Small Breast Research Articles

Breast hypoplasia markers among women who report insufficient milk production: A retrospective online survey.

To estimate the proportions of anatomical breast characteristics suggestive of breast hypoplasia among breastfeeding women self-reporting low milk supply. We also explored breast hypoplasia risk factors. Online survey conducted between October 2021 and January 2022. Five low milk supply Facebook groups. 487 women reporting low milk supply with their first child born ≥ 37 weeks gestation within 5 years of participation in this study, and residing in the USA, Australia or the UK. We present data on the primary outcome ('breast type') for 399 women. Women were excluded if the dyad was separated for more than 24 hours during the hospital stay, or if the mother reported removing milk less than 6 times per day from each breast on most days before being aware of having insufficient milk production. The proportions of proposed breast hypoplasia markers including atypical breast type, widely spaced breasts, breast asymmetry, stretch marks on the breast and lack of pregnancy breast growth. We also estimated the odds of having breast hypoplasia markers in at-risk groups compared to reference groups, adjusting for covariates. Approximately 68% reported at least one atypical breast (270/399; 95% CI: 62.9%, 72.1%). Around 47% reported widely spaced breasts (212/449; 95% CI: 42.7%, 52.7%), 72% a lack of pregnancy breast growth (322/449; 95% CI: 68.3%, 77.4%), and 76% stretch marks on the breast (191/250; 95% CI: 70.7%, 81.3%). Multiple logistic regression analyses identified being overweight during pubertal years as a risk factor for atypical breast type and lack of pregnancy breast growth. Participants in low milk supply Facebook groups reported high rates of breast hypoplasia markers. Being overweight during adolescence was a risk factor for breast hypoplasia markers. These findings should be confirmed in well-conducted large cohort studies to determine the strongest combination of hypoplasia markers in predicting low supply.

Synchronous double primary small cell lung cancer and invasive ductal breast carcinoma: a case report

BackgroundAlthough lung and breast cancers are common malignancies, the occurrence of primary synchronous neoplasms involving these organs has been rarely reported in literature.Case presentationA 75-year-old female patient presented at a local hospital with a ten-day history of dizziness and slurred speech. A CT contrast-enhanced scan revealed a 4.2 cm mass in the lower lobe of the right lung and a 3.8 cm space-occupying lesion in the right breast. Subsequent breast ultrasound identified a hypoechoic lesion measuring5.41 × 4.75 × 3.06 cm in the right breast, and an ultrasound-guided biopsy confirmed the presence of infiltrating ductal carcinoma of the right breast. The immunohistochemistry analysis of the breast mass revealed positive staining for ER, PR, HER-2, AR and Ki67 in the tumor cells, while negative staining was observed for P63, Calponin, CK5/6 and CK14. MR imaging of the head detected abnormal signals in the right frontal lobe (3.6 cm×2.9 cm in size), left cerebellar hemisphere, and punctate enhancement in the left temporal lobe, indicating potential metastasis. Pathological examination of a lung biopsy specimen confirmed the presence of small cell lung cancer (SCLC). Furthermore, immunohistochemistry analysis of the lung lesions demonstrated positive staining for TTF-1, CK-Pan, Syn, CgA, CD56, P53 (90%) and Ki67 (70%), and negative staining for NapsinA and P40 in the tumor cells. The patient’s diagnosis of SCLC with stage cT2bN0M1c IVB and brain metastases (BM), as well as invasive ductal breast carcinoma (IDC), was confirmed based on the aforementioned results. Whereupon we proposed a treatment plan consisting of whole-brain radiation (40 Gy/20fractions), focal radiotherapy (60 Gy/20fractions), and adjuvant concurrent chemotherapy with oral etoposide (50 mg on days 1 to 20).ConclusionsTo the best of our knowledge, the present case is the first of its kind to describe the synchronous double cancer, consisting of primary SCLC and IDC.

The occurrence of myopathies and meat abnormalities in modern broiler farming

Over the past few decades, there has been a significant increase in the production and consumption of poultry meat due to its high-quality nutritional profile, relatively low production costs, and ease of meat processing. This growing demand has led to progressive improvements in genetic selection for fast-growing broilers, triggering several spontaneous idiopathic muscle abnormalities along with an increased susceptibility to stress-induced myopathy. These muscle abnormalities have a negative impact on the quality of both fresh and processed chicken meat, primarily affecting the large breast muscle (m. pectoralis major) of broilers, which is also the most valuable part of the carcass. Frequent meat abnormalities include the occurrence of pale, soft, and exudative meat, primarily characterized by reduced water-holding capacity, while Deep Pectoral Myopathy results in a change in colour and a significant reduction in the attractive appearance of the small breast muscle (m. pectoralis minor). Myopathies labelled as "White Striping" are characterized by superficial white stripes, "Wooden Breast" is marked by pale and bulging areas of significant hardness, while "Spaghetti Meat" is described by the separation of muscle fibres resembling spaghetti pasta. These mentioned abnormalities and myopathies negatively impact the economic aspect of the poultry industry during the removal of affected parts and, furthermore, reduce the qualitative and nutritional value of the meat, posing challenges during technological processes. This paper describes recent findings on the occurrence, characteristics, and prevalence of the most common myopathies affecting modern broiler farming.

(353) Gender-Specific Variations in Perception of Normal Genital Anatomy and Function

Abstract Introduction Understanding perceptions of “normal” genitalia and function can explain and predict trends in cosmetic and sexual health treatments. Previous studies reported male preferences for female genitalia appearance, but female opinion remains understudied. Objective We aimed to assess gender-specific variations in perceptions of “normal” genital anatomy and function. Methods A 54-item survey was developed using RedCap and distributed to volunteers aged ≥18 years through the ResearchMatch database from January to March 2023. We collected data on public perceptions of "normal" genital anatomy and function and sexual activity. Analysis was performed using JMP Pro 16. Results 649 participants initiated and 558 completed the survey (86% completion rate). 27.9% of respondents identified as male and 72.1% as female (Table 1). Compared to men, women believed men had larger testicles (24.5% vs. 10.3% believed one testicle was 60.1-90 mL, p<0.01), smaller breasts (45.5% vs. 35.9% felt “none” was normal, p<0.04), and shorter orgasms (55.0% vs. 44.9% felt orgasms lasted 2.6-5.0 seconds, p=0.03) (Table 2). 73.0% women vs. 56.4% men felt labia were darker than surrounding skin (p=0.01). More men than women felt the average woman required no supplementary vaginal lubrication (p=0.02) and that female orgasms lasted longer (12.2% vs. 5.7% believed orgasms lasted >12.5 seconds, p<0.01). Fewer men than women considered their genitals normal (75.0% vs. 89.4%, p<0.01). Conclusions Our results reveal gender-specific variations in perceptions of “normal” genital anatomy and function. Variations in perceived female sexual function were striking, with more men than women expecting spontaneous vaginal lubrication during sexual encounters and longer female orgasms. These differences have important implications for counseling patients on sexual health. Disclosure No.

Adipose perforator flaps without skin donor site: “in between” single scar approach for reconstruction of small peripheral breast defects after lumpectomy

In breast conserving surgery, the reconstruction of defects in small breasts where volume displacement techniques are not feasible can be challenging. In contrast, patients with bigger breasts may not wish to undergo major breast remodeling surgery or breast symmetrization procedures. In such cases, volume replacement techniques can be beneficial, but these leave additional scars and are time consuming.The authors propose an “in between” single scar approach to perform both lumpectomy and reconstruction of small peripheral breast tumors. This approach reduces morbidity and operating time compared with standard volume replacement techniques. The tumors are resected from below, guided by wire, using an incision in the lateral breast crease or inframammary fold, depending on their location. The same incision is used to raise an adipose or adipofascial flap based on perimammary perforators, lateral thoracic artery perforator flap (LTAP), lateral intercostal artery perforator flap (LICAP), or anterior intercostal artery perforator flaps (AICAP) flaps, without skin donor site. Between March and November 2022, eight patients underwent this procedure. In four cases LICAP flap was used; in three—AICAP flap was chosen; and in one—LTAP perforator flap was used. Clear surgical margins were achieved in all cases. The average follow-up time was 9.9 months, during which no local recurrences were detected. All flaps survived. Two patients experienced seromas at the donor site, and an organized hematoma was also reported. This approach represents a viable alternative to volume displacement techniques or no reconstruction for small peripheral lumpectomy defects.

A retrospective comparison between large ptotic versus small non ptotic breasts in nipple-sparing mastectomy and immediate prepectoral breast reconstruction.

A retrospective comparison between large ptotic versus small non ptotic breasts in nipple-sparing mastectomy and immediate prepectoral breast reconstruction.

Cryoablation for the treatment of breast cancer: immunological implications and future perspectives.Utopia or reality?

Cryoablation is a minimally invasive technique currently employed in breast cancer care, that uses freeze and thaw cycles to treat benign breast lesions, small breast cancers or focal sites of metastatic disease in patients not eligible for surgery. The final goal of this procedure is to destroy breast cancer cells using extreme cold. In addition, several studies have shown that this technique seems to have an enhancing effect on the immune response, especially by increasing the expression of tumor neoantigens specific to tumor cells, which are then attacked and destroyed. Exploiting this effect, cryoablation in combination with immunotherapy could be the key to treating early-stage breast cancers or patients who are unsuitable for surgery. According to some recent studies, there are other potential tools that could be used to enhance the therapeutic effect of cryoablation, such as FE3O4 nanoparticles or the manipulation of aquaporin expression. The aim of this narrative review is to summarize the current evidence regarding the use, indications, advantages and disadvantages of cryoablation in the treatment of breast cancer.

A Model Combining Conventional Ultrasound Characteristics, Strain Elastography and Clinicopathological Features to Predict Ki-67 Expression in Small Breast Cancer.

To establish a predictive model incorporating conventional ultrasound, strain elastography and clinicopathological features for Ki-67 expression in small breast cancer (SBC) which defined as maximum diameter less than2 cm. In this retrospective study, 165 SBC patients from our hospital were allocated to a high Ki-67 group (n = 104) and a low Ki-67 group (n = 61). Multivariate regression analysis was performed to identify independent indicators for developing predictive models. The area under the receiver operating characteristic (AUC) curve was also determined to establish the diagnostic performance of different predictive models. The corresponding sensitivities and specificities of different models at the cutoff value were compared. Conventional ultrasound parameters (spiculated margin, absence of posterior shadowing and Adler grade 2-3), strain elastic scores and clinicopathological information (HER2 positive) were significantly correlated with high expression of Ki-67 in SBC (all p < .05). Model 2, which incorporated conventional ultrasound features and strain elastic scores, yielded good diagnostic performance (AUC = 0.774) with better sensitivity than model 1, which only incorporated ultrasound characteristics (78.85%vs. 55.77%, p = .000), with specificities of 77.05% and 62.30% (p = .035), respectively. Model 3, which incorporated conventional ultrasound, strain elastography and clinicopathological features, yielded better performance (AUC = 0.853) than model 1 (AUC = 0.694) and model 2 (AUC = 0.774), and the specificity was higher than model 1 (86.89% vs. 77.05%, p = .001). The predictive model combining conventional ultrasound, strain elastic scores and clinicopathological features could improve the predictive performance of Ki-67 expression in SBC.

The Impact of Tuberous Breast on Adolescents: A Cross-sectional Study.

Tuberous breast deformity is a nondiagnostic, descriptive term for a congenital breast difference that becomes apparent at puberty. Although the negative physical and psychosocial effects of macromastia and breast asymmetry are established, no studies to date have explored the impact of tuberous breasts on health-related quality of life (HRQoL) outcomes using a robust sample size. In this cross-sectional study, HRQoL surveys were administered to adolescent women with tuberous breasts and healthy female controls, aged 12-21 years. Surveys included the Short-Form 36v2, Rosenberg Self-Esteem Scale, and Eating Attitudes Test-26. Demographics were compared, and linear regressions were fit to determine the effect of tuberous breast deformity on survey scores, with body mass index (BMI) category as a covariate. Thirty-four patients with tuberous breasts and 264 controls participated. Patients with tuberous breasts had higher mean BMI than controls (P < 0.05). After adjusting for differences in BMI category, patients with tuberous breasts scored lower than controls on the Rosenberg Self-Esteem Scale and in Short-Form 36v2 domains related to physical and psychological health (P < 0.05, all). Compared with controls, patients with tuberous breasts had a higher mean score on the Eating Attitudes Test-26 (P < 0.05). Tuberous breast deformity may negatively impact patients' physical and psychosocial HRQoL and increase their risk for disordered eating and higher BMIs. It is imperative that healthcare providers and third-party payors understand tuberous breast deformity is not just a cosmetic issue and tailor care and coverage policies accordingly.

Multiscale Monte Carlo simulations for dosimetry in x-ray breast imaging: Part I - Macroscopic scales.

X-ray breast imaging modalities are commonly employed for breast cancer detection, from screening programs to diagnosis. Thus, dosimetry studies are important for quality control and risk estimation since ionizing radiation is used. To perform multiscale dosimetry assessments for different breast imaging modalities and for a variety of breast sizes and compositions. The first part of our study is focused on macroscopic scales (down to millimeters). Nine anthropomorphic breast phantoms with a voxel resolution of 0.5mm were computationally generated using the BreastPhantom software, representing three breast sizes with three distinct values of volume glandular fraction (VGF) for each size. Four breast imaging modalities were studied: digital mammography (DM), contrast-enhanced digital mammography (CEDM), digital breast tomosynthesis (DBT) and dedicated breast computed tomography (BCT). Additionally, the impact of tissue elemental compositions from two databases were compared. Monte Carlo (MC) simulations were performed with the MC-GPU code to obtain the 3D glandular dose distribution (GDD) for each case considered with the mean glandular dose (MGD) fixed at 4mGy (to facilitate comparisons). The GDD within the breast is more uniform for CEDM and BCT compared to DM and DBT. For large breasts and high VGF, the ratio between the minimum/maximum glandular dose to MGD is 0.12/4.02 for DM and 0.46/1.77 for BCT; the corresponding results for a small breast and low VGF are 0.35/1.98 (DM) and 0.63/1.42 (BCT). The elemental compositions of skin, adipose and glandular tissue have a considerable impact on the MGD, with variations up to 30% compared to the baseline. The inclusion of tissues other than glandular and adipose within the breast has a minor impact on MGD, with differences below 2%. Variations in the final compressed breast thickness alter the shape of the GDD, with a higher compression resulting in a more uniformGDD. For a constant MGD, the GDD varies with imaging modality and breast compression. Elemental tissue compositions are an important factor for obtaining MGD values, being a source of systematic uncertainties in MC simulations and, consequently, in breastdosimetry.

Two-Day Fraction Gamma Knife Radiosurgery for Large Brain Metastasis.

We investigated how treating large brain metastasis (LBM) using 2-day fraction Gamma Knife radiosurgery (GKRS) affects tumor control and patient survival. A prescription dose of 10.3 Gy was applied for 2 consecutive days, with a biologically effective dose equivalent to a tumor single-fraction dose of 16.05 Gy and a brain single-fraction dose of 15.12 Gy. Between November 2017 and December 2021, 42 patients (mean age, 68.3 years; range, 50-84 years; male, 29 [69.1%]; female, 13 [30.9%]) with 44 tumors underwent 2-day fraction GKRS to treat large volume brain metastasis. The main cancer types were non-small cell lung cancer (n=16), small cell lung cancer (n=7), colorectal cancer (n=7), breast cancer (n=3), gastric cancer (n=2), and other cancers (n=7). Twenty-one patients (50.0%) had a single LBM, 19 (46.3%) had a single LBM and other metastases, and two had two (4.7%) large brain metastases. At the time of the 2-day fraction GKRS, the tumors had a mean volume of 23.1 mL (range, 12.5-67.4). On each day, radiation was administered at a dose of 10.3 Gy, mainly using a 50% isodose-line. We obtained clinical and magnetic resonance imaging follow-up data for 34 patients (81%) with 35 tumors, who had undergone 2-day fraction GKRS. These patients did not experience acute or late radiation-induced complications during follow-up. The median and mean progression-free survival (PFS) periods were 188 and 194 days, respectively. The local control rates at 6, 9, and 12 months were 77%, 40%, and 34%, respectively. The prognostic factors related to PFS were prior radiotherapy (p=0.019) and lung cancer origin (p=0.041). Other factors such as tumor volumes, each isodose volumes, and peri-GKRS systemic treatment were not significantly related to PFS. The overall survival period of the 44 patients following repeat stereotactic radiosurgery (SRS) ranged from 15-878 days (median, 263±38 days; mean, 174±43 days) after the 2-day fraction GKRS. Eight patients (18.2%) were still alive. Considering the unsatisfactory tumor control, a higher prescription dose should be needed in this procedure as a salvage management. Moreover, in the treatment for LBM with fractionated SRS, using different isodoses and prescription doses at the treatment planning for LBMs should be important. However, this report might be a basic reference with the same fraction number and prescription dose in the treatment for LBMs with frame-based SRS.

Ultrasound computed tomography image reconstruction with multi-mode aperture matching of ring array

Ultrasound computed tomography (USCT) imaging with a ring array holds significant potential for the inspection of small animals, breast tissue, and industrial components. Despite its promise, current techniques face challenges in terms of image quality. This paper presents a multi-mode aperture matching method for USCT image reconstruction with a ring array, aiming to enhance imaging performance. The proposed method utilizes a full ring transducer to transmit signals with a designated sub-aperture, while the receiving sub-aperture is adjusted based on the reference center element. By altering the transmitting and receiving sub-apertures under different conditions, specific imaging effects can be achieved. Experimental validation was conducted using a hair strand of 0.03 mm diameter placed at both center and eccentric positions within the ring array, in conjunction a breast phantom. Image resolution and contrast were assessed using full width at half maximum and contrast-to-noise ratio metrics. The results identified optimal transmitting and receiving sub-aperture matching modes for imaging the hair strand at various positions, and demonstrated the impact of this method on imaging targets at different positions within the breast phantom. These findings and experimental validations provide significant implications for enhancing imaging performance in USCT with a ring array.

Analyzing the Ingredients Available and Choosing the Appropriate Tools: Our Algorithm for a Winning Recipe to Treat Tuberous Breasts.

Analyzing the Ingredients Available and Choosing the Appropriate Tools: Our Algorithm for a Winning Recipe to Treat Tuberous Breasts.

Feed-forward networks using logistic regression and support vector machine for whole-slide breast cancer histopathology image classification

The performance of an image classification depends on the efficiency of the feature learning process. This process is a challenging task that traditionally requires prior knowledge from domain experts. Recently, representation learning was introduced to extract features directly from the raw images without any prior knowledge. Deep learning using a Convolutional Neural Network (CNN) has gained massive attention for performing image classification, as it achieves remarkable accuracy that sometimes exceeds human performance. But this type of network learns features by using a back-propagation approach. This approach requires a huge amount of training data and suffers from the vanishing gradient problem that deteriorates the feature learning. The forward-propagation approach uses predefined filters or filters learned outside the model and applied in a feed-forward manner. This approach is proven to achieve good results with small size labeled datasets. In this work, we investigate the suitability of using two feed-forward methods such as Convolutional Logistic Regression Network (CLR), and Convolutional Support Vector Machine Network for Histopathology Images (CSVM-H). The experiments we have conducted on two small breast cancer datasets (Sultan Qaboos University Hospital (SQUH) and BreaKHis dataset) demonstrate the advantage of using feed-forward approaches over the traditional back-propagation ones. On those datasets, the proposed models CLR and CSVM-H were faster to train and achieved better classification performance than the traditional back-propagation methods (VggNet-16 and ResNet-50) on the SQUH dataset. Importantly, our proposed approach CLR and CSVM-H efficiently learn representations from small amounts of breast cancer whole-slide images and achieve an AUC of 0.83 and 0.84, respectively, on the SQUH dataset. Moreover, the proposed models reduce memory footprint in the classification of Whole-Slide histopathology images since their training time is significantly reduced compared to the traditional CNN on the SQUH and BreaKHis datasets.

Learning active contour models based on self-attention for breast ultrasound image segmentation

Computer-aided diagnosis (CAD) systems based on ultrasound have been developed and widely promoted in breast cancer screening. Due to the characteristics of low contrast and speckle noises, breast ultrasound image segmentation, one of the crucial steps of CAD systems, has always been challenging. Recently, the emerging Transformer-based medical segmentation methods, which have a better ability to model long dependencies than convolutional neural networks (CNNs), have shown significant value for medical image segmentation. However, due to the limited data with the high-quality label, Transformer performs weakly on breast ultrasound image segmentation without pretraining. Thus, we propose the Attention-Gate Medical Transformer (AGMT) for small breast ultrasound datasets, which introduces the attention-gate (AG) module to suppress background information and the average radial derivative increment (ΔARD) loss function to enhance shape information. We evaluate the AGMT on both a private dataset A and a public dataset B. On dataset A, the AGMT outperforms MT on the metrics of true positive ratio, jaccard index (JI) and dice similarity coefficient (DSC) by 6.4%, 2.3% and 1.9%, respectively. Meanwhile, when compared with UNet, the AGMT improves JI and DSC by 5.3% and 4.9%, respectively. The results show performance has significantly improved compared with mainstream models. In addition, we also conduct ablation experiments on the AG module and ΔARD, which prove their effectiveness.

Interventional oncology in breast cancer.

Breast cancer (BC) is the most common cancer and one of the most important causes of death in women. Surgery is the standard therapy for breast cancer and in the last decades evolved towards a more conservative approach, with lumpectomy, followed by radiation therapy, the most common option. Unfortunately, up to 40% of women affected by BC will develop metastases and will receive systemic therapy, which improves survival and quality of life. Interventional oncology (IO), thanks to the improvement in technology and clinical experience, is gaining an important role in the field of breast cancer, both in treating the primary tumour and also in metastasis in well-selected cases. Percutaneous thermal ablation and more recently cryoablation are reported to achieve promising results in the radical treatment of small breast cancer, with optimal cosmetic outcome and a very high safety profile. Percutaneous ablation as well as intra-arterial therapies, such as chemoembolization and radioembolization, might also be indicated in metastatic BC patients. In advanced stage disease, breast cancer liver metastases (BCLM) represent the main factor affecting the overall survival. Metastatic breast disease is a systemic disease, with tumour deposits potentially spread into different organs and tissues for which systemic therapy is the standard approach. Local therapies for liver metastases might have an important role in improving survival and quality of life in well-selected patients. Clinical and technical indications with their limitations, results and potential complications in local IO treatment for BCLM, will be also described.

Mammographic features and risk of breast cancer death among women with invasive screen-detected cancer in BreastScreen Norway 1996–2020

ObjectivesWe explored associations between mammographic features and risk of breast cancer death among women with small (<15 mm) and large (≥15 mm) invasive screen-detected breast cancer.MethodsWe included data from 17,614 women diagnosed with invasive breast cancer as a result of participation in BreastScreen Norway, 1996–2020. Data on mammographic features (mass, spiculated mass, architectural distortion, asymmetric density, density with calcification and calcification alone), tumour diameter and cause of death was obtained from the Cancer Registry of Norway. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for breast cancer death by mammographic features using spiculated mass as reference, adjusting for age, tumour diameter and lymph node status. All analyses were dichotomised by tumour diameter (small versus large).ResultsMean age at diagnosis was 60.8 (standard deviation, SD=5.8) for 10,160 women with small tumours and 60.0 (SD=5.8) years for 7454 women with large tumours. The number of breast cancer deaths was 299 and 634, respectively. Mean time from diagnosis to death was 8.7 (SD=5.0) years for women with small tumours and 7.2 (4.6) years for women with large tumours. Using spiculated mass as reference, adjusted HR for breast cancer death among women with small tumours was 2.48 (95% CI 1.67–3.68) for calcification alone, while HR for women with large tumours was 1.30 (95% CI 1.02–1.66) for density with calcification.ConclusionsSmall screen-detected invasive cancers presenting as calcification and large screen-detected cancers presenting as density with calcification were associated with the highest risk of breast cancer death.Clinical relevance statementSmall tumours (<15 mm) presented as calcification alone and large tumours (≥ 15 mm) presented as density with calcification were associated with the highest risk of breast cancer death among women with screen-detected invasive breast cancer diagnosed 1996–2020.Key Points• Women diagnosed with invasive screen-detected breast cancer 1996–2020 were analysed.• Small screen-detected cancers presenting as calcification alone resulted in the highest risk of breast cancer death.• Large screen-detected cancers presenting as density with calcification resulted in the highest risk of breast cancer death.

Extended Superior Dermoglandular Pedicle Approach: A Versatile Technique for a Variety of Breast Deformities.

Although the selected pedicle is important in how it maintains nipple viability and is of equal importance, it can be utilized with the remaining breast tissue to reshape the breast mound. It is ideally used as an extended pedicle, as it allows us to use the tissue in the lower pole of the breast. The purpose of this article was to evaluate additional indications and outcomes using the extended superior pedicle approach along with conventional techniques. This is a retrospective study over 5 years of using an extended superior dermoglandular pedicle approach for managing a variety of breast deformities. Postoperative complications, along with patient and surgeon satisfaction, were assessed. All 68 patients expressed that the results were either excellent (85.3%) or very good (14.7%) according to the evaluation parameters. Among the 68 patients, there were 62 very good outcomes (91.2%) and six good outcomes (8.8%) according to surgeon evaluation. Only one reduction experienced a superficial partial loss, which was improved with no intervention. There was minor asymmetry in three patients (4.4%), which was not experienced by the patients, and poor scar quality in one dark-skinned patent. The author was able to expand the utility of extended superior pedicle for various breast deformities, such as reduction mammoplasty; mastopexy; augmentation mastopexy, either autoaugmentation or prosthetic; tuberous breast; after lumpectomy resection; and even in secondary breast deformities with reproducible and reliable outcomes across a wide patient population.

Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients.

Poland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population. We present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed. Preoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction. Free tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature.

Introduction of Stereotactic Vacuum-Assisted Breast Biopsy in Bulgaria

Summary Breast cancer is the most common cancer in women worldwide. The gold standard for biopsy is core needle biopsy. However, in certain cases, core needle biopsy cannot be applied, and the method of choice is vacuum-assisted biopsy. It is a minimally traumatic and precise method for diagnosing microcalcifications and small breast lesions. We aimed to present the initial experience with stereotactic vacuum-assisted biopsy in breast diseases at the Department of Surgical Oncology. We show indications and contraindications for this kind of biopsy and present our initial experience. From February 2020 to December 2022, 29 stereotactic vacuum-assisted biopsies were performed. Benign histology was found in 9 cases, malignant – in 15, and 5 cases were precancerous. Therefore, being an innovative, minimally invasive, and highly accurate method for diagnosing breast lesions with a good cosmetic effect, it allows early diagnosis of breast cancer, and, last but not least, the procedure can be curative for benign lesions.