Conventional CT versus Dedicated CT Angiography in DIEP Flap Planning: A Feasibility Study.

The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study's goal was to investigate the accuracy of conventional CT (cCT), performed during disease staging, compared to CTa in preoperative DIEP flap planning. In this retrospective, single-center study, we enrolled patients scheduled for mastectomy and DIEP flap breast reconstruction, subjected to cCT within 24 months after CTa. We included 35 patients in the study. cCT accuracy was 95% (CI 0.80-0.98) in assessing the three largest perforators, 100% (CI 0.89-100) in assessing the dominant perforator, 93% (CI 0.71-0.94) in assessing the perforator intramuscular course, and 90.6% (CI 0.79-0.98) in assessing superficial venous communications. Superficial inferior epigastric artery (SIEA) caliber was recognized in 90% of cases (CI 0.84-0.99), with an excellent assessment of superficial inferior epigastric vein (SIEV) integrity (96% of cases, CI 0.84-0.99), and a lower accuracy in the evaluation of deep inferior epigastric artery (DIEA) branching type (85% of cases, CI 0.69-0.93). The mean X-ray dose spared would have been 788 ± 255 mGy/cm. Our study shows that cCT is as accurate as CTa in DIEP flap surgery planning.

Therapeutic nipple-sparing mastectomy combined with endoscopic immediate prosthetic breast reconstruction via axillary incision. A further step towards evidence-based and personalized surgery.

INTRODUCTION: Nipple-sparing mastectomy is an oncologically validated technique for selected breast cancer patients and allows to improve aesthetic results and patients' quality of life. Conventional skin incisions are often a suboptimal solution due to the visibility of the scars. Aim of this work is to show our innovative technique, which allows to perform nipple-sparing mastectomy, lymph-node surgery, and endoscopic immediate prosthetic breast reconstruction using a single cosmetic axillary incision. MATERIALS AND METHODS: Between June 2016 and October 2019, 14 consecutive patients underwent therapeutic nipple- sparing mastectomy with endoscopic immediate reconstruction via axillary incision; inclusion criteria were cup A or B breasts and tumors less than 3 cm in diameter. Data were recorded in order to evaluate reproducibility, feasibility, safety, aesthetic outcomes and patients' quality of life. RESULTS: Mean age was 46 years old (range: 34-54 years); median tumor size was 1.7 cm; average follow-up time was 11 months (range 3-42); median operation time was 340 minutes; mean hospital stay was 4,1 days. Tumor-free margins were obtained in all 14 cases. No local-regional recurrence occurred during follow-up. No major complications were experienced. No systemic complications were observed. All patients were satisfied with their aesthetic results, especially the absence of visible scars. CONCLUSIONS: Therapeutic nipple-sparing mastectomy with endoscopic immediate prosthetic reconstruction via axillary incision is a safe and appropriate procedure in cup A and B breasts, alternative to conventional techniques. It allows to improve aesthetic outcomes and patients' quality of life thanks to a single well-hidden axillary scar. KEY WORDS: Axillary Incision, Breast Cancer, Endoscopic Breast Reconstruction, Nipple-Sparing Mastectomy, Oncological and Aesthetic Outcomes, Quality of Life.

A giant papillary carcinoma of the breast treated with mastectomy and bipedicled TRAM flap.

Although the surgical treatment of breast cancer has become more conservative in the last decades, some patients still arrive at the first physical examination with advanced diseases and with large skin infiltration. We report an unusual case of giant invasive papillary carcinoma of the breast underwent mastectomy and reconstruction with a bipedicled transverse rectus abdominis myocutaneous (TRAM) flap.