BackgroundIdiopathic granulomatous mastitis (IGM) is an uncommon benign chronic inflammatory disease which can clinically and radiographically mimic abscess or breast cancer. Definitive diagnosis was made by histopathology and exclusion of an identifying etiology. Optimal treatment has not been yet established. The aim of this study was to report and describe the clinical signs, radiological findings, managements, clinical course, and clinical outcomes after treatment of IGM.MethodWe retrospectively studied IGM medical records of 44 patients in our institute collected from March 1990 to October 2016. The patient characteristics, clinical presentations, radiological findings, microbiological workups, tissue pathology, treatment modalities, outcomes, and follow-up data were reviewed and analyzed. The success rate, recurrence rate and time-to-healing were compared focusing on the treatment modalities to find the proper treatments for IGM patient.ResultsForty-four patients were diagnosed as IGM. The median follow-up time was 20.73 months ranging from 1.26 to 118.8 months while the median time of the diagnosis was 21 days ranging from 2 to 246 days. Due to the follow-up period, only thirty-nine patient data were used for the analysis. In the first setting, 30 patients were treated by surgery, 6 patients were treated by using steroid while other 3 patients were treated by other different treatments. Only 25 from 39 patients (64.10%) were cured by the first modality. The overall median time-to-healing was 84 days while the medians of time-to-healing treated by surgery, steroid and the rest were 75, 114.5, and 238 days respectively. The surgical treatment had the shortest time-to-healing but not statistically significant (p = 0.23). Thirteen patients out of twenty-five (52%) had wound complications after performing an excision. Lastly, five patients out of thirty-nine (12.82%) had recurrence.ConclusionIGM is an uncommon benign disease which is hardly distinguished from malignancy. There is not a significant difference among treatment modalities in term of time-to-healing and recurrence of disease. The result shows that surgery is outperformed by the shortest healing time. However, the surgical treatment must be chosen with careful due to high rate of wound complications. Multimodality treatment is recommended as the proper treatments for IGM patient.

Background:Transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after mastectomy in breast cancer patients has become one of the milestones in breast reconstruction. There are several techniques that have been used in an attempt to minimize untoward complications. We present the whole muscle with partial sheath-sparing technique that focuses on the anatomy of arcuate line and the closure of the anterior abdominal wall techniques with mesh and determine factors associated with its complications and outcomes.Methods:We retrospectively and prospectively review the results of 30 pedicled TRAM flaps that were performed between November 2013 and March 2016, focusing on outcomes and complications.Results:Among the 30 pedicled TRAM flap procedures in 30 patients, there were complications in 5 patients (17%). Most common complications were surgical-site infection (7%). After a median follow-up time of 15 months, no patient developed abdominal wall hernia or bulging in daily activities in our study, but 6 patients (20%) had asymptomatic abdominal wall bulging when exercised. Significant factors related to asymptomatic exercised abdominal wall bulging included having a body mass index of more than 23 kg/m2.Conclusion:Pedicled TRAM flap by using the technique of the whole muscle with partial sheath-sparing technique combined with reinforcement above the arcuate line with mesh can reduce the occurrence of abdominal bulging and hernia.

Background:Nipple-sparing mastectomy (NSM) has been proven to be oncologically safe for treating breast cancer. This procedure had been developed to optimize the esthetic outcome and reduce feeling mutilation after mastectomy. Risks of necrotic complications and diminishing nipple-areola complex (NAC) sensation are common complications affecting the patient’s satisfaction after the surgery. The evaluation of NAC sensation should be also investigated.Methods:We prospectively analyzed 55 NSMs that were performed on 52 patients for both therapeutic and prophylactic indications in Ramathibodi Hospital from May 2007 to September 2015. Patients’ demographics, operative details, oncologic outcome, and postoperative complications, focusing on NAC sensation and necrotic complications, were analyzed.Results:Forty-seven NSMs (87%) were performed for therapeutic indications, and another 7 NSMs (13%) were risk-reducing operations. Of the 43 patients performing NSM for breast cancer treatment, 33 patients (77%) had invasive cancer and 11 patients (23%) had ductal carcinoma in situ. One subareola base tissue was found an occult cancer, and the NAC was then removed. There were 3 locoregional recurrences after a median follow-up time of 24 months (range, 2–104 months). The NAC sensation was evaluated in a total of 35 patients. Twenty-five patients (46%) underwent serial evaluation after 6 months of operation, and 10 patients were evaluated at more than 1 year after operation. In the first 6 months, 11 patients (44%) showed partial sensation recovery, and 3 more patients had partial recovery after 1-year follow-up. Only 1 patient (2%) had complete sensation recovery in all area of the NAC. In late evaluation group, 7 out of 10 patients had partial recovery. Most pain sensation remained in the lower aspect of the areola away from surgical incision.Conclusions:NSM is technically feasible in selected patients with low rates of NAC removal. Some patients can preserve the NAC sensation. Long-term outcome should receive follow-up.

BACKGROUNDNipple-areola complex (NAC) is a signature of the breast. Preservation of the NAC has a positive impact on patients' satisfaction with cosmetic results and feeling of mutilation. 1 Nowadays, there are still no reconstruction techniques quite as satisfying as the real NAC. Nipplesparing mastectomy (NSM) is developed to optimize es-thetic outcomes. However, the oncologic safety and the postoperative viability of the NAC are important concerns. Welling and Jensen 2 postulated that the origin and progression of ductal carcinoma in the breast are from terminal duct lobular unit, and pathological study found only 9% of terminal duct lobular unit at the base of the nipple from mastectomy specimens. 3 According to the aforementioned data, preservation of NAC can still be performed if there is no evidence of cancer cell at the base of the nipple. NSM is also an option for patients requiring riskreduction mastectomy and has a role in treating breast cancer in selected patients. 4 Several studies reported an occult NAC involvement on mastectomy specimens varying from 0% to 58%. These results are due to the differences in the inclusion criteria and the pathological assessment method between stud- From the Breast and

Background The latissimus dorsi (LD) flap is one of the most popular techniques in breast reconstruction. Although numerous studies have not shown functional impairment of the shoulder after surgery, other studies have reported significant functional impairment, especially after extended LD flap reconstruction. The present study compared functional deficit and shoulder movement between extended LD and LD flap reconstruction. Materials and methods Between December 2015 and May 2018, this study enrolled 31 patients undergoing LD flap reconstruction. Data on patient demographics, operative details, morbidities, and degree of shoulder movement were collected. Outcomes were compared between the extended LD and LD flap groups. Results Twenty-one women and 10 women underwent LD flap and extended LD flap reconstruction, respectively. The median patient age was 43 years. No demographic data differed between groups. Seroma, especially around the back incision, was the most common complication (90.5% in the LD flap and 90% in the extended LD group). Five patients in the LD flap group and one patient in the extended LD flap group showed decreased shoulder range of motion (ROM) at 6 months post-operation. Only one patient in the LD flap group showed impairment based on American Shoulder and Elbow Surgeons Shoulder Score (ASES). The results did not differ significantly between groups; however, the LD flap group showed faster functional recovery. Conclusion LD flap reconstruction can be performed with a very low impact on shoulder function. We observed a slightly decreased ROM for both LD flap techniques, with no impact on functional outcome.

Key Clinical MessageThis report presents the results of immediate breast reconstruction with autologous flap in Pregnancy‐associated breast cancer (PABC). There was no obstetrics and surgical complications in our report. Immediate breast reconstruction can be performed in PABC after a careful selection. Multidisciplinary team approach is the key in managing these groups of patients.

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