Re-Excision After Positive Margins in Breast-Conserving Surgery: Can a Risk-Based Strategy Avoid Unnecessary Surgery?

Re-excision after breast-conserving surgery (BCS) is routinely recommended when positive margins are found. However, secondary surgery often reveals no residual disease, exposing patients to unnecessary interventions that compromise cosmetic outcomes, increase costs, and reduce quality of life. This study investigates clinicopathological predictors of a residual tumour to identify low-risk patients who may safely avoid re-excision.

Prepectoral Breast Reconstruction: Early and Long-term Complications and Outcomes of Total Coverage ADM and Implants vs Polyurethane-Coated Implants Without Use of Acellular Dermal Matrix.

Background: Immediate prepectoral breast reconstruction (IPBR) has emerged as a prominent alternative to subpectoral techniques, offering favorable outcomes in selected patients. Among available options, implant coverage with acellular dermal matrix (ADM) and the use of polyurethane (PU)-coated implants without ADM represent two widely adopted strategies.

Objectives: The aim of this study was to examine the comparative efficacy and complication profiles of implant coverage with acellular dermal matrix (ADM) and the use of polyurethane (PU)-coated implants without ADM.

Immediate Breast Reconstruction with Prepectoral Polyurethane-Covered Implant After Conservative Mastectomy in Large and Ptotic Breasts.

Introduction: Immediate breast reconstruction in patients with large and ptotic breasts represents a significant challenge due to the presence of skin redundancy and potential uncertain vascularization. This study investigates an innovative approach of performing immediate reconstruction using prepectoral polyurethane-covered (PU) implants after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) with the aim of avoiding potential complications related to skin-reducing approaches and enhancing cosmetic outcomes.

Materials And Methods: This retrospective study analyzed 62 patients who underwent NSM or SSM followed by immediate prepectoral reconstruction with polyurethane-covered implants between December 2018 and May 2024.

Long term outcomes of breast primary sarcomas and malignant phyllodes tumors: 20 years observational analysis of the BEAM∗ study group. (∗the breast European association for mesenchymal tumors).

Background: Primary breast sarcomas (PBS) and malignant phyllodes tumors (MPT) represent less than 1 % of breast malignancies. Current evidence relies on heterogeneous retrospective series, resulting in controversial therapeutic approaches. This study aimed to analyze long-term outcomes in a large multicentric cohort treated with consistent strategies.

Predictive risk factors of recurrence in breast cancer after neoadjuvant treatment: the NEORISK study.

Background: Neoadjuvant chemotherapy (NACT) improves oncologic and cosmetic outcomes in breast cancer (BC), yet recurrence remains a concern. This study identifies factors associated with recurrence at 3 and 5 years in BC patients receiving NACT.

Methods: A retrospective analysis of 933 stage I - III BC patients (2014-2021) evaluated event-free survival (EFS) predictors using multivariate analyses.

Personalizing Neoadjuvant Chemotherapy: The Impact of BRCA Variants on Pathologic Complete Response in Luminal B Breast Cancer.

: Neoadjuvant chemotherapy (NACT) is effective in downstaging locally advanced breast cancer, improving surgical and oncological outcomes. However, luminal B breast cancer typically exhibits a poorer response to NACT, with only 10-15% of patients achieving a pathologic complete response (pCR). This study investigates whether BRCA pathogenic variants (BRCA PVs) influence pCR rates in luminal B breast cancer patients, aiming to identify potential predictors for personalized treatment strategies.

Malignant Mesenchymal Tumors of the Breast: Current Challenges and New Perspectives on Primary Sarcomas and Malignant Phyllodes Tumors.

Mesenchymal tumors of the breast constitute a rare and heterogeneous group of neoplasms, representing only 0.5% to 1% of all breast tumors. Originating from mesenchymal tissues, these tumors include various histological subtypes.

Oncological Safety of Prepectoral Implant-Based Breast Reconstruction After Conservative Mastectomy: Insights from 842 Consecutive Breast Cancer Patients.

Background: Implant-based breast reconstruction (IBBR) following conservative mastectomy is the most common approach for women undergoing breast cancer surgery. The aim of this study was to compare the oncological outcomes of conservative mastectomy combined with prepectoral IBBR to the subpectoral technique.

Methods: The clinical and demographic data of consecutive breast cancer patients who underwent conservative mastectomy with either prepectoral or subpectoral IBBR between January 2018 and December 2023 were retrospectively analyzed.

Personalizing Breast Cancer Surgery: Harnessing the Power of ROME (Radiological and Oncoplastic Multidisciplinary Evaluation).

Breast cancer treatment has evolved significantly in recent decades, with personalized care models gaining prominence both for the optimization of oncological outcomes and aesthetic results. At the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, we have developed a multidisciplinary, evidence-based model for the management of breast cancer patients, called ROME (Radiological and Oncoplastic Multidisciplinary Evaluation). This innovative model integrates the expertise of various specialists in a seamless, patient-centered approach to improve treatment planning and outcomes.

Advancing Breast Cancer Care in Patients Aged 80 and Above: A Personalized and Multidisciplinary Management to Better Outcomes.

Breast cancer in women aged 80 years and older accounts for about 12% of cases, but its management is challenging due to the population's heterogeneity and the lack of relevant evidence-based guidelines. Treatment decisions must consider biological age, comorbidities, life expectancy, therapy-related toxicities, and tumor biology. This study evaluates the clinical outcomes of elderly breast cancer patients treated with a multidisciplinary approach, including oncologists, surgeons, and geriatric specialists.

The LYMPH trial: comparing microsurgical with conservative treatment for chronic breast cancer-associated lymphoedema - study protocol of a pragmatic randomised international multicentre superiority trial.

Introduction: Up to one-fifth of breast cancer survivors will develop chronic breast cancer-related lymphoedema (BCRL). To date, complex physical decongestion therapy (CDT) is the gold standard of treatment. However, it is mainly symptomatic and often ineffective in preventing BCRL progression.

Baseline F-FDG PET/CT for predicting pathological response to neoadjuvant chemotherapy and prognosis in locally advanced breast cancer patients: analysis of tumor and lymphoid organs metabolic parameters.

Purpose: To investigate metabolic parameters from baseline F-FDG PET/CT as predictors of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) and disease recurrence in locally advanced breast cancer (LABC) patients.

Materials And Methods: From 142 LABC in 137 patients (bilateral-synchronous BC: 5/137), the following parameters from baseline (pre-treatment) F-FDG PET/CT were retrospectively analyzed, along with clinic-histological data: primary tumor activity (SUVmax, SUVmean, SUVpeak, tumor-to-liver ratio-TLR-, MTV, TLG); lymphoid organs activity (spleen and bone marrow SUVmax and SUVmean, spleen-to-liver ratio-SLR-, bone marrow-to-liver ratio-BLR); and PET-positive lymph-nodes' number. Predictors of pCR and recurrence-free survival (RFS) were assessed by univariable logistic regression and Cox regression (significant or suggestive association: p < 0.

Navigating the Uncertainty of B3 Breast Lesions: Diagnostic Challenges and Evolving Management Strategies.

B3 breast lesions, classified as lesions of uncertain malignant potential, present a significant diagnostic and therapeutic challenge due to their heterogeneous nature and variable risk of progression to malignancy. These lesions, which include atypical ductal hyperplasia (ADH), papillary lesions (PLs), flat epithelial atypia (FEA), radial scars (RSs), lobular neoplasia (LN), and phyllodes tumors (PTs), occupy a "grey zone" between benign and malignant pathologies, making their management complex and often controversial. This article explores the diagnostic difficulties associated with B3 lesions, focusing on the limitations of current imaging techniques, including mammography, ultrasound, and magnetic resonance imaging (MRI), as well as the challenges in histopathological interpretation.

Assessing Malignant Risk in B3 Breast Lesions: Clinical Insights and Implications.

: B3 breast lesions, characterized by uncertain malignant potential, pose a significant challenge for clinicians. With the increasing use of preoperative biopsies, there is a need for careful management strategies, including watchful waiting, vacuum-assisted excision (VAE), and surgery. This study aims to assess the concordance between preoperative biopsy findings and postoperative histology, with a focus on evaluating the positive predictive value (PPV) for malignancy in B3 lesions.

Fat Grafting and Prepectoral Prosthetic Reconstruction with Polyurethane-Covered Implants: Protective Role against Adjuvant Radiotherapy.

Breast cancer treatment increasingly incorporates immediate prepectoral prosthetic reconstruction after conservative mastectomy, including nipple-sparing (NSMs) and skin-sparing mastectomies (SSMs). Although recent data from the literature show that postmastectomy radiotherapy (PMRT) after prepectoral reconstruction presents good clinical results, with reduction in capsular contracture and implant migration, compared to the traditional submuscular technique, these patients have higher rates of long-term complications when compared with nonradiated patients. This study evaluates the protective effects of autologous fat grafting to reduce long-term radiotherapy-induced complications in breast cancer patients submitted for prepectoral reconstruction with polyurethane-covered (PU) implants.

Young Women with Early-Stage Breast Cancer Treated with Upfront Surgery: Overview of Oncological Outcomes.

: Breast cancer in young women aged < 40 years is rare and often aggressive with less favorable survival rates. The lack of systematic screening, later stage at diagnosis, and a more aggressive disease biology may all contribute to their poor prognosis. Data on the best management remain conflicting, especially those regarding surgical management, either breast-conserving or mastectomy.

Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience.

Oncoplastic surgery (OPS) reliability in the post-neoadjuvant chemotherapy (NACT) setting is still debated due to weak scientific evidences in such scenarios. Our analysis aims to report results obtained in a retrospective series of 111 patients consecutively treated with level II OPS after NACT at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between 1998 and 2018. The surgical endpoints were the mean specimen volume, rates of positive margins (PMR), re-excision (RR), conversion to mastectomy (CMR), and complications (CR).

An Innovative Scoring System to Select the Optimal Surgery in Breast Cancer after Neoadjuvant Chemotherapy.

Introduction: The selection of surgery post-neoadjuvant chemotherapy (NACT) is difficult and based on surgeons' expertise. The aim of this study was to create a post-NEoadjuvant Score System (pNESSy) to choose surgery, optimizing oncological and aesthetical outcomes.

Methods: Patients (stage I-III) underwent surgery post-NACT (breast-conserving surgery (BCS), oncoplastic surgery (OPS), and conservative mastectomy (CMR) were included.

Magnetic seed versus skin tattoo localization of non-palpable breast lesions: a single institution cohort study.

Objective: The objective of this retrospective study was to investigate the accuracy and feasibility of magnetic seed compared to skin tattoo in preoperative localization of impalpable breast lesions in terms of accuracy of placement, re-excision and positive margins rates, and breast/surgical specimen volume ratio.

Methods: We retrospectively analyzed 77 patients who underwent breast conservative surgery in our center from November 2020 to November 2021, with previous localization with skin tattoo or magnetic seed.

Results: Thirty-seven magnetic seeds were placed in 36 patients (48.

Local Treatment of Triple-Negative Breast Cancer: Is Mastectomy Superior to Breast-Conserving Surgery?

Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer that lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). TNBC accounts for about 15% of breast cancers and has a poorer prognosis as compared with other subtypes of breast cancer. The more rapid onset of this cancer and its aggressiveness have often convinced breast surgeons that mastectomy could provide better oncological results.

Conservative Surgery in cT4 Breast Cancer: Single-Center Experience in the Neoadjuvant Setting.

Background: The diffusion of screening programs has resulted in a decrease of cT4 breast cancer diagnosis. The standard care for cT4 was neoadjuvant chemotherapy (NA), surgery, and locoregional or adjuvant systemic therapies. NA allows two outcomes: 1.

Pathologic response and residual tumor cellularity after neo-adjuvant chemotherapy predict prognosis in breast cancer patients.

Introduction: Residual tumor cellularity (RTC) and pathologic complete response (pCR) after neo-adjuvant chemotherapy (NAC) are prognostic factors associated with improved outcomes in breast cancer (BC). However, the majority of patients achieve partial pathologic response (pPR) and no clear correlation between RTC patterns and outcomes was described. Our aims were to define predictive factors for pCR and compare different outcomes of patients with pCR or pPR and with different RTC patterns.