Clinical experience supports a role for palliative procedures in patients with locally advanced or recurrent breast cancer, yet numerous challenges are entailed in both the extirpation and reconstruction of the chest wall in these cases. The defects may be profound and complicated by prior surgery, radiation therapy, or patient-related variables. The reconstructive techniques employed must neither encumber nor delay any necessary postoperative therapy and must not result in unacceptable morbidity or compromise quality of life. Our surgical approach to these cases incorporates a team of specialists from a broad spectrum of medical and surgical disciplines. Each operative plan is tailored to the specific needs and requirements of the individual patient.

Background While negative impacts of radiation on breast reconstruction have been well accepted, timing of autologous breast reconstruction in the setting of postmastectomy radiation therapy (PMRT) is still evolving. This study aims to address the dilemma of breast reconstruction timing in patients receiving PMRT. Methods A retrospective chart review was performed evaluating patients who underwent PMRT and autologous breast reconstruction. Postoperative complication and revision rates were compared. Results Thirty‐six immediate (immediate breast reconstruction [IBR]) and 89 delayed reconstructions (delayed breast reconstruction [DBR]) were included with comparable patient characteristics between groups. Overall complication rates were not significantly different, or when separately assessing for surgical site infections, wound dehiscence, fat necrosis, or substantial volume loss. No free flaps were lost in either group. Revision rates were significantly lower in the IBR group (p = 0.02). DBR resulted in appreciably larger volumes of fat grafting to the therapeutically reconstructed breast (p = 0.01) and more contralateral mastopexies (p = 0.02). No significant difference was observed in fat necrosis excision, breast reduction, or need for secondary flap reconstruction or prosthetic use for volume loss. Conclusions IBR in the setting of PMRT does not result in higher rates of complications and requires fewer overall revisions, making it a compelling option for patients undergoing PMRT.

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Purpose: Long lasting facial paralysis should always be treated by dynamic restoration. However, results obtained by a single muscle transfer may not provide adequate balance. The aim of this paper is to evaluate the functional result of the temporalis muscle transfer (TT) combined with lateral orbicularis oris plication (MP) in the smile reconstruction of the long lasting unilateral facial paralysis.Methods: 16 patients House Brackmann (HB) V to VI with unilateral facial paralysis (UFP) underwent TT plus MP from July 2007 to January 2008. Mean age was 59.5 years. The distance from the lip philtrum and mouth corner to the nasogenian sulcus at rest and at smiling was obtained before and after the operation and patients were followed for two years.Results: Distance to the nasogenian sulcus changed significantly (p>0.001) at smiling, improving the HB score to III in all 16 patients. Distance from the mouth corner decreased after the operation, assuring the impression of adequate facial balance. The maximum strength of muscle excursion was seen two years after the operation. Conclusion:The functional result of the TT combined with MP improved the HB score in all 16 patients with long lasting facial paralysis. This was attested by the amount of movement enough to elevate the mouth corner, and a more symmetric smiling.

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