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Dermatofibrosarcoma protuberans (DFSP) is a soft tissue tumor with high propensity for local recurrence. We present a case of a 53-yearold woman with a recurrent DFSP of the clavicular region. The patient underwent extensive local excision including the external cortical bone of the left clavicle. The resulting large defect was reconstructed using pedicled Latissimus Dorsi myocutaneous flap. The histopathological examination confirmed dermatofibrosarcoma protuberans with clear surgical margins and the patient was satisfied with the final aesthetic result.

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Background: Autologous fat transfer can be safely offered for total breast reconstruction after nipple-sparing mastectomy. The aim of this study was to extend a fat transfer protocol to smokers and compare the long-term results among them and irradiated and nonirradiated patients. Methods: One hundred seventeen breasts after nipple-sparing mastectomy were prospectively enrolled and stratified in group A (25 irradiated), group B (21 smokers), or group C (71 controls). A standardized fat transfer protocol was used. Data collected were patient demographics, surgery information, and aesthetic analysis. Continuous and categorical variables were analyzed with the Kruskal-Wallis test, and the Cohen Kappa test was used to test interrater variability for the aesthetic analysis. Results: Groups were homogeneous for demographics (p > 0.05) but significantly different in number of fat transfer sessions (p < 0.001), mean volume of the first two treatments (p = 0.003), and mean total volume of injected fat (p = 0.002). Volume, shape, position of the breast mound, inframammary fold, and scar location subscales obtained high score evaluations without a significant difference among groups (p > 0.05), whereas skin texture subscale showed a lower score evaluation in group A (p = 0.003). Although a significant difference for total subscales was worse in group A (p = 0.004), the global score had a high rate evaluation in all groups (p = 0.145). Interrater reliability showed substantial agreement among all categories. Conclusion: Although further investigation is required, the authors confirm the efficacy of their fat transfer protocol for both irradiated and nonirradiated nipple-sparing mastectomy patients and propose its indication to smokers with comparable clinical and aesthetic results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

We present a 23-year-old male patient with severe PS, characterized by marked left thoracic wall deformity. Reconstruction was performed using the Fat-Augmented Latissimus Dorsi flap, which was fixed to the chest wall hollowing corresponding to where the pectoralis major muscle was missing. Patient was satisfied with final aesthetic and functional result.

How to cite this article: Longo B, D'Orsi G, Pistoia A, et al. T-inverted shaped rectus abdominis myocutaneous (Ti-RAM) flap for chest wall reconstruction.

Background: Autologous fat transfer has an important role in breast reconstructive surgery. Nevertheless, some concerns remain with regard to its oncologic safety. The authors present a single-center, case-matching study analyzing the impact of autologous fat transfer in the cumulative incidence of local recurrences. Methods: From a prospectively maintained database, the authors identified 902 patients who underwent 1025 breast reconstructions from 2005 to 2017. Data regarding demographics, tumor characteristics, surgery details, and follow-up were collected. Exclusion criteria were patients with distant metastases at diagnosis, recurrent tumor, or incomplete data regarding primary tumor; and patients who underwent prophylactic mastectomies and breast-conserving operations. Statistical analysis was conducted to evaluate the impact of the variables on the incidence of local recurrence. A value of p < 0.05 was considered statistically significant. Results: After 1:n case-matching, we selected 919 breasts, of which 425 patients (46.2 percent) received at least one autologous fat transfer session versus 494 control cases (53.8 percent). Local recurrences had an overall rate of 6.8 percent, and we found local recurrences in 14 autologous fat transfer cases (3.0 percent) and 54 controls (9.6 percent). Statistical analysis showed that autologous fat transfer did not increase the risk of local recurrences (hazard ratio, 0.337; CI, 0.173 to 0.658; p = 0.00007). Multivariate analysis identified invasive ductal carcinoma subtype and lymph node metastases to have an increased risk of local recurrences (hazard ratio >1). Conversely, positive hormonal receptor status was associated with a reduced risk of events (hazard ratio <1). Conclusions: Autologous fat transfer was not associated with a higher probability of locoregional recurrence in patients undergoing breast reconstruction; therefore, it can be safely used for total breast reconstruction or aesthetic refinements. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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