Focused Issue on Novel Innovations and Advancements in Breast Reconstruction

Regarding this focused issue in Annals of Breast Surgery, as Prof. Edward I. Chang predominantly focuses on reconstruction, a dedicated issue to Novel Innovations and Advancements in Breast Reconstruction would seem to be the most fruitful and worthwhile topic. In this issue, the Guest Editor Prof. Chang has included a diverse group of authors both in terms of institutions and global geography.

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Application of the CARE Guideline as reporting standard in Annals of Breast Surgery

Annals of Breast Surgery welcomes case reports which are supposed to report new observations of diseases, clinical findings or novel/unique treatment outcomes relevant to practitioners in the fields of medicine.

For completeness and transparency for published case reports, Annals of Breast Surgery will apply the CARE guidelines (1) as reporting standards for case reports starting from October 14, 2019.

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Serum tumor markers and positron emission tomography-computed tomography scan as post-breast cancer treatment surveillance

Background: Post-operative surveillance is an important aspect in managing breast cancers. The primary aim is to allow early detection of metachronous breast cancers. However, post-operative breast cancer surveillance has not been standardized. Mammography has been the only evidence-based imaging modality for detecting metachronous breast cancers. The value of regular monitoring with serum carcinoembryonic antigen (CEA) and CA 15-3 has been controversial. The aim of this study is to evaluate the efficacy of using tumor markers as a surveillance tool in post-operative patients.

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Nipple adenoma: a review of the literature

Nipple adenomas (NA) are benign proliferations that can behave in a locally infiltrative manner and can thus mimic and present with features of breast malignancy. This article presents an up-to-date review of the literature on the presentation, diagnosis pathological assessment and surgical treatment of these rare lesions. A Medline, PubMed and OVID search was performed for all articles on nipple adenomata using keywords “nipple” and “adenoma, papillomatosis, adenosis, syringomatous, erosive, pathology and nodule”. The literature on nipple adenomata consists mainly of case series or case reports, with a variety of management techniques described. Nipple adenomata remain rare benign proliferations with most standard breast units expecting to see one to two cases per year.

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Twenty-five years of risk-reducing mastectomies and immediate breast reconstruction—lessons learned from a single institution

Risk-reducing mastectomy is an established surgical option for patients with inherited high risk for breast cancer. At the Karolinska University Hospital, a structured care plan for this patient group has been developed over a 25-year period. This paper describes the gradual evolution of patient care and surgical technique at a single high-volume university hospital. The results presented are based upon multidisciplinary collaborative efforts, prospective and retrospective studies and the patients’ and their partners’ own experiences after approximately 700 risk-reducing mastectomies.

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Reduction of postoperative opioid use in oncologic breast surgery and the creation of multimodal pain management guidelines and practices

Background: The US is in the midst of an opioid crisis. Prescribing physicians are now pressured to balance patient pain management and opioid prescribing behavior. The responsibility of curbing the flow of opioids into the general US populace and optimizing pain management for their patients is in the hands of the prescribing physician.

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Do all BRCA1/2 carriers with breast cancer benefit from bilateral mastectomy?

Surgical management of hereditary breast cancer is influenced by several variables pertaining tumor biology as well as patients’ physical and psychological characteristics. The prevalence of BRCA1/2 mutations among breast cancer patients is low, but many carriers are not diagnosed according current criteria of access to genetic testing. This is becoming even more relevant as specific drugs for carriers have now been included in the armamentarium of medical oncologists. Indeed, the whole therapeutic strategy, including pros and cons of radiotherapy, is influenced by BRCA1/2 status. Although no major differences have been reported between the outcome of BRCA1/2 negative vs. BRCA1/2 positive patients, the latter carry a substantially higher cumulative risk of metachronous breast and ovarian cancers.

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In patients with micrometastases in sentinel lymph node biopsies, involvement of the non-sentinel lymph nodes cannot be predicted by clinicopathological variables

Background: The sentinel lymph node biopsy (SLNB) procedure is long considered as an accurate method of staging the axilla for axillary involvement in early stage breast cancer. The question remains as to whether patients with micrometastases should undergo axillary clearance. We aimed to assess the indicators for positive non-sentinel lymph nodes (SLN) following completion axillary lymph node dissection (CALND).

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Pathological complete response in the axillary lymph nodes post neo-adjuvant chemotherapy in breast cancer, is it predictable?

Background: With the recent advances in breast cancer management in the neo-adjuvant chemotherapy (NACT) setting the rates of pathological complete response (pCR) in the breast and the axilla has become more achievable. This has imposed a more conservative surgical approach. While, axillary node clearance (ANC) is still the gold standard procedure in node positive axilla. Converting a node positive into node negative axilla allows surgical de-escalation. However, an evidence-based selection criteria would improve outcomes in this group of patients.

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Necrotizing soft tissue infection of the breast: bilateral presentation in a male patient

Necrotizing soft tissue infections (NSTIs) can affect any part of the body but are rarely seen in the breast. To date, most cases have presented unilaterally, and all published reports have occurred in female patients. We describe the first case of bilateral NSTI of the breasts in a male patient with history of mastitis and breast biopsies. He was successfully treated with antibiotics and bilateral mastectomy. A history of mastitis or instrumentation of the breast should raise suspicion for a necrotizing soft infection of the breast even in a male, in the setting of systemic and radiologic signs consistent with a necrotizing infection.

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