Background: "Seromas" represent a frequent complication after complete axillary lymph node dissection (CALND) for breast cancer. The aims of this work were to analyze patients with seromas at our institution and to try to define patients at risk for such events. Methods:The medical reports of 223 women who underwent CALND after mastectomy (n=127) or lumpectomy (n=96) for breast cancer and who were followed in our institute were retrospectively reviewed to obtain the following: the characteristics (volume and duration) of the drained seromas; the number, volume, and duration of punctures performed after hospital discharge; the patient's age and body mass index; the presence or absence of hypertension (HTA); the pT of the tumor, the TNM stage, the number of axillary lymph nodes removed (nLN), the number of positive LN, the associated treatments (the pre and post-operative chemotherapy or not); and whether or not there was an infection at the level of the breast and/or arm.Results: Only 18.75% of the patients after lumpectomy and 9.45% after mastectomy did not have a puncture for seroma after hospital discharge. The patients who had a mastectomy with CALND had a significantly higher number of punctures (Np), longer duration, and higher volumes than those who had a lumpectomy. The risk of infection significantly increased with the Np. Conclusions:This institutional survey highlights the problem of post-operative seromas and their related punctures. The seromas were statistically more frequent after mastectomy than lumpectomy. Therefore, in the future, neo-adjuvant approaches with conservative surgeries are recommended. Our analysis identified an abnormally high Np and/or total puncture volume (VpTot) as outliers.

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the oesophagus is being considered routinely during radiotherapy treatment planning. This study aims to describe exposure of the oesophagus from modern breast cancer regimens.Material and Methods: A systematic review of oesophageal doses from breast cancer radiotherapy regimens published during 2008-2018 was undertaken. Average mean oesophageal doses and average maximum oesophageal doses were described for different anatomical regions irradiated and techniques used. Oesophageal exposure from current modern regimens was compared to that received in previous decades.Results: Seventy-three regimens from 16 countries reporting oesophagus doses were identified. The average mean oesophagus dose was 0.2 Gy (range 0.1-0.4) for partial breast irradiation, 1.5 Gy (Range 0.1-10.4) for whole breast/chest wall radiotherapy and 14.2 Gy (range 1.1-29.3) with the addition of regional nodal irradiation. For regimens that included regional nodal irradiation, the average mean oesophageal dose was higher for IMRT (21.6 Gy static IMRT, 13.6 Gy rotational IMRT) than tangential radiotherapy (5.5 Gy) (p < 0.001). Overall, average oesophageal exposure from modern regimens was similar to that estimated from regimens used in previous decades.Conclusions: Exposure of the oesophagus remains an issue in modern breast cancer radiotherapy. Routine avoidance of the oesophagus during treatment planning may reduce the number of women developing a subsequent primary oesophageal cancer in the future.

An efficient evaluation of the lymphatic drainage from the breasts (thoracic wall) and/or the upper limbs is essential in the management of patients with breast cancer (BC) and/or BC-related lymphedema. Lymphoscintigraphy was performed in 2 patients with lymphedema. Lymphatic drainage was observed from the upper limb or breast to the posterior paravertebral and/or pararenal lymph nodes. The cases demonstrate lymphatic drainage pathways toward unusual and mostly unrecognized lymph nodes, which may be at risk for further evolution of BC and may be important for the physical treatment of BC-related lymphedema.