAST-Q mastopexy modul about satisfaction with the nipples (n=38) Satisfaction with the nipples Table 3: Results from the BREAST-Q BCT Modul after BCT and periareolar mastopexy und adjuvant radiation (n=38) BREAST-Q Scores Citation Format: Therese Peter, Konstantin Koban, Denis Ehrl, Pamina Geiger, Nadia Harbeck, Steffen Kahlert, Carolin Luczak, Johannes Schmid, Rachel Wuerstlein, Friederike Hagemann. Nipple areolar complex changes after breast-conserving surgical therapy and periareolar mastopexy: a three-dimensional Surface Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-08.

Background: Surgical management of breast cancer has drastically changed. Breast-conserving surgery (BCS) has now become a commonly used method for its treatment. Oncoplastic techniques are widely applied with satisfactory aesthetic results. We evaluated the aesthetic and oncological outcomes of BCS with glandular tissue displacement techniques. Methods: Seventy-five patients with invasive breast cancer were surgically treated by oncoplastic techniques. Preoperative evaluations, including breast and tumor size, localizations and features, were performed by physical examination, imaging methods, and histopathological analysis. Appropriate volume displacement techniques were planned according to breast and tumor size and localization. Early and late aesthetic results were evaluated. Results: The mean age of the patients was 54 years, and mean tumor size was 25 mm. Tumors were located in the upper–outer quadrant in 44% of patients. Glandular flaps were used in 55 (73%) patients. Racquet mammoplasty was the most preferred method. Nipple areolar complex (NAC) recentralization was performed in 26 (47.3%) of 55 patients with glandular tissue displacement. Therapeutic reduction mammoplasty was performed in 20 patients. All patients underwent adjuvant radiotherapy. After an average follow-up of 24 months, neither locoregional recurrence nor distant metastases were observed. Aesthetic results of the oncoplastic BCS method were very good in 54 (72%) patients. Conclusion: Breast remodeling by glandular flap displacement after a wide local excision should be the primary aim in patients with breast cancer for better aesthetic outcomes. NAC recentralization is the primary component that could be considered for achieving better results. BCS associated with oncoplastic techniques allows wide excision of larger tumors and provides good and satisfactory aesthetic results at long-term follow-up.

Introduction: In the context of breast oncologic surgery, the major advantage of the oncoplastic approach lies in embracing the medical principle of primum non nocere, aligning with the needs for breast conservation and aesthetic outcomes in oncologic treatment. This approach expands surgical options, reduces the rates of mastectomy, and helps prevent deformities. The initial record of oncoplastic surgery dates back to Grisotti's publication in 1994, which reported that approximately 15% of patients experience poor aesthetic results after purely conservative surgery—outcomes influenced by factors such as the extent of excision relative to breast size, tumor location, and the effects of radiotherapy. In this scenario, there arises a need to seek the best functional and aesthetic results in the primary surgical procedure. With the consolidation of oncoplastic surgery within the range of oncologic surgical interventions, various techniques have been developed to achieve adequate tumor excision while avoiding excessive tissue removal that could lead to deformities. Among the most common oncoplastic techniques are elliptical segmentectomy incision, circum-areolar approach for segmental resection, progressive mastopexy, batwing (or bat wing) technique, hemibatwing, donut mastopexy/round-block, bilobed excision, central quadrantectomy, triangular incision, inframammary incision, and reduction mastopexy. Among these techniques, the batwing stands out as a suitable approach for excising cancers located in the upper or central quadrants of the breast, due to its short operative time, low complication rate, good applicability across different breast profiles, minimal dissection and remodeling requirements, low delay for adjuvant treatment, and favorable aesthetic outcomes, with high patient satisfaction. In this context, an integrative bibliographic review of the topic Batwing Oncoplastic Surgery was conducted, based on data collected from studies published in the last 15 years (2008–2023) in the United States National Library of Medicine database (PubMed). Methodology: This is an integrative review study, with data collection carried out through a bibliographic survey to achieve the proposed objectives, based on the examination of relevant research to the theoretical foundation, identified and analyzed through published evidence related to the topic Batwing Oncoplastic Surgery. The study in question is a literature review of an integrative type, with a qualitative approach. For the continuation of this study, the following steps were followed: a) definition of the topic; b) formulation of the guiding question; c) search for descriptors; d) database research; e) establishment of inclusion and exclusion criteria for articles; f) evaluation of information extracted from the selected articles; g) discussion of the results; and finally, h) compilation of the review. For the foundation, the following guiding question was posed: What information is available about the oncoplastic breast surgery technique Batwing? The search for studies was conducted in January 2024 through the United States National Library of Medicine database (PubMed), using the keywords: "oncoplastic" AND "breast surgery batwing technique." The inclusion criteria were: full text available; languages: English, Spanish, and Portuguese; published within the last 15 years. For exclusion, the following criteria were used: articles outside the specified time frame, duplicates, coursework papers, or studies that did not address the guiding question. Conclusion: The literature review reveals that breast oncoplasty is becoming a fundamental part of breast cancer treatment. This approach allows surgeons to perform extensive tumor resections without compromising aesthetic outcomes, prioritizing both tumor removal and cosmetic results. Given the variety of surgical techniques available, it is crucial to consider the patient’s profile, lesion characteristics, systemic conditions, comorbidities, healing capacity, breast volume, and tumor location to identify potential risk factors for surgical complications. A key principle in any breast reduction procedure is preserving vascular supply to the areola–nipple complex and the remaining breast tissue. Therefore, planning the skin incision is the first and most critical step, tailored to the tumor’s location. Considering these principles, the Batwing technique stands out as it is recommended for lesions located in the upper and central quadrants, and is also applicable to deep or adjacent tumors near the areola–nipple complex. This approach is favored due to its shorter surgical time, lower tissue dissection, and highly satisfactory aesthetic results, positioning it as a major advantage among oncoplastic surgical options.

Breast-conserving surgery has become the standard approach for about 80% of patients treated for primary breast cancer in most centres. However, mastectomy is still required in case of multicentric and/or large tumours or where recurrences occur after conservative treatment. When a total mastectomy is performed, the removal of the nipple areola complex (NAC) is a strongly debated issue. In fact, although removal of the NAC greatly increases the patient's sensation of mutilation, and the risk of tumor involvement of the areola is reported as a very variable percentage, NAC excision still remains the standard treatment. From March 2002 to September 2003, 106 nipple sparing mastectomies (NSM) were peformed in 102 patients, 63% of whom had invasive carcinoma and 37% of whom had in situ carcinoma. Four patients underwent bilateral surgery. In all cases, a large or multicentric tumour and/or diffuse microcalcifications, clinically distant from the NAC, were present. During surgery, the tissue under the areola was routinely sampled to exclude the presence of tumor. If disease-free at the frozen sections, the NAC was spared and a NSM was performed. Additionally, a total dose of 16 Gy of radiotherapy (ELIOT) was delivered intraoperatively in the region of the NAC. All the patients underwent an immediate plastic breast reconstruction. In eleven patients (10.4%), the breast tissue under the areola resulted infiltrated at the definitive histological examination: in 10 cases a single or multiple foci of in situ carcinoma and in one case an invasive component were present. Eleven patients (10.4%) developed a superficial skin areolar slough followed by spontaneous healing, and 5 patients (4.7%) lost their NAC due to total necrosis. Among these, one patient had a poor cosmetic result on the NAC with asymmetrical location and required further surgical removal and reconstruction with tattoo and local flap in a better position. When rating the results from 0 (bad) to 10 (excellent), on average, the colour of the areola was rated 9/10, the sensitivity of nipple 3/10, the overall aesthetic result was rated 8/10 by both the surgeon and the patients. Early radiodystrophy (pigmentation) was observed in eight cases (7.5%). After an average follow up of 13 months, one local recurrence, located under the clavicula, far from the NAC, was observed. The preliminary results of the psychological study show a very high satisfaction with the preservation of the nipple (97.6 %), with younger women expressing a higher satisfaction than older counterparts. In selected cases, NSM with ELIOT of NAC has so far permitted good local control of the disease and satisfactory cosmetic results. Wider surgical experience is required to minimise the risk of leaving tumor cells in the region of the spared NAC and a longer follow up is necessary to evaluate the long term tumor recurrence rate at the NAC.

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

The aim of this study was to explore features of patients reporting early poor aesthetic outcome after simple breast-conserving surgery. We prospectively evaluated 709 patients shortly after breast-conserving surgery. Aesthetic outcome was measured by aesthetic status scores of the Breast Cancer Treatment Outcome Scale. Clinical, surgical, and pathologic variables were assessed to identify predictors of poor aesthetic outcome. Poor aesthetic outcome was reported by 46 (6.5%) patients, and 209 (29%) patients reported an intermediate aesthetic outcome. A single factor analysis of variance showed a negative impact of higher specimen weight (P < 0.001). Univariate logistic regression analysis revealed the following significant risk factors for poor aesthetic outcome: 12 o'clock positioning of tumor localization, a tumor behind the nipple areolar complex (NAC), fishmouth-shaped incision with resection of the NAC, quadrantectomy, central segmental resection, and pT stages 3 and 4. Multivariate logistic regression analysis indicated statistically independent associations between poor aesthetic outcome and tumor position in the inner half of the breast or behind the NAC, quadrantectomy, and pT stages 3 and 4. Poor aesthetic outcome is relatively rare shortly after breast-conserving surgery, but predictable in specific situations.

Introduction: Breast conserving therapy (BCT) is considered the treatment of choice for early stage breast cancer by National Cancer Institute guidelines. Little data exists on patient-reported satisfaction and quality of life outcomes after lumpectomy with radiation. This study aims to identify factors influencing satisfaction with cosmetic outcome and quality of life in patients receiving BCT using a validated instrument. Methods: All patients treated with lumpectomy and radiation for breast cancer at our institution from 1997-2012 received a mailed questionnaire containing the BREAST-Q breast conservation module (graciously provided by Dr A. Pusic, Memorial Sloan Kettering Cancer Center), a validated quality of life survey instrument. A retrospective chart review was performed for survey responders for demographic, treatment, and staging information. Scores were calculated for satisfaction with appearance of the breast, adverse effects of radiation, sexual wellbeing, psychosocial wellbeing and physical wellbeing: upper body and arm. Pearson correlation coefficients were obtained. Wilcoxon rank-sum and one-way ANOVA were used to identify associations between patient variables and satisfaction scores. Multivariate regression was used to assess confounding variables. Results: A total of 110 questionnaires (response rate of 29.5%) fit criteria for analysis. The mean age of respondents was 65.9±11.2 yrs, and mean time since diagnosis was 91.8±53.1 mos. We observed the strongest correlations between satisfaction with breast appearance and sexual wellbeing (r=0.66, p&amp;lt;0.01), breast appearance and psychosocial wellbeing (r=0.62, p&amp;lt;0.01), and fewer effects of radiation and physical wellbeing (r=0.65, p&amp;lt;0.01). Lumpectomy volume was associated with decreased satisfaction with breast appearance (r=-0.32, p &amp;lt;0.01) and psychosocial wellbeing (r=-0.19, p&amp;lt;0.05). There was no correlation between satisfaction with breast appearance and patient age, time since surgery, history of re-excision, stage or localization technique. Patients with older age at diagnosis reported significantly fewer effects of radiation and better psychosocial, physical, and sexual wellbeing (all p&amp;lt;0.05) (Table 1). The incidence of recurrence was 2.7% and did not impact satisfaction scores. Distribution of Satisfaction/Quality of Life Outcomes by Age at Diagnosis Satisfaction/Quality of Life*AgeNBreastAdverse Effects of RadiationPsychosocialSexualPhysical&amp;lt;451458±2282±1973±1945±2074±1645-553264±2683±1980±2054±2579±1756-602667±1794±983±2370±1885±1361-651267±2989±2383±2053±2983±17&amp;gt;652670±2391±1288±1663±2588±25All11065±2388±1682±2058±2482±19P 0.1590.0190.0140.0300.002*Rasch scores range from 0-100 where 100 indicates highest satisfaction Conclusions: In women undergoing BCT, patient satisfaction with appearance of the breast and psychosocial wellbeing at 7.6 years of follow-up correlated with the volume of tissue removed but no other patient or tumor characteristics. Increasing age at diagnosis was associated with greater satisfaction in multiple domains. These results emphasize the importance of precise surgical technique and patient selection in order to achieve long-term patient satisfaction with BCT. Citation Format: Welsh JL, Fu S, Liao J, Sugg SL, Scott-Conner CE, Weigel RJ, Erdahl LM, Lizarraga IM. Long-term patient satisfaction with cosmetic outcome and psychosocial wellbeing after breast conserving therapy is affected only by lumpectomy volume. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-11-04.

BackgroundComplex breast ptosis may be caused by moderate and severe degrees of skin and glandular sagging associated with breast' and nipple-areola complex (NAC) asymmetries and deformity. The use of traditional peri-areolar mastopexy (t-PM) with or without implants is limited only for mild or moderate breast ptosis. ObjectivesThis article aims to report the safety and efficacy of the modified peri-areolar mastopexy (m-PM) characterized by a vertical shift of the classical pattern with implants and fat grafting (FG) in complex breast ptosis also evaluating the influence of breast and NAC asymmetries, breast, and chest deformities in the aesthetics outcomes. MethodsAn open label randomized controlled trial was performed. 40 women (study group - SG) affected by breast ptosis (moderate, and severe), asymmetries, and deformities were treated with m-PM, implants, and FG, comparing outcomes with those of a control group (CG) (n = 35) treated with t-PM and implants. Aesthetic outcomes were evaluated through the patient’s satisfaction grade, the physician's assessment score, and the visual Analog Scale (VAS). Results75% (n = 30) of SG patients reported excellent results on breast lift, shape, volume, NAC position, and scar quality after 12 months, while the CG reported the same outcomes in 60% (n = 21) of cases. SG patients showed a vertical NAC shift and a satisfaction degree higher than in the CG (p < 0.001 vs. CG). ConclusionsThe m-PM with implants and FG was safe and effective in this trial.

Background:In conservative breast surgery, the achievement of a satisfactory cosmetic result could be challenging; oncoplastic techniques may be helpful in many cases. A comparative analysis was performed among 3 groups of patients undergoing oncoplastic techniques plus external radiation therapy or intraoperative radiotherapy (IORT) and breast conservative surgery plus external radiation therapy; long-term oncologic results in terms of disease relapse and aesthetic outcomes were compared.Methods:Ninety-six patients were considered: 32 patients treated with oncoplastic surgery, 16 then subjected to radiotherapy (group 1) and another 16 treated with IORT (group 2); 64 patients treated by conservative surgery and radiotherapy formed the control group (group 3). Patients were asked to give a judgment on the cosmetic result considering the following parameters: breast symmetry, appearance of the residual scar, symmetry between the 2 nipple-areola complexes, global aesthetic judgment, and satisfaction about the result.Results:With respect to the oncological and aesthetic outcome, the statistical significance of the results obtained in the 3 groups was calculated using the chi-square test. The results, processed by the chi-square test, were not statistically significant; however, the overall judgments expressed by the patients of all 3 groups were more than satisfactory (scores greater than or equal to 6).Conclusions:In our experience, when the inclusion criteria are satisfied and the equipment is available, oncoplastic techniques associated with IORT should be considered the treatment of choice for breast cancer in early stage. The excellent cosmetic results and patient’s satisfaction encourage us to continue on this way.

Preoperative breast volume evaluation of one-stage immediate breast reconstruction using three-dimensional surface imaging and a printed mold.

IntroductionThe oncoplastic conservative surgery was developed as a natural evolution of traditional surgery, attempting to improve the therapeutic and aesthetic outcomes where tumor resection could be followed by not-adequate results. Our primary aim is to evaluate how patient satisfaction and quality-of-life after conservative oncoplastic surgery, using BREAST-Q (BCT Module), change pre- and post-operatively. The secondary aim is to compare patient-reported outcome after oncoplastic or traditional conservative surgery.Patients and methodsWe enrolled 647 patients who underwent traditional conservative surgery or oncoplastic surgery from January 2020 to December 2022. Only 232 women (35.9%) completed the BREAST-Q questionnaire on a web-based platform, at the preoperative phase and 3 months after treatment.ResultsThe average score of “Psychosocial well-being” and “Satisfaction with Breasts” 3 months after surgery showed a statistically significant improvement, while the average score for “Physical well-being: Chest” at 3 months showed a worsening compared to the baseline. “Sexual well-being” did not show statistically significant change. A significant difference between the post-operative outcome of oncoplastic surgery and traditional surgery was observed only for Physical well-being (better for traditional surgery).ConclusionsThe study showed significant improvement in patient-reported outcomes 3 months after the surgery, except for physical discomfort that increases especially after oncoplastic surgery. Furthermore, our data, as well as many others, point to the appropriateness of using OCS where there is an effective indication, while the perspective of patients cannot find significant superiority over TCS in any of the areas analyzed.

In women with early-stage breast cancer, breast-conserving therapy (BCT) provides comparable survival to mastectomy. BCT has the advantage of preserving most of the breast, its skin envelope and the nipple-areola complex. However, deformity may result from the excision of significant amounts of breast tissue, as well as radiation therapy. Several studies have compared patients who underwent BCT to different patients who underwent mastectomy and reconstruction, and found superior aesthetic outcomes in the latter group. Our goal in this study was to compare the aesthetic outcomes in the same women who underwent BCT followed by mastectomy and reconstruction. Between 2007 and 2012, 42 women with a history of BCT developed cancer recurrence and underwent mastectomy and microsurgical breast reconstruction at our institution. Photographs before and after mastectomy and reconstruction were rated by a panel of nine judges (two independent plastic surgeons, three surgical oncologists, one radiation oncologist, one medical oncologist, and two medical students), using a validated scale Overall, patients received a significantly higher aesthetic score after mastectomy and reconstruction than after BCT. The greatest areas of aesthetic improvement were breast volume, contour, and projection. Patients whose lumpectomy was in the lower inner quadrant, those undergoing bilateral mastectomy and reconstruction and those completing all stages of their reconstruction had the greatest aesthetic improvement When advising patients with early-stage breast cancer, the superior aesthetic outcome of mastectomy and microsurgical reconstruction compared to BCT must be weighed against disadvantages such as loss of sensation, length of surgery, and donor-site morbidity.

INTRODUCTION: Breast cancer is the most frequent type of cancer among women, registering a relative percentage variation of more than 80% in just over two decades: The standardized mortality rate by age per 100, 000 women, increased from 5. 77 in 1979 to 9. 74 in 2000 (Ministry of Health, 2002). Considering the concept of oncoplastic surgery, mastectomy techniques using periareolar incision and preservation of the nipple-areola complex (NAC) have been carried out, increasing the degree of satisfaction of women affected by breast cancer. MATERIALS AND METHODS: It was studied 48 pieces of mastectomy for female patients, suffering from breast cancer, with a mean age of 52. 69 years ranging between 34 and 75 years who underwent surgery at Cancer Hospital of Paraiba - Napoleon Laureano Foundation. Inclusion criteria were diagnosis of breast cancer, mastectomy as surgical treatment employed, and NAC- free infiltration and other lesions diagnosed by clinical and radiological examination. Exclusion criteria were Paget s disease, status post-neoadjuvant chemotherapy, and macroscopic changes of neoplastic involvement of the NAC. Histological sections of the NAC were made at intervals of 2 mm from the distal portion of the nipple and extending to a depth of 2cm tissue retroareolar. The correlation of histological type with neoplastic involvement of the NAC was performed using multivariate discriminant analysis, where the samples were separated by dimensionless axes in two groups (with and without neoplastic invasion of NAC) and the minimum values ??were estimated for variable histologic type. RESULTS: Among the 48 samples studied, the neoplastic invasion of the NAC was present in 7 cases, with a frequency of 14.58%. Among the 7 patients with neoplastic invasion of the CAM, 6 were found in histologic type infiltrating ductal carcinoma associated with ductal carcinoma in situ (IDC + DCIS) (85. 7%) and 1 case of pure invasive ductal carcinoma (14. 3%). DISCUSSION: The combination of IDC with DCIS appears to be associated with neoplastic involvement of the NAC. The findings of this study corroborate Morimoto et al (1985), who evaluated 141 mastectomy specimens, relating the extension of tumor into the NAC with tumor size, histological type and tumor-nipple distance. They found invasion in 31% (44 cases) and it was observed that this invasion was more frequent when there was extensive intraductal component (82%). CONCLUSION: The association of IDC with DCIS showed a higher possibility of neoplastic involvement of the NAC, which is an important predictor of neoplastic invasion of NAC in patients with breast cancer.

The aim of this study was to compare the agreement between three different methods for evaluation of aesthetic outcome following breast-conserving surgery and adjuvant radiotherapy: a patient questionnaire, panel evaluation of photographs and the software BCCT.core. A further aim was to examine how these modalities predict health-related quality of life as measured by the validated Breast-Q™ questionnaire. At 1-year follow-up after breast-conserving surgery, patients completed a study-specific questionnaire. Postoperative photographs were evaluated using the software BCCT.core. A panel of three healthcare professionals assessed preoperative and postoperative photographs. Agreement between methods was assessed using Spearman's correlation coefficients (rs ). The Breast-Q™ questionnaire was sent to study participants. The ability of the different evaluation methods to predict Q-scores for the health-related quality-of-life (HRQoL) domains satisfaction with breasts and psychosocial well-being was investigated using receiver operating characteristic (ROC) curves. A total of 532 patients undergoing breast-conserving surgery were examined before surgery. At 1-year follow-up, 334 patients completed the study-specific questionnaire. Postoperative photographs from 310 patients were evaluated using BCCT.core. The panel of healthcare professionals assessed photographs from 215 patients. Agreement between the different evaluation modalities was poor. The strongest agreement was noted between the panel evaluation for symmetry and BCCT.core results (rs = 0·59, P < 0·001). The Breast-Q™ questionnaire was returned by 348 patients. Patient satisfaction ratings at 1-year follow-up best predicted long-term HRQoL measured using the Breast-Q score, both in terms of satisfaction with breasts (area under the curve (AUC) 0·80, P < 0·001) and psychosocial well-being (AUC 0·73, P < 0·001). There is currently no ideal method for evaluating aesthetic outcome after breast-conserving surgery and adjuvant radiotherapy. These results emphasize the use of patient-related outcome measures.

ObjectiveThis study aims to explore the application value of chest wall perforator flaps (CWPF) in oncoplastic breast-conserving surgery.MethodsA retrospective review was conducted on 22 early-stage breast cancer patients who underwent oncoplastic breast-conserving surgery using CWPF between January 2021 and December 2022. This included 4 cases (18.2%) utilizing lateral intercostal artery perforator (LICAP) flaps, 10 cases (45.4%) employing lateral thoracic artery perforator (LTAP) flaps, 4 cases (18.2%) combining LICAP and LTAP flaps, and 4 cases (18.2%) using anterior intercostal artery perforator (AICAP) flaps. The perforators used in this study included lateral thoracic artery perforators (LTAP), anterior intercostal artery perforators (AICAP), and lateral intercostal artery perforators (LICAP). In some cases, a combination of LICAP and LTAP was employed to ensure adequate blood supply. All flaps were supplied by dominant perforators, with some cases using multiple perforators to enhance flap perfusion and survival. Our single-center experience with CWPF, including surgical details, complications, aesthetic, and oncological outcomes, is reported.ResultsAmong all patients, tumors were located in the outer quadrant (68.2%), central quadrant (13.6%), and inner quadrant (18.2%) of the excision cavity. In the 22 patients, 15 tumors were located in the outer quadrant: 6 in the left upper outer quadrant (1–2 o’clock), 4 in the right upper outer quadrant (10–11 o’clock), and 5 in the outer quadrants (3 o’clock in 3 cases and 9 o’clock in 2 cases). Four tumors were in the lower inner quadrant: 2 in the left lower inner quadrant (7–8 o’clock) and 2 in the right lower inner quadrant (4–5 o’clock). Three tumors were in the central area extending toward the outer quadrant. All tumors were located more than 2 cm from the nipple-areola complex (NAC), and intraoperative frozen sections confirmed negative margins behind the NAC. All patients had negative surgical margins. The average operative time was 100.5 ± 10.2 min, with flap lengths ranging from 10 to 18 cm and widths from 4 to 10 cm. All flaps survived, with only one instance of surgical site infection, which improved with conservative treatment. Overall patient satisfaction was rated as excellent or good in 85.6%, and physician evaluation was 89.0% excellent or good. In addition to subjective patient and surgeon satisfaction surveys, objective aesthetic outcomes were evaluated using the BCCT.core software. This tool provided a standardized assessment of breast symmetry, contour, and cosmetic outcomes, enhancing the objectivity and reproducibility of the cosmetic evaluation in the study. The median follow-up period was 14.5 months, with one case of tumor recurrence and no patient mortality.ConclusionCWPF can be effectively used in small-to-medium volume, non-ptotic breasts for oncoplastic surgery, yielding high patient satisfaction. In the era of oncoplastic breast surgery, chest wall perforator flaps are a reliable and safe option for partial breast reconstruction with acceptable aesthetic results.