Phyllodes tumor is an uncommon breast neoplasm that is present in variable sizes. Giant phyllodes are those larger than 10 cm in diameter. Clinically, giant phyllodes tumors present as a visible, rapidly growing mass distorting the breast contour. Such tumors with large size and rapid growth rate suggest a phyllode diagnosis of fibroadenoma. Planning a standard treatment strategy for these tumors is quite challenging. While adequate surgical excision with tumor-free resection margins is the standard of care for most giant phyllodes cases, borderline and malignant giant phyllodes tumors might require wider resections given their high recurrence rates. Some authors described total mastectomy as the treatment option for giant borderline and malignant phyllodes to obtain wide, clear margins. Between March 2022 and September 2023, our surgical oncology department presented and operated on three cases of giant phyllodes. They underwent a nipple-sparing mastectomy and immediate breast reconstruction using pre-pectoral silicone implants. We think that with such a procedure, we can benefit from the wide, safe margins of mastectomy that have been proven to decrease local recurrence rates while considering the aesthetic outcome.

UNASSIGNED: Breast reconstruction following mastectomy is a critical component of breast cancer treatment, aimed at improving patient quality of life. However, the management is fraught with potential complications, including skin necrosis and wound dehiscence, which can significantly impact clinical outcomes.
UNASSIGNED: We report a unique case of a patient, 5 years post-breast reconstruction following mastectomy and radiation therapy, who developed severe skin necrosis and wound dehiscence due to a brown recluse spider bite on the reconstructed breast. The complication necessitated the debridement of skin, removal of the implant, and further reconstruction with a latissimus flap.
UNASSIGNED: The case underscores the unusual etiology of spider bite-induced necrosis in breast reconstruction and highlights the challenges and strategic considerations in managing such complications. Upon presentation, the patient\'s affected breast area showed signs of extensive necrosis and wound dehiscence, directly attributed to the cytotoxic effects of the brown recluse spider\'s venom. The venom\'s pathophysiology involves a complex cascade, leading to local and systemic effects. The local effects, marked by dermonecrosis, com- promised skin integrity in this instance. Systemic effects, not observed in this patient but potentially severe, can include hemolysis, coagulopathy, and acute renal failure, highlighting the seriousness of brown recluse spider bites.
UNASSIGNED: In conclusion, this case illustrates the complexities of managing breast reconstruction post-mastectomy complications, particularly those caused by external factors such as brown recluse spider bites. It highlights the need for meticulous attention to unusual etiologies of necrosis and dehiscence, demonstrating the importance of adaptable surgical strategies and a thorough understanding of venom pathophysiology in ensuring successful patient outcomes.

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UNASSIGNED: Persistent lactation, or galactorrhoea, is a common problem which is infrequently seen in the setting of aesthetic surgery. Increasing frequency of aesthetic breast surgery such as breast augmentation suggests a need for improved understanding of the effect of galactorrhoea on surgical outcomes.
UNASSIGNED: A 34-year-old patient underwent day-case bilateral breast reduction/mastopexy combined with sub-muscular implant augmentation, abdominoplasty and bilateral liposuction to the flanks. She reported to have stopped breastfeeding more than 6 months prior. Intraoperatively, the breast tissue was noted to be lactating. The procedure was completed as planned and a routine postoperative plan was followed including oral antibiotics, analgesia and compression garments. The patient was discharged, however reattended on postoperative day 10 with breast pain and fevers. She was treated for right breast surgical site infection and required washout and implant removal. She was referred to Endocrinology for treatment of galactorrhoea with Bromocriptine and Cabergoline. She subsequently underwent revision implant augmentation with good outcomes.
UNASSIGNED: This case highlights the increased likelihood of post-operative infection in galactorrhoea associated with breast implant augmentation. It is important to exclude lactation preoperatively and avoid a prosthesis in this situation, to minimise this risk and optimise surgical outcomes.
UNASSIGNED: Aesthetic breast surgeons must be aware of the incidence of galactorrhoea, and its possible effects on risks of postoperative complications and poor aesthetic outcomes. The authors suggest deferring implant augmentation until complete resolution of lactation where possible.

Pyoderma gangrenosum (PG) is a rare disease characterized by ulcerative cutaneous lesions that can occur postoperatively and is often associated with autoimmune disorders. PG is diagnosed by excluding other conditions that can cause ulcerations, such as infections, which may also result in immunosuppressive treatment delays and suboptimal wound care. Operative debridement of wounds has traditionally been avoided in the acute setting secondary to pathergy. This article presents a case of extensive breast PG that was successfully treated with surgical debridement, porcine-derived extracellular matrix, and negative pressure wound therapy while on systemic immunosuppressive therapy.

UNASSIGNED: To explore the effects of Beck\'s cognitive therapy on the anxiety of patients after breast reconstruction.
UNASSIGNED: This study retrospectively analyzed clinical data of 150 patients with breast cancer undergoing breast reconstruction from June 2020 to June 2021 in our hospital, excluded 5 patients who did not meet the inclusion criteria, divided the remaining cases into an experimental group (EG, n = 70, perioperative routine management + Beck\'s cognitive therapy intervention) and a reference group (RG, n = 75, perioperative routine management) in accordance with different perioperative intervention programs, and compared the emotions of anxiety and depression, sense of social disability, and prognosis quality in both groups.
UNASSIGNED: At 2 months after surgery (T2) and 3 months after surgery (T3), EG had overtly lower Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores than RG (P < .05), with no difference in HAMA and BDI scores at 3 days before surgery (T0) and 1 month after surgery (T1) (P > .05). At the T0 stage, both groups were diagnosed as having a social disability, with no overt difference (P > .05). At T1 stage, The Social Disability Screening Schedule (SDSS) scores in both groups increased remarkably and fell back at the T2 and T3 stages. At T1-T2 stages, SDSS scores of EG were significantly different from those of RG (P < .05), with no significant difference at T3 stage (P > .05). The excellent rate of prognosis in EG was 78.57% (55/70), higher than 77.33% (58/75) in RG, with no statistical difference in both groups (P < .05).
UNASSIGNED: The implementation of Beck\'s cognitive therapy in patients with breast reconstruction effectively improves adverse emotions in patients, which is of great significance for promoting postoperative rehabilitation and is an effective intervention program in the perioperative period.

UNASSIGNED: In today\'s world, the concept of gender has been scrutinized and an appreciation for those who experience dysphoria with their birth sex and gender classification is becoming more commonplace. Keeping in mind the patients gender orientation in addition to their birth sex is necessary when assessing health conditions more prevalent in one sex, such as breast cancer.
UNASSIGNED: In this report, we present a 51-year-old African American transgender female with history of chemotherapy and mantle-field radiation treatment for sub-clavicular and mediastinal Hodgkin\'s lymphoma 24 years prior to presentation of a new left neck mass. The enlarged lymph node was removed revealing metastatic salivary adenocarcinoma with features corresponding to metastatic breast carcinoma. Computed tomography (CT) of the chest, abdomen, and pelvis detected metastasis to the pelvis and a few lucent bone lesions in the lumbar spine. Of note, the patient underwent free silicone injections into both breasts to emphasize her desired gender three years after treatment for Hodgkin\'s lymphoma. Based on her history of metastatic disease and history of mantle radiation, it was determined that her previous cancer diagnoses were likely due to metastatic breast cancer that was obscured by silicone injections. Bilateral skin-sparing mastectomy was performed, patient recovered well, and continued with palliative care at follow up.
UNASSIGNED: Even though there is significant data regarding the incidence of breast cancer in the separate female and male populations, review of the literature shows minimal information regarding incidence in the transgender population. Our hope is that this report will contribute to the current base of knowledge present in the literature while also bringing attention to the need for further investigation of sex-specific diseases in transgender individuals.

Borderline phyllodes tumor is a rare and benign form of breast cancer with malignant potential. According to the World Health Organization (WHO), phyllodes tumor is classified into three categories: benign, borderline, and malignant. The treatment of phyllodes tumor is wide focal excision combined with radiotherapy and chemotherapy in certain cases. Herein, we report a 47-year-old female who presented with a giant borderline mass approximately 19.5 x 16.9 x 9.3 cm in size. From medical history, we noticed that the mass begun to develop during puberty. Wide focal excision of the tumor and immediate implant-based reconstruction with free nipple graft was performed, with the tumor specimen measuring 16.5 x 14.2 x 8.7 cm. Histological examination reported a borderline phyllodes tumor, and in this case, the patient did not undergo adjuvant treatment.

In the vast expanse of restorative surgical procedures, the Deep Inferior Epigastric Perforator (DIEP) flap, originating from the inferior epigastric artery, has emerged as the preferred method of breast reconstruction, attributable to its myriad advantages. The technique provides reliable vascular supply, robust tissue volume for excision, minimal invasiveness to the donor site, with direct closure and concealment of the said site. This paper embarks on an elaborate elucidation of the DIEP surgical procedure, pivoting on the analytical exploration of a particular instance where necrosis of the skin flap occurred following immediate DIEP breast reconstruction in a patient diagnosed with early-stage breast cancer. This patient had previously undergone Nipple Areola Complex Sparing Mastectomy (NSM). We endeavor to extrapolate insights from this singular case of post-NSM DIEP breast reconstruction failure and correlate our findings with current literature dedicated to similar instances of surgical failure in DIEP breast reconstruction.

UNASSIGNED: Ehlers-Danlos syndrome (EDS) refers to a group of heritable connective tissue disorders (HCTDs). Clinical hallmarks of EDS include tissue fragility, joint hypermobility, and skin hyperextensibility. One of the consequences of tissue fragility is abnormal wound healing and scar formation, posing potential challenges for surgeons treating these patients. There are limited previous reports of EDS patients undergoing mastectomy and/or breast reconstruction, and none wherein the patient had diagnoses of both vascular EDS (vEDS) and classical EDS (cEDS).
UNASSIGNED: A 41-year-old female was referred to the plastic surgery clinic for breast reconstruction consultation after diagnosis of left breast lobular carcinoma in situ (LCIS). She has a past medical history of cEDS and vEDS with associated pectus carinatum, thoracic root dilation, and hypermobile joints. After shared decision making with the patient and her breast surgeon, it was decided the patient would benefit from bilateral prophylactic mastectomies with immediate 2-stage tissue expander (TE) reconstruction.
UNASSIGNED: The patient reported here had an unremarkable postoperative course. Her complications were limited to more than average bleeding during the first stage of reconstruction, which was easily managed with meticulous intraoperative hemostasis, and a small uncomplicated submuscular seroma 1week postoperative. She had no complications following TE to implant exchange and continues to heal well.
UNASSIGNED: This case report documents a case in which a patient with both cEDS and vEDS had an unremarkable surgical and postoperative course following bilateral prophylactic mastectomies with 2-stage TE reconstruction.