Seroma formation is a common postoperative complication of breast cancer surgery, leading to delayed wound healing, infection, patient discomfort, and repeated outpatient visits. In severe cases, it can cause skin flap necrosis, imposing physical, psychological, and financial burdens on patients. Applying compression bandaging to the patient's postoperative wound with a chest strap is an effective measure to prevent seroma formation. However, the commonly used elastic chest straps cannot provide specific compression values, limiting their use. Therefore, we aim to compare the efficacy of standard elastic chest straps versus controlled localised air-balloon compression chest straps in preventing seroma formation following breast cancer surgery. This is a superiority, single-blind randomised controlled trial conducted at a tertiary hospital in Guizhou Province, China, involving female breast cancer patients undergoing mastectomy. Eligible participants will be recruited by attending surgeons during routine preoperative consultations. Patients aged 18years or older diagnosed with unilateral breast cancer who meet the criteria for mastectomy (including modified radical mastectomy and/or simple mastectomy) and provide informed consent will be eligible for inclusion. Exclusion criteria include patients with severe concomitant diseases before surgery, those with chest deformities or trauma, those with chest strap allergies, and those with psychiatric disorders who are unable to cooperate. Sixty patients were randomly assigned to two groups (control group and intervention group) in a 1:1 ratio, without stratification. Patients in the control group received postoperative compression bandaging with standard elastic chest bandages. In contrast, those in the intervention group received postoperative compression bandaging with a controlled-pressure local air-balloon chest bandage, with pressure sensors measuring the air-balloon inflation level. The air-balloon inflation period lasted one week, with inflation values ranging from 4 to 8kPa. Both sets of chest straps were worn for one month. Safety measures to be collected include adverse events, postoperative complications (seroma, wound infection), and device-related skin reactions or discomfort. Primary outcomes included seroma incidence, postoperative drainage volume, and drainage tube retention time. Secondary outcomes encompassed quality of life, comfort, and satisfaction with the chest straps. Postoperative wound compression dressing is essential for promoting flap-to-chest wall adhesion, reducing cavities, preventing seroma formation, and facilitating wound healing. By applying the Controlled Local Air-Balloon Compression Chest Belt, we aim to reduce postoperative complications, improve postoperative comfort, and promote patient recovery. Chinese Clinical Trial Registry (ChiCTR), ChiCTR 2500105194. Date of first planned enrolment: February 2025. June 30, 2025 (Clinical Trial Registration Date, retrospectively registered). https://www.chictr.org.cn/showproj.html?proj=277304.

Over 75% of women who have post-mastectomy reconstruction feel significant pain right away, and about 50% endure chronic pain. Thus, increasing the efficiency of postoperative pain management is crucial. Our study investigated the effects of ultrasound-guided erector spinae plane blocks (ESPB) and rhomboid intercostal blocks (RIB) on perioperative fentanyl use and pain scores in patients undergoing radical mastectomy surgery. This was a double-blind, randomised controlled trial conducted at a tertiary care hospital. Patients with breast cancer aged 18-70 years and American Society of Anaesthesiologists status I-II who were scheduled for unilateral modified radical mastectomy were included. They were randomly assigned to two groups. ESPB was performed in the ESPB group, and RIB was performed in the RIB group, using ultrasound guidance. Total postoperative fentanyl usage in the first 24 hours was the primary outcome indicator of the study. Intraoperative fentanyl requirements and numerical rating scale (NRS) scores at seven distinct time points were used as secondary outcome measures. The difference between the mean of total postoperative fentanyl consumption in 24 hours in Group ESPB (2.67±0.68 μg kg-1) and Group RIB (3.68±1.22 μg kg-1) was statistically significant (t value: -4.183, df:66, P value: < 0.001). There was no difference in intraoperative opioid consumption between the groups (P=0.7). However, NRS scores were not significantly different between the ESPB group and the RIB group. Our study's outcome demonstrates ultrasound-guided ESPB to be more effective than RIB in terms of lower perioperative fentanyl consumption.

Since our 2015 manuscript, nipple-sparing mastectomy (NSM) has been increasingly adopted in breast cancer management, though concerns regarding long-term oncologic safety persist. We provide a 10-year update on oncologic outcomes following NSM, including overall survival (OS), disease-free survival (DFS), local recurrence (LR), and nipple-areolar complex recurrence (NACR). A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review identified studies reporting oncologic outcomes after NSM. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in the meta-analysis. Studies lacking comparison arms were included in pooled analyses for NSM outcomes using a random-effects model. Weighted averages and 95% confidence intervals (CI) were calculated, and studies were stratified by duration of follow-up. A total of 60 studies comprising 7752 NSM patients were included: 11 studies had comparison arms; 9 studies reporting OS demonstrated a significant pooled risk difference of 2.1% favoring NSM over MRM/SSM (95% CI 0.0-4.3%, p = 0.047); 7 studies reporting DFS showed a nonsignificant pooled risk difference of 4.8% favoring NSM (95% CI -0.8 to 10.3%, p = 0.093); 11 studies reporting LR demonstrated a nonsignificant pooled risk difference of -0.7% (95% CI -2.1 to 0.8%, p = 0.35). The systematic review included all 60 studies. Weighted average follow-up ranged from 25.6 to 133.4 months across groups. Among patients with 10 years of follow-up (n = 391), OS was 82.0% (80.9-93.2%), DFS 60.7% (58.8-62.7%), LR 15.1% (13.9-16.2%), and NACR 1.1% (1.0-1.1%). NSM is associated with excellent long-term survival and low recurrence rates comparable to SSM/MRM, with minimal NAC recurrence in appropriately selected patients, supporting its long-term oncologic safety.

Modified radical mastectomy (MRM) is frequently associated with moderate to severe postoperative pain, which may negatively affect recovery and quality of life. Regional anesthesia techniques such as the erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), and pectoral nerve block (PECS) have been increasingly used as part of multimodal analgesia strategies for breast surgery. However, their comparative effects on analgesic efficacy and quality of recovery remain unclear. The study included 90 female patients undergoing unilateral elective MRM. Patients were randomly allocated into three groups (n = 30 each) to receive ESPB, TPVB, or PECS block preoperatively with 0.25% bupivacaine. All patients subsequently underwent standardized general anesthesia. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 0, 1, 3, 6, 12, and 24h. The primary outcome was total morphine consumption at 24h. Secondary outcomes included time to first morphine request, incidence of rescue fentanyl use, postoperative nausea and vomiting, patient satisfaction, and scores. Demographic characteristics and operative durations were comparable among the groups (p > 0.05). Total 24-hour morphine consumption was significantly higher in the ESPB group (median 10mg) compared with TPVB (9mg, p = 0.009) and PECS (9mg, p = 0.018) groups. Kaplan-Meier analysis revealed that the time to first morphine request was significantly shorter in the ESPB group (p < 0.001), while TPVB provided the longest analgesic duration. No significant differences were found in postoperative pain scores, rescue opioid requirements, or nausea-vomiting incidence (p > 0.05). QoR-15 scores were significantly lower in the ESPB group compared with TPVB and PECS groups (p < 0.001). Both PECS and TPVB provided superior postoperative analgesia and better quality of recovery scores compared to ESPB in patients undergoing modified radical mastectomy. These findings support the use of PECS or TPVB as effective components of multimodal analgesia strategies for breast cancer surgery. ISRCTN Registry, ISRCTN17247698.

This study evaluated health-related quality of life (HRQoL), anxiety, and depression among Haitian women following modified radical mastectomy (MRM). This cross-sectional study included women who underwent MRM for breast cancer between 2018 and 2023. Clinical data were abstracted from medical records, and participants completed the multidimensional Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Hospital Anxiety and Depression Scale (HADS). FACT-B well-being subscales (physical, social, emotional, functional, and breast-specific) and total scores were summarized descriptively. Nonparametric tests and logistic regression were used to assess group differences and associations. The cohort included 85 women, with a median age 50 years (IQR, 43-58). Most were postmenopausal (83.5%), had locally advanced disease (65.9%), and were unemployed (77.7%). Nearly all received systemic chemotherapy (98.8%). The median FACT-B score was 111.5 (IQR, 97.2-122.7), reflecting favorable HRQoL. Younger women (<50 years) reported the lowest emotional well-being scores compared with women age 50-60 and >60 years (P = .002). There were significant differences in multiple subscales by type of systemic chemotherapy received including physical (P = .02), emotional (P = .007), and breast-specific scores (P = .04); women who received both neoadjuvant and adjuvant chemotherapy had lowest scores compared with those treated with neoadjuvant or adjuvant therapy alone. The median HADS-A score of 8 (IQR, 6-11) and HADS-D score of 13 (IQR, 12-15) correspond to mild anxiety and moderate depression. Women <50 years also had a higher prevalence of anxiety (P = .01). Overall HRQoL after MRM was favorable, but anxiety and moderate-to-severe depressive symptoms were widespread across the cohort. Younger women are particularly vulnerable and represent a priority population for integrated mental health support.

Erector spinae plane block (ESPB) versus modified pectoral plane block (PECS II) in managing post modified radical mastectomy pain: A systematic review and meta-analysis.

Male breast cancer (MBC) is an uncommon malignancy, accounting for <1% of all breast cancers and often presenting as a diagnostic challenge due to a lack of awareness and absence of screening in males. Invasive papillary carcinoma (IPC) is a rare subtype of MBC, constituting <3% of cases, typically showing strong hormone receptor positivity and better prognosis than other invasive subtypes. A 65-year-old male presented with a left breast lump for 15 years, with intermittent nonprogressive pain for 2 years. Clinical examination revealed a single, nonmobile, nontender mass measuring 2 cm × 1 cm in the upper inner quadrant of the left breast, with a normal nipple-areolar complex and no axillary lymphadenopathy. Ultrasonography showed a mixed solid-cystic lesion with internal vascularity and microcalcifications. FNAC indicated an atypical proliferative lesion/low-grade carcinoma. PET-CT confirmed a solitary FDG-avid lesion with no metastasis. ER and PR were strongly positive. Histopathology revealed Grade I IPC. The patient underwent a modified radical mastectomy with axillary lymph node dissection. Final staging: pT2N0M0 (AJCC 8th edition). This case underscores the need to evaluate persistent breast lumps in males, regardless of duration. IPC carries a favorable prognosis when diagnosed early, and timely histopathological evaluation, along with surgical management, leads to optimal outcomes in MBC.

This study investigated the relationship between preoperative serum vitamin D levels and acute postoperative pain scores in patients undergoing unilateral breast cancer surgery. The study was conducted at Fayoum University Hospital between September 2024 and April 2025. 184 American Society of Anesthesiologists (ASA) II-III female patients scheduled to undergo elective unilateral modified radical mastectomy were classified into two groups: 92 vitamin D-deficient (<30 nmol/L) and 92 vitamin D-sufficient (≥30 nmol/L). The primary outcome was the occurrence of moderate to severe postoperative pain (Numerical Rating Scale (NRS) >3) at 12 hours. A secondary 24-hour composite outcome (NRS >3 at any time within the first 24 hours) was used for the multivariable logistic regression. Other secondary outcomes included: preoperative serum 25(OH)D level, postoperative NRS, intraoperative fentanyl consumption, postoperative tramadol consumption, sedation scores, intraoperative and postoperative hemodynamics, patient satisfaction, and hospital stay. The baseline characteristics were well balanced between the groups, with small standardized mean differences for all variables. Patients with vitamin D deficiency had a higher occurrence of moderate to severe pain at 12 hours. In multivariable analysis, vitamin D deficiency was independently associated with moderate to severe postoperative pain at any time point during the first 24 hours (adjusted OR 3.12, 95% CI 1.58 to 6.13). Vitamin D-deficient patients had higher intraoperative fentanyl consumption (mean difference 8.04 µg, 95% CI 3.21 to 12.88) and postoperative tramadol consumption (mean difference 112.17 mg, 95% CI 101.44 to 122.91). Vitamin D deficiency is associated with a higher occurrence of moderate to severe postoperative pain and increased opioid consumption in patients undergoing unilateral modified radical mastectomy.

Background/Objectives: The main objective of the study was to determine the frequency of patients who underwent breast-conserving surgery (BCS) and those with modified radical mastectomy and to compare the clinical–paraclinical parameters between these groups. Methods: We conducted an observational, retrospective study, which included 101 patients diagnosed with breast cancer that had surgical interventions between January 2024 and April 2025. Results: The BCS category was represented by 36.6% cases, while 63.4% were in the mastectomy subgroup. Hemoglobin at the time of admission had an average of 13 g/dL, the difference between the two categories of patients being statistically significant. (13.7 vs. 12.7, p = 0.010). Conclusions: Although it has been a hotly debated topic in recent years, the choice of surgical technique for breast tumors still presents novelties and remains a subject of interest within surgical specialties. Selection criteria such as disease stage, histopathological subtype, and the intervention chosen by the surgeon may vary and oncological results may be comparable.

Modified radical mastectomy is a widely used operative method for patients with breast cancer. Although it can significantly improve the survival rate, it can also lead to various adverse reactions, such as the loss of sexual characteristics, skin damage, and hair loss, which in turn can cause body image disorders and social avoidance among postoperative patients. Exercise therapy and cognitive behavior therapy are frequently employed as rehabilitation treatments to increase the mental well-being and stress coping styles of patients with breast cancer. However, no studies have directly explored the impact of exercise therapy and cognitive behavior therapy on the body image and social distance of patients with breast cancer. This is a three-arm randomized controlled trial. A total of 60 patients who underwent modified radical mastectomy for breast cancer will be recruited and divided into three groups: the exercise therapy group, the cognitive behavior therapy group, and the combined treatment group. The intervention will be delivered in a hybrid mode combining online and offline sessions. All participants will receive a 60-min intervention twice a week for 8weeks. The primary outcomes are the Body Image Scale and the Social distancing test, which will be conducted before and after the intervention, as well as at the 3-month follow-up. This study aims to evaluate a rehabilitation program combining digital exercise therapy and cognitive behavioral therapy for postoperative breast cancer patients, focusing on improving body-image disturbances and abnormal social-distance adjustment following modified radical mastectomy. The intervention is expected to help patients return to family and society in a positive and confident state, achieving psychophysiological-social rehabilitation. The use of digital remote intervention in research can not only ensure the security of patients' personal information but also reduce the time and money spent on commuting and seeing doctors, providing new ideas for clinical treatment. This trial was registered with Chinese Clinical Trial Registry (ChiCTR2400084427) on May 16, 2024.

One of the most popular procedures for breast cancer is modified radical mastectomy (MRM), which is associated with severe postoperative pain. The rhomboid intercostal subserratus (RISS) plane block, a recently developed procedure, is used to treat postoperative pain after MRM. The aim of this study was to compare the analgesic effectiveness of RISS block with erector spinae plane (ESP) block in terms of 24-hour opioid consumption in patients following MRM. In this randomised control study, we enroled 40 American Society of Anesthesiologists (ASA) physical status I-II patients aged 18-65 years who were posted for MRM surgery. The patients were allocated into two groups: Group I: ESP block with 20 ml of 0.25% bupivacaine; Group II: RISS block with 40 ml of 0.25% bupivacaine. Total postoperative fentanyl consumption over 24 hours was the primary outcome. Intraoperative fentanyl requirement, first rescue analgesic administration time, numerical rating scale (NRS) score at 24 hours postoperatively at different time intervals, and patient satisfaction score were the secondary outcomes. The fentanyl requirement in the 24 hours postoperatively for the ESP group was 79.50 ± 35.46 μg, compared to 80.50 ± 39.79 μg for the RISS group. No significant difference was found between the groups (P = 0.88). Similarly, intraoperative fentanyl requirement did not differ significantly (P = 0.11). The first rescue analgesia time did not show a statistically significant difference between the groups (P = 0.25). Additionally, there were no significant differences (P > 0.05) between the groups in the NRS scores measured at various time intervals. The RISS block can be used as an alternative to the ESP block in patients scheduled for a MRM.

BackgroundBreast cancer is a major global health concern with increasing incidence and mortality, particularly in low- and middle-income countries such as Bangladesh. Cystatin SN (CST1) has emerged as a potential oncogenic biomarker; however, its expression and clinical relevance remain underexplored in Bangladeshi populations. This study aimed to evaluate CST1 expression in tumor and adjacent normal breast tissues and to assess its association with the clinical characteristics of breast cancer patients.MethodsA hospital-based cross-sectional study was conducted at Dhaka Medical College, Bangladesh, from January 2023 to June 2023. A total of 34 adult female patients (aged 25-70 years) with histologically confirmed, treatment-naïve breast cancer were recruited via purposive sampling. Paired tumor and adjacent normal tissue samples were collected following a modified radical mastectomy. CST1 gene expression was measured via next-generation sequencing. The data were analyzed via SPSS version 26 (IBM Corp., Armonk, NY, USA). The Wilcoxon signed-rank test was used to compare gene expression between paired samples, and Spearman's correlation coefficient was applied to assess associations with clinical variables.ResultsThe mean age of the participants was 47.41 ± 12.19 years. CST1 gene expression was significantly greater in tumor tissue than in adjacent normal tissue (median -0.068 vs -1.988, p = 0.035). A statistically significant positive association was observed between CST1 expression and a family history of breast cancer (rho = 0.267, p = 0.027). In contrast, CST1 expression was significantly negatively associated with contraceptive use (rho = -0.437, p < 0.001) and weakly negatively associated with breastfeeding history (rho = -0.240, p = 0.049). No significant associations were observed between CST1 expression and age, body mass index, parity, or age at menarche.ConclusionCST1 gene expression is significantly elevated in tumor tissue and is associated with selected clinical factors, suggesting its potential relevance as a molecular marker in breast cancer. Further large-scale and longitudinal studies are needed to establish its clinical and prognostic significance.

Fascial plane blocks have emerged as a promising element for multimodal analgesia in breast surgeries. This study aimed to compare intra-operative and post-operative opioid requirements following costotransverse block (CTB) and erector spinae plane block (ESPB) for perioperative analgesia in patients scheduled for modified radical mastectomy (MRM). Sixty patients aged 25 to 65 years scheduled for MRM were randomised to receive either CTB or ESPB with 25 ml of 0.5% bupivacaine. The primary outcome was to compare the effectiveness of these two blocks in reducing the consumption of opioids for post-operative pain relief, measured by 24-hour morphine requirement. Secondary outcomes included time required to perform the block, intra-operative haemodynamics, total intra-operative fentanyl requirement, post-operative nausea and vomiting (PONV), and any complications related to the blocks. The numeric rating scale scores were comparable between the groups at all time points during the 24-hour post-operative period. The rescue analgesic requirement (morphine), median (interquartile range) was similar in the CTB group (3 [3, 3] mg) and in the ESPB group (3 [3, 3.75] mg) (P = 1.00). The intra-operative fentanyl requirement median (interquartile range) was significantly higher in the ESPB group, 100 (100, 150) μg, than in the CTB group, 100 (100, 100) μg (P = 0.006). Incidence of PONV was comparable between the groups. Both CTB and ESPB are comparable in providing post-operative analgesia for MRM patients. However, CTB likely offers better intra-operative analgesia as observed by the lower intra-operative opioid requirement.

To investigate the best combination of parameters by changing the collimator and increment in the volumetric modulated arc therapy after modified radical mastectomy for breast cancer. Ten patients with left breast cancer and ten patients with right breast cancer who underwent modified radical mastectomy were selected in our research cohort. Treatment plans were established utilizing the 3-arc beam configuration spanning 240 degrees. The collimator angle was systematically adjusted in increments of 10 degrees, ranging from - 90 to 90 degrees. Additionally, increment values of 10, 20, 30, and 40 were employed for each corresponding collimator angle. All other planning parameters remained constant across the plans. Finally the impact of different values was analyzed in terms of plan quality and execution efficiency. Regarding the dose distribution within the target and the ipsilateral lung, the optimal collimator angles were observed to range from - 60 to 30 degrees for the left breast and from - 30 to 60 degrees for the right breast. As for the increment value, 10 yielded the optimal outcome, 40 resulted in the least desirable outcome, and 20 and 30 demonstrated a balanced effect between 10 and 40. In terms of execution efficiency and treatment complexity, the impact of the collimator angle on the results exhibits symmetric distribution, and the most favorable collimator angle approaches 0 degrees. Additionally, with a gradual increase in the collimator angle, the execution efficiency diminishes while the complexity correspondingly increases. In the context of treatment planning following modified radical mastectomy for left and right breast cancer, optimal collimator angles fall within the ± 30-degree range, while increment values of 20 and 30 degrees yielded the best overall outcomes, ensuring the attainment of the prescribed dose while accounting for execution efficiency and treatment complexity.

This study aims to compare the analgesic efficacy and procedural efficiency of pectoral (PECS II) blocks performed using artificial intelligence (AI)-integrated ultrasonography (USG) versus conventional USG in patients undergoing modified radical mastectomy (MRM). Between November 2021 and March 2023, a total of 70 female patients scheduled for unilateral MRM under general anesthesia were included in this randomized study. The patients were randomly allocated into two groups: USG group (n = 35) and AI-USG group (n = 35). A fourth-year anesthesiology resident performed the PECS II blocks under the supervision of a senior anesthesiologist. The primary outcome was the postoperative pain score as assessed by Visual Analog Scale (VAS) at 12 hours. Secondary outcomes included pain scores at other postoperative time points, total opioid consumption, time first to rescue analgesia request within 24 hours, and the resident's skill development at the end of the study. The mean age was 55.3±11.4 (range, 35 to 75) years. Intraoperative remifentanil consumption was higher in USG group than in AI-USG group; however, the difference was not statistically significant (p > 0.05). The durations of anesthesia and surgery were shorter in AI-USG group (p = 0.005 and p = 0.008, respectively). A comparison of local anesthetic injection times between the first 35 and the last 35 patients revealed a statistically significant decrease in the USG group (4.0 min vs. 3.0 min, p = 0.014). The VAS pain scores in the post-anesthesia care unit were initially higher in the AI-USG group (p = 0.05); however, at 12 and 24 postoperative hours, VAS scores were significantly lower than those in the USG group (p = 0.005 and p < 0.001, respectively). There was no significant difference in total tramadol consumption via PCA during the first 24 hours postoperatively (p > 0.05). Surgeon satisfaction scores were lower in the AI-USG group (p = 0.037). Our study results suggest that AI-enhanced USG guidance is associated with improved analgesic outcomes and may offer clinical and educational advantages in the performance of PECS II blocks, particularly for residents in training. The integration of AI into routine USG-guided regional anesthesia practice holds promise for improving procedural consistency and supporting novice practitioners.

IntroductionBreast cancer (BC) is common in young women in India, with 68.8% of cases occurring under 50 years. Key factors regularly evaluated to predict the prognosis and treatment response include tumor size, lymph node, ER, PR, HER2 status, tumor grade, and age. The molecular subtypes Luminal A, Luminal B, HER2- over expressed and triple negative breast cancers carry different treatment plan and prognosis. Regardless of surgical strategy, margin status of the resection specimen remains one of the most important factors of recurrence.ObjectiveThis study investigated the association between molecular subtypes and surgical margin status, as well as other prognostic parameters, in women from North Eastern India, where triple negative breast cancer (TNBC) subtype and poor 5-year survival rates are prevalent.MethodologyThis cross-sectional study was conducted at a tertiary care centre in Upper Assam, North East India, from October 2019 to March 2025. BC cases that underwent breast conservative surgery (lumpectomy) or modified radical mastectomy (MRM) and fulfilled the inclusion criteria were included. Tumors were classified into molecular subtypes by immunohistochemistry. Surgical margin status was assessed by histopathological examination, with margins considered positive if neoplastic cells were present at the inked margin. Prognostic parameters with surgical margin status were analyzed using Pearson’s Chi-square test and Fisher’s exact test.ResultsA total of 155 breast cancer cases were included in the study with average age of 47 years. The distribution of molecular subtypes was: TNBC (36.77%), Luminal A (29.67%), Luminal B (18.06%), and HER2-enriched (15%). Histologic grade III tumors were predominant (58.70%). Total positive margin was 34.83% cases. Positive surgical margins were associated with HER2-enriched subtype (p < 0.05) and grade I tumors. Lymph node involvement was 77%, with stage 2 and 3 accounting for 80.64% of cases.ConclusionOur study highlights the high prevalence of TNBC and the significant association between positive tumor margins and HER2-enriched subtype. The findings emphasize the need for tailored treatment strategies to improve outcomes in this population.

Radiotherapy for right-sided modified radical mastectomy (MRM) patients carries a risk of secondary malignancies due to radiation exposure to nearby organs-at-risk (OARs). Techniques such as 3D-CRT, IMRT (sliding window), and VMAT differ in their dose distribution to these OARs. This retrospective study analyzed dose-volume histograms from 25 female patients with right-sided MRM to compare the three techniques in terms of dosimetric parameters, radiobiological outcomes, and secondary cancer risks. Mean doses to key OARs-the heart, contralateral lung, ipsilateral lung, and contralateral breast-were evaluated, and NTCP calculations were used to quantify radiation-induced secondary malignancy risks. 3D-CRT delivered lower mean doses to contralateral OARs, reducing secondary cancer risks compared to IMRT and VMAT, but was associated with higher NTCP in the ipsilateral lung. VMAT achieved superior target conformity but increased low-dose exposure to contralateral OARs, raising secondary cancer risks. These findings highlight the importance of individualized treatment planning for right-sided MRM patients. Overall, 3D-CRT appears favorable for minimizing secondary cancer risks in contralateral organs, despite higher ipsilateral lung NTCP. This study provides a framework for integrating dosimetric, radiobiological, and secondary cancer risk assessments in radiotherapy planning, supporting future strategies to optimize both efficacy and safety.

Objective: To evaluate the efficacy of intravenous analgesia versus intraoperative pectoral nerve block (PECs block) for postoperative pain management in patients having modified radical mastectomy (MRM). Methods: This randomized controlled trial was conducted at Akbar Niazi Teaching Hospital, Islamabad, from July to December 2025 (NCT07257874). PECs block (Group A, n=30) and intravenous analgesia (Group B, n=30) were the two groups into which 60 adult female patients (18–65 years) undergoing elective unilateral MRM were randomly assigned. Ten milliliters of 0.5% bupivacaine split between two fascial planes were used to administer PECs block. The Numeric Pain Rating Scale (NPRS) was used to measure postoperative pain intensity at 0, 6, 12, and 24 hours. Postoperative nausea and vomiting (PONV), time to first rescue analgesia, total opioid consumption within 24 hours, and patient satisfaction were secondary outcomes. Results: At every time point, Group A—NPRS scores were significantly lower than Group B (0 h: 2.1±0.8 vs. 3.4±1.1; 6 h: 2.6±0.9 vs. 4.1±1.2; 12 h: 2.9±0.8 vs. 4.0±1.0; 24 h: 2.4±0.7 vs. 3.5±0.9; p&lt;0.001). Group B consumed more opioids overall (28.7±6.2 mg) than Group A (mean 18.3±4.5 mg; p&lt;0.001). The PECs group experienced a significantly longer time to first rescue analgesia (412±85 minutes vs. 263±74 minutes; p&lt;0.001). PONV incidence was reduced in Group A (10%) versus Group B (33%). No block-related complications were observed. Group A had higher patient satisfaction scores (p&lt;0.01). Conclusion: When compared to intravenous analgesia alone, PECs block improves recovery profiles, reduces the need for opioids, and offers better postoperative analgesia in MRM patients. It ought to be incorporated into standard perioperative pain management techniques.

Analysis of alexithymia and resilience levels in young breast cancer patients following modified radical mastectomy

Quilting sutures versus conventional closure after modified radical mastectomy with axillary dissection: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials with pre-specified subgroups by quilting extent.