Impact of Mastectomy Flap Necrosis on Patient-Reported Quality-of-Life Measures After Nipple-Sparing Mastectomy: A Preliminary Analysis.

BACKGROUND: Mastectomy skin flap necrosis (SFN) is common following nipple-sparing mastectomy (NSM), but studies on its quality-of-life (QOL) impact are limited. We examined patient-reported QOL and satisfaction after NSM with/without SFN utilizing the BREAST-Q patient-reported outcome measure (PROM) survey. PATIENTS AND METHODS: Patients undergoing NSM between April 2018 and July 2021 at our institution were examined; the BREAST-Q PROM was administered preoperatively, and at 6 months and 1 year postoperatively. SFN extent/severity was documented at 2-3 weeks postoperatively; QOL and satisfaction domains were compared between patients with/without SFN. RESULTS: A total of 573 NSMs in 333 patients were included, and 135 breasts in 82 patients developed SFN (24% superficial, 56% partial thickness, 16% full thickness). Patients with SFN reported significantly lower scores in the satisfaction with breasts (p = 0.032) and psychosocial QOL domains (p = 0.009) at 6 months versus those without SFN, with scores returning to baseline at 1 year in both domains. In the "physical well-being-of-the-chest" domain, there was an overall decline in scores among all patients; however, there were no significant differences at any time point between patients with or without SFN. Sexual well-being scores declined for patients with SFN compared with those without at 6 months and also at 1 year, but this did not reach significance (p = 0.13, p = 0.2, respectively). CONCLUSIONS: Patients undergoing NSM who developed SFN reported significantly lower satisfaction and psychosocial well-being scores at 6 months, which returned to baseline by 1 year. Physical well-being of the chest significantly declines after NSM regardless of SFN. Future studies with larger sample sizes and longer follow-up are needed to determine SFN's impact on long-term QOL.

Invasive lobular breast cancer: Focus on prevention, genetics, diagnosis, and treatment.

Invasive lobular cancer (ILC) is the most common of the breast cancer special types, accounting for up to 15% of all breast malignancies. The distinctive biological features of ILC include the loss of the cell adhesion molecule E-cadherin, which drives the tumor's peculiar discohesive growth pattern, with cells arranged in single file and dispersed throughout the stroma. Typically, such tumors originate in the lobules, are more commonly bilateral compared to invasive ductal cancer (IDC) and require a more accurate diagnostic examination through imaging. They are luminal in molecular subtype, and exhibit estrogen and progesterone receptor positivity and HER2 negativity, thus presenting a more unpredictable response to neoadjuvant therapies. There has been a significant increase in research focused on this distinctive breast cancer subtype, including studies on its pathology, its clinical and surgical management, and the high-resolution definition of its genomic profile, as well as the development of new therapeutic perspectives. This review will summarize the heterogeneous pattern of this unique disease, focusing on challenges in its comprehensive clinical management and on future insights and research objectives.

Lesöes mamárias näo-palpáveis: quando näo biopsiar? / Non palpable breast lesions: when biopsy is not necessary

O uso em larga escala do exame mamográfico permite que grande número de lesöes mamárias benignas seja identificado. Biópsias indiscriminadas dessas lesöes fazem com que muitos procedimentos cirúrgicos desnecessários sejam realizados. Este trabalho avalia a associaçäo entre os aspectos mamográficos e os resultados histológicos em lesöes mamárias näo-palpáveis. Foram examinadas 375 lesöes (218 nódulos, 142 microcalcificaçöes e 15 nódulos associados a microcalcificaçöes). Os casos foram classificados mamograficamente como benignos, suspeitos ou malignos. As lesöes foram localizadas antes da cirurgia por meio de estereotaxia (279), ultra-sonografia (24), a mäo-livre (68) e com reparo metálico (4). Confirmou-se a retirada de todas as lesöes. Em 86 (22,9 por cento) casos foi diagnosticado malignidade, em 264 (70,4 por cento) benignidade e em 25 (6,7 por cento) o diagnóstico foi de lesäo pré-maligna. No grupo de lesöes classificadas mamograficamente como benignas, duas foram identificadas histologicamente como pré-malignas. Nos casos de lesöes suspeitas ou malignas, em 42,3 por cento o diagnóstico de malignidade foi confirmado. A associaçäo foi de 40,2 por cento em nódulo (p<0,001); de 45,5 por cento em microcalcificaçöes (p<0,001) e de 20 por cento em nódulos associados a calcificaçäo (p=0,143). A sensibilidade do método foi de 100 por cento, a especificidade de 59,9 por cento, o valor preditivo positivo de 42,3 por cento, o valor preditivo negativo de 100 por cento e a acurácia de 68,8 por cento. Houve uma significante associaçäo (p<0,001) entre os aspectos mamográficos e a histologia de lesöes mamárias näo-palpáveis

Tratamento cirúrgico conservador do câncer de mama / Conservative surgical treatment of breast cancer

Nos últimos 15 anos o tratamento cirúrgico do câncer de mama foi revolucionado por alguns novos conceitos na história natural destes tumores. A impossibilidade de controlar a doença com uma cirurgia alargada, a identificaçäo de tumores cada vez menores com o uso da mamografia, a possibilidade da "paciente atual" participar da escolha do tratamento , criaram as condiçöes para um tratamento conservador. Os resultados retrospectivos e, especialmente, prospectivos, dos estudos sobre o tratamento conservador têm demonstrado que a terapia de combinaçäo pode fornecer um adequado controle local do tumor. O Trial I de Miläo, comparando a mastectomia de Halsted versus a QUART (quadrantectomia, dissecçäo axilares e radioterapia), forneceu uma importante contribuiçäo mostrando näo existir diferenças na sobrevida global, período livre de doença e recidivas locais entre os dois tipos de tratamento