Breast-Related Herniation: A Call for Multidisciplinary Awareness and a Proposal for a Classification.

Breast-related herniation (BRH) is a vague term for many clinicians. The absence of a universal nomenclature and the different nature of the herniation process involved, being true or false, contribute to this vagueness. BRH includes a spectrum of disorders ranging from a few congenital breast disorders to commoner herniation processes related to acquired breast diseases.

Defining a danger zone for iatrogenic long thoracic nerve injury in gender-affirming mastectomy.

The long thoracic nerve's (LTN) superficial location on the chest wall renders it vulnerable to iatrogenic injury. Plastic surgeons' gender-affirming mastectomy volumes are rapidly increasing. This operation involves lateral chest contouring placing the distal LTN at risk of injury along the chest wall.

Combined chest wall perforator flap and synchronous fat grafting for partial breast reconstruction.

Chest wall perforator flaps (CWPFs) have been a well-recognised surgical option for volume replacement following breast conservation surgery (BCS). However, the flap volume can sometimes be limited, which may adversely affect the aesthetic outcome or even disqualify the patient from having BCS. We report the first case of hybrid partial breast reconstruction using immediate autologous fat injection into CWPF.

Pectoralis I and Serratus Anterior Plane Block Analgesia for Bilateral Mastectomy: A Case Series.

Background: Poorly controlled acute breast surgery postoperative pain is associated with delayed recovery, increased morbidity, impaired quality of life, and prolonged opioid use during and after hospitalization. Recently, ultrasound-guided pectoralis nerve (PECS) I block and serratus anterior plane (SAP) block, together or individually, have emerged as a potential method to relieve pain, decrease opioid requirements, and improve patient outcomes.

Objective: The aim of this study was to assess if the addition of a PECS I/SAP block in patients undergoing bilateral mastectomies provides more effective perioperative analgesia compared to standard analgesia.

Functional and Aesthetic Outcomes of Patients Underwent Modified Ravitch Technique for Repair of Pectus Excavatum.

Background: Pectus excavatum is the most frequent congenital defect of the chest wall. Surgical treatment with modified Ravitch-type repair is recommended in patients with cosmetic dissatisfaction or considerable cardiopulmonary symptoms. We aimed to analyze the surgical, aesthetic, cardiopulmonary functions and patient satisfaction outcomes of modified Ravitch repair pre and postoperatively.

[Chest Wall Reconstruction with Polypropylene Mesh After Resection of Primary Sternal Chondrosarcoma].

Although rare, primary sternal chondrosarcoma (PSC) is the most common primary malignant chest wall tumor. Here, we report a rare case of PSC treated with partial sternal resection and reconstruction. A 47-year-old man presented with subcutaneous anterior chest wall mass and chest pain.

Five-year experience with titanium mesh for rigid chest wall reconstruction.

Objective: To characterize the performance of titanium mesh (TM) (off-label) for rigid chest wall reconstruction at a single institution over a 5-year period.

Methods: Between January 1, 2019, and May 15, 2023, 22 patients (median age, 61 years) underwent chest wall resection with TM reconstruction at Cleveland Clinic. Indications for resection included sarcoma (n = 15), breast cancer (n = 2), lung cancer (n = 2), chondroblastoma (n = 1), and benign neoplasm (n = 2).

Contemporary Trends in Reconstruction for Patients With Sarcoma of the Breast.

Introduction: Breast sarcomas are rare, heterogeneous malignancies often associated with prior radiation and require a multidisciplinary approach, including a comprehensive reconstruction plan. We analyzed reconstructive outcomes in a large cohort of patients with breast sarcomas and provide a contemporary treatment algorithm.

Methods: We retrospectively reviewed patients who underwent breast reconstruction after surgical treatment for breast sarcoma at our institution between January 2010 and December 2023.

Traumatic Thoracic Blast Injury With Extensive Soft Tissue Damage, Volumetric Muscle Loss, and Full-Thickness Burns From a Flashbang Detonation: A Case Report.

Chest trauma is a common injury in civilian and military polytrauma patients and is a leading cause of death and chronic disabilities. Evolving surgical techniques and advancements in chest wall reconstruction have improved clinical outcomes, reduced operative complications, and decreased mortality. In this case report, a 23-year-old male U.

Impact of Pre-pectoral Implant Placement and Radiation Modalities (Protons/Photons) in Mastectomy Patients undergoing Immediate Direct-to-Implant Breast Reconstruction.

Background: For breast cancer patients receiving mastectomy with direct-to-implant (DTI) immediate breast reconstruction, placing the implant in the pre-pectoral or subpectoral plane remains debatable; especially in settings of postmastectomy radiotherapy (PMRT).

Materials/methods: We reviewed 3,039 patients who underwent mastectomy and reconstruction at our institution between 2005 and 2020. Patients receiving DTI with and without PMRT were included.

Endoscopic-Assisted Latissimus Dorsi Muscle Flap for Chest Wall Reconstruction in Poland Syndrome: Clinical Application and Literature Review.

Background: Poland syndrome is a rare congenital chest wall developmental defect. Traditional reconstruction applies open to harvest of the latissimus dorsi muscle flap, but issues like large incisions and high complication rates exist. Endoscopic-assisted harvest of the latissimus dorsi muscle flap has minimally invasive advantages worth exploring for application in Poland syndrome patients.

Surgical Algorithm of Poland Syndrome Based on Thorax, Breast, and Nipple-areola Complex Classification.

Background: Poland syndrome (PS) is a rare congenital syndrome characterized by unilateral pectoralis major muscle defect. In 2016, we proposed the thorax, breast, and nipple-areola complex (TBN) classification and a subsequent treatment algorithm, which included conservative and surgical procedures. Our aim is to report the results we obtained treating all thoracic anomalies according to the proposed algorithm in a cohort of adolescents affected by PS.

Complex Surgical Management of Extensive Chest-Wall Desmoid Fibromatosis.

Desmoid fibromatosis (DF) is a rare tumor that arises from fibroblasts and myofibroblasts and typically presents on the trunk and limbs. While metastasis of fibromatosis is exceedingly uncommon, DF can spread rapidly to adjacent tissue. Its aggressive nature and frequent recurrence pose challenges for treatment, often requiring a multidisciplinary approach.

Treatment approaches and outcomes of major chest wall resections and reconstructions in patients with soft tissue and bone sarcomas: a retrospective observational study.

Background: Chest wall sarcomas are rare and pose significant technical challenges in surgical management, particularly in patients with advanced disease. In this study, we examined the extent of resection, reconstruction techniques, and oncological outcomes of patients with chest wall soft tissue and bone sarcomas.

Methods: This retrospective single-center series included patients who underwent surgery at our center between May 2014 and February 2022 for deep-seated/subfascial primary and recurrent soft tissue or bone sarcomas of the chest wall requiring significant resection and extensive reconstruction.

Chest wall resections for advanced breast cancer: a narrative review.

Background And Objective: Advanced breast cancer (BC) can involve the chest wall through local invasion by the primary tumor, locoregional recurrence, hematogenous metastasis, or sternum infiltration of the internal mammary chain lymph nodes. The purpose of this article is to review indications and the methods of chest wall resection and reconstruction in patients with advanced BC.

Methods: An online literature search was conducted on PubMed database using the following keywords: "chest wall reconstruction" or "chest wall resection" and "breast cancer".

Optimizing Surgical Outcomes: A Case Series on BREAST-V for Treating Breast Asymmetries.

Background: Breast asymmetry occurs when there is a discrepancy in the shape, volume, or positioning of the breasts. Various factors, including unequal development of breast buds, endocrine disorders, chest wall deformities, and surgical or posttraumatic sequelae, can contribute to this condition. Although breast asymmetry is common, clinically severe cases are rare and often require surgical correction because of potential postural, aesthetic, and psychological issues.

Internal mammary artery perforator-based plug flap.

Introduction: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fascio-cutaneous pedicled chest wall perforator flaps or local perforator flaps (CWPF).

Case Presentation: We present a case of reconstruction with internal mammary artery perforator (IMAP)-based plug flap to fill the infero-medial defect caused by a tumor close to skin, with visible retraction.

Repair of Radiation Ulcers After Breast Cancer Surgery With Simple Local Random Flaps.

Background: Radiation ulcers that develop after breast cancer surgery are mainly repaired with pedicled flaps or free flaps rather than local random flaps or skin grafts due to large skin defects and poor wound healing. Complicated surgical techniques and donor site reconstruction increase the risk of failure. We report our experience of using the local random long neck reading man flap (LNRMF) to cover large chest wall radiation ulcers, achieving good outcomes.

Surgical management of a chest wall osteosarcoma with pleural and lung invasion through chest resection and complex reconstruction. Case report.

Osteosarcomas of the ribs are rarely reported but have a high potential for pulmonary metastases. The therapeutic strategies for this disease are not well defined. The primary treatment recommendations include wide resection with clear surgical margins and chest wall reconstruction if needed.