PurposeIndications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion.MethodsThe panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology.ResultsConsensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference.ConclusionsIn case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.

Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.

The technique allowed breast conservation in situations requiring large resection of affected skin, with free surgical margins, correction of ptosis, satisfactory symmetry, and few complications.

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Duct ectasia consists of dilation of the mammary ducts and is clinically manifested as nipple discharge, which is more commonly multiductal, bilateral, and colored. To identify clinical factors that might be related to duct ectasia. A case-control study was carried out on a population of 150 patients divided into two groups. Group 1 (the experimental group) comprised 100 patients with multiductal, bilateral, and colored nipple discharge, clinically representing the nipple secretion of duct ectasia. Group 2 (the control group) was composed of 50 patients without nipple discharge. The odds ratio of duct ectasia was three times higher for current smokers (p=0.04). Likewise, smokers from the duct ectasia group had smoked for a longer time (median 25 months) compared to smokers from the control group (median 15 months) (p=0.02). Parity, history of abortion or termination, breast-feeding, hormonal contraceptive use, and history of breast abscess did not increase the risk for duct ectasia. The group of women with duct ectasia was associated with current tobacco smoking.

CONTEXT AND OBJECTIVE: Excessive gestational weight gain is related to many complications (both maternal and fetal), such as macrosomia. The most common complications in macrosomic fetuses include: increased risk of intrauterine death, need for intensive care, fractures, neonatal hyperbilirubinemia, paralysis of the brachial plexus and obesity in childhood and adulthood. The aim of this study was to evaluate the association between gestational and fetal weight gain and the incidence of macrosomia in two maternity hospitals. DESIGN AND SETTING: Cohort study in two public maternity hospitals in Goiânia, Brazil. METHODS:This was a cohort study on 200 healthy pregnant women with normal body mass index, divided into two groups: one with normal weight gain and the other with excessive weight gain during pregnancy. RESULTS:The cohorts were similar regarding maternal age, per capita income, schooling level and reproductive behavior. The fetal weight was greater in the cohort with excessive maternal weight gain (3,388.83 g ± 514.44 g) than in the cohort with normal weight (3,175.86 g ± 413.70 g) (P < 0.01). The general incidence of macrosomia was 6.5%: 13.0% (13 cases) in the cohort with excessive maternal weight gain and 0.0% (0 cases) in the cohort with adequate weight gain. CONCLUSION: Excessive maternal weight gain was associated with increased fetal birth weight and incidence of macrosomia.RESUMO CONTEXTO E OBJETIVO: O ganho de peso gestacional excessivo está relacionado a inúmeras complicações tanto maternas como fetais, como por exemplo, a macrossomia. Esta, por sua vez, pode aumentar o risco de morte intra-uterina, necessidade de cuidados intensivos, fraturas, hiperbilirrubinemia neonatal, paralisia do plexo braquial e obesidade na infância e fase adulta. O objetivo deste estudo foi avaliar a associação do ganho de peso gestacional com o ganho de peso fetal e a incidência de macrossomia em duas maternidades. TIPO DE ESTUDO E LOCAL: Estudo de coorte em duas maternidades públicas em Goiânia, Brasil. MÉTODOS: Estudo de coorte com 200 gestantes saudáveis com índice de massa corporal normal, divididas em dois grupos, um com ganho de peso adequado e o outro com peso excessivo na gravidez. RESULTADOS: As coortes foram semelhantes quanto à idade materna, renda per capita, escolaridade e comportamento reprodutivo. O peso fetal foi maior na coorte de ganho de peso materno excessivo (3388,83 g ± 514,44 g) do que na de peso normal (3175,86 g ± 413,70 g) (P < 0,01). A incidência geral de macrossomia foi 6,5% sendo de 13,0% (13 casos) na coorte com ganho de peso materno excessivo e de 0,0% (0 casos) na de peso adequado. CONCLUSÃO: O ganho de peso materno excessivo esteve associado ao aumento do peso fetal ao nascer e à incidência de macrossomia.

O câncer de mama apresenta elevada incidência e mortalidade em todo o mundo, representando um grave problema de saúde pública. A incidência dessa neoplasia vem aumentando nas últimas décadas, mesmo em áreas de tradicional baixa incidência, em grande parte devido às mudanças nos hábitos de vida e no perfil epidemiológico da população. Vários países desenvolvidos têm conseguido, apesar desse aumento na incidência, reduzir a sua mortalidade, através de um diagnóstico mais precoce e de um tratamento mais eficaz. Nesse artigo comentamos as tendências atuais para o câncer de mama em vários locais do mundo, de forma comparativa, bem como os possíveis fatores envolvidos nessas mudanças. Dispensamos particular atenção à situação do Brasil, e da cidade de Goiânia.

The onset of the COVID-19 pandemic has changed the face of the treatment of breast cancer and breast reconstruction globally. Mastectomy with immediate implant-based breast reconstruction was on the rise due to advances in meshes and implants. However, due to the prioritisation of the critically ill and diversion of the work force, breast cancer treatment has drastically changed. This is an opinion paper written by the authors with experience and importance in the scenario of breast reconstructive surgery. The authors are from different countries with the COVID-19 pandemic in different stages.