Introduction:The aim of the study was to report the safety, efficacy, and patient-reported outcomes of a prospective trial of weekly hypofractionated radiotherapy (RT) for symptomatic locoregionally advanced breast cancer. Methods:In this single-arm, prospective phase II trial, 24 patients received a palliative RT course of 40 Gy delivered in five, weekly 8-Gy fractions. The primary endpoint was dose-limiting toxicity (DLT), defined as grade ≥3 acute radiation dermatitis. Secondary endpoints included objective response rate (ORR) and health-related quality of life (HRQoL), assessed longitudinally using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30/BR23 and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaires. Results:All 24 enrolled patients completed the prescribed treatment. The regimen led to profound and statistically significant improvements in EORTC Global Health/QoL scores (+44.1 points; 95% Confidence Intetval [CI]: 34.6 to 53.7; p < 0.001) and pain scores (-33.3; 95% CI: -39.0 to -27.7; p < 0.001) at 3 months, which were sustained at 6 months. At 3 months, the Overall Response Rate (ORR) was 40.9% (95% CI: 20.7% to 63.6%). The primary DLT was grade ≥3 acute dermatitis, occurring in 29.2% of patients; however, this toxicity was transient, with all events occurring at treatment completion and the rate decreasing to 8.3% by the 1-month follow-up. Conclusion:This signal-seeking study demonstrates the feasibility of a 40 Gy in 5-fraction palliative regimen. It presents a manageable, transient acute toxicity profile and offers promising signals of symptom palliation, locoregional disease control, and associated improvements in patient-reported QoL.
Introduction:As healthcare systems aim to optimize resource utilization, ambulatory breast surgery has been proposed as an alternative to inpatient care. However, data comparing direct hospital costs and identifying cost drivers for needle-localized breast biopsy (NLB) remain limited, particularly in low- and middle-income settings. Methods:This retrospective cohort study included adult patients who underwent NLB at a tertiary academic medical center between January 2020 and December 2024. Patients were classified as ambulatory (day surgery) or inpatient according to admission status. Total direct hospital costs were compared between groups, and multivariable linear regression was used to identify factors associated with increased cost. Costs were reported in Thai Baht (THB) and converted to U.S. dollars (USD) using an exchange rate of 1 USD = 33.82 THB. Results:A total of 392 patients were included, of whom 33 underwent ambulatory surgery and 359 underwent inpatient surgery. The ambulatory group was younger (47.9 ± 8.7 vs. 53.3 ± 10.5 years; p = 0.005) and had lower median hospital costs (13,250 THB [391.7 USD] vs. 21,470 THB [634.9 USD]; p < 0.001). In multivariable analysis, inpatient admission (β = 6,378.03 THB [188.48 USD]; p < 0.001) and longer operative time (β = 122.86 THB [3.63 USD] per minute; p < 0.001) were independently associated with higher costs. Age, American Society of Anesthesiologists (ASA) classification, and preoperative biopsy status were not significant predictors. Conclusions:Ambulatory NLB was associated with lower direct hospital costs than inpatient care in this single-center cohort. Admission status and operative time were associated with higher expenditure. These findings reflect real-world practice in selected patients; however, the observational design, marked group imbalance, and absence of safety events limit causal inference and preclude firm conclusions regarding comparative safety.
Introduction: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory breast condition that frequently mimics carcinoma, posing significant diagnostic and therapeutic challenges. In tuberculosis-endemic regions, differentiation from tuberculous granulomatous mastitis (TGM) is particularly critical. This dual-centre retrospective study from North India evaluates the clinical, radiological, and pathological profiles of granulomatous mastitis and compares outcomes across different management strategies. Methods: We retrospectively reviewed 67 consecutive patients with histopathologically confirmed granulomatous mastitis treated between 2022 and 2024. Diagnosis was established using core needle biopsy, followed by a standardized evaluation to exclude tuberculosis. Patients were managed with observation with aspiration, corticosteroid therapy (systemic or intralesional), or surgical intervention based on disease severity and treatment response. Results: Of the 67 patients, 58 (86.5%) were diagnosed with IGM and 9 (13.4%) with TGM. Observation with aspiration was the most common initial approach for IGM (n=37, 63.7%). Although 35.1% experienced recurrence by 6 months, all achieved complete remission by 18 months without treatment escalation. Systemic corticosteroid therapy (n=3) was associated with recurrence in all cases, whereas intralesional steroid injections (n=3) resulted in sustained remission without recurrence. Surgical intervention was reserved for 13 patients with refractory disease and yielded favourable long-term outcomes. Conclusion: Accurate distinction between IGM and tuberculosis is essential in endemic settings. Our findings support a step-wise approach to IGM with a long-term follow-up to address the high rate of recurrence in these patients.
Introduction:Liquid biopsy (LBx) is a minimally invasive diagnostic approach that allows molecular profiling of circulating tumor DNA. In hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer, early detection of actionable mutations is critical for guiding therapy. ESR1 mutations mediate resistance to aromatase inhibitors and predict response to (oral) selective estrogen receptor degraders. Despite its clinical relevance, data on the real-world application of LBx remain limited. Methods:We retrospectively analyzed 162 patients with HR-positive, HER2-negative metastatic breast cancer who underwent LBx testing in routine clinical care. Hybrid capture-based next-generation sequencing with high read depth (∼5,000-7,000×) was used to assess mutation profiles across a multigene panel, rather than single-gene assays such as ddPCR. Particular focus was placed on the detection of ESR1 mutations and their therapeutic implications. Results:Of 162 patients, ESR1 mutations were detected in n = 46 (28.4%). Among these, 20 (43.5%) patients received elacestrant based on the molecular findings. LBx was feasible, rapidly implemented (∼8.7 days), and repeatable in routine practice. Detection of ESR1 mutations directly influenced treatment decisions, enabling the timely initiation of targeted endocrine therapy. Other recurrent mutations included PIK3CA, PTEN, and AKT, with potential therapeutic relevance. Conclusion:These real-world data support the clinical utility of LBx guidance in the metastatic setting. It is a rapid, minimally invasive, and informative diagnostic method for identifying resistance mutations such as ESR1 and guiding endocrine therapy decisions, including the use of elacestrant. LBx should be integrated as early as possible in the treatment algorithm and not reserved for late treatment stages when therapeutic options are limited. Repeating LBx at the time of progression of disease should be discussed depending on possible therapeutic implications.
Introduction:Negative experiences during mammography can reduce patient's adherence. Yet patient-reported measures focusing on the diagnostic pathway remain limited, particularly in general radiology departments that are not specialized in breast imaging only. This prospective study evaluated the overall patient satisfaction with digital mammography (DM) using a tailored patient-reported experience measure (PREM) and examined associations with personal, clinical, and procedural factors to identify actionable quality-assurance targets. Methods:Women undergoing DM or digital breast tomosynthesis for screening, surveillance, follow-up of high-risk lesions, or diagnostic clarification at a medium-sized general hospital were recruited between February and July 2023. Of 885 eligible women, 549 (62%) aged 29-88 years completed a validated 23-item PREM questionnaire. Associations between satisfaction and personal (age, anxiety, pain), clinical (breast density, cancer history), and procedural factors (radiographer communication, radiologist consultation) were assessed using Fisher's exact test, Kendall's tau-b (τb) correlations, and ordered logistic regression. Significance was set at p < 0.05. Free-text comments were analyzed using IRaMuTeQ to identify thematic clusters. Results:Overall, 78% (428/549) of participants reported full satisfaction with DM. Satisfaction was significantly related to personal and procedural factors (p < 0.05), particularly anxiety (τb = -0.2), pain (τb = -0.3), age (τb = 0.1), radiographer communication (τb = 0.3), and efforts to reduce discomfort (τb = 0.4). Consultations with a breast radiologist immediately after DM markedly increased the likelihood of full satisfaction (+14 percentage points). In contrast, clinical variables, including breast cancer history, breast density, and familial risk, showed no significant association with satisfaction (p > 0.05). Free-text analysis revealed four influencing dominant themes: waiting time before radiologist consultation, staff competence, gratitude toward radiographers and radiologists, and the physical environment of examination rooms. Conclusion:Patient satisfaction with DM in a nonspecialized general radiology department is predominantly shaped by modifiable procedural and interpersonal factors rather than clinical factors. Radiographers' communication and efforts to reduce discomfort emerged as key determinants of satisfaction, alongside immediate result communication by radiologists. PREMs are feasible to implement in routine breast imaging workflows and offer valuable insights for quality assurance and patient-centered optimization of mammography services. Clinical relevance statement:Systematically measuring women's experiences using PREMs help identify practical improvement targets, such as communication quality, workflow design, and timely result disclosure, that may enhance patient satisfaction, reduce anxiety, and potentially increase adherence to breast cancer imaging recommendations.
Introduction:Invasive lobular carcinoma (ILC) is a distinct histological subtype of breast cancer characterized by hormone receptor positivity, low proliferative activity, and unique metastatic patterns. However, recent evidence suggests that biomarker profiles in metastatic sites may differ from those in primary tumors, potentially reflecting biological heterogeneity. Methods:A retrospective review was conducted on 108 patients diagnosed with ILC who underwent immunohistochemical evaluation of both primary breast tumor and metastatic axillary lymph node specimens between 2012 and 2021. Differences in estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 expression were analyzed using paired statistical tests, including McNemar's and Wilcoxon signed-rank tests. Subgroup analyses were performed according to the receipt of neoadjuvant chemotherapy (NeoCT), although findings in the NeoCT subgroup were interpreted as exploratory because treatment may influence biomarker expression. Histological grade was also evaluated, and its association with primary tumor Ki-67 was analyzed exploratorily. Results:No significant differences were observed in ER, PR, or HER2 expression between primary tumors and metastatic axillary lymph nodes (p > 0.05). However, a significant increase in the Ki-67 proliferation index was found in metastatic lymph nodes compared with matched primary tumors (median 28% vs. 18%, p < 0.001). Consequently, 37.9% of patients exhibited a surrogate molecular subtype conversion from Luminal A-like to Luminal B-like. Histological grade was significantly associated with primary tumor Ki-67, with median values of 10%, 12.5%, and 32.5% for grade 1, grade 2, and grade 3 tumors, respectively (p = 0.00014). Conclusion:Metastatic axillary lymph nodes in ILC display higher proliferative activity compared to primary tumors, resulting in a substantial rate of conversion from Luminal A-like to Luminal B-like. These findings support biological heterogeneity between primary and nodal disease; however, their direct prognostic and therapeutic implications remain uncertain.
Introduction:Breast cancer is a significant disease as it is the most frequently diagnosed cancer and the leading cause of cancer-related mortality among women. The factors affecting the prognosis of breast cancer are receiving considerable attention. Although lesions with uncertain malignant potential (B3 lesions) show benign histological characteristics, they are associated with an increased risk of malignancy. Methods:This study included 296 patients who underwent surgery and were followed up with a diagnosis of breast cancer in our clinic. The patients were divided into two groups based on the presence of at least one pathologically confirmed B3 lesion in the surgical specimen. The demographic characteristics and clinicopathological data of the patients were recorded, and the effect of B3 lesions on prognosis was examined. Recurrence and metastasis dates were examined to evaluate disease-free survival and overall prognosis. Results:It was observed that patients with breast cancer who had accompanying B3 lesions were diagnosed at an earlier stage and had better survival rates than those without these lesions. The survival and disease-free survival rates of patients with lobular neoplasia accompanying invasive lobular carcinoma were better compared to those without this condition. Conclusion:In this study, breast cancer patients with concomitant B3 lesions were diagnosed at earlier stages, and the presence of B3 lesions in early-stage disease was associated with improved prognosis. This may be explained by earlier clinical presentation due to symptoms related to B3 lesions or by more frequent imaging surveillance prompted by their detection. Another possible explanation is that cancers associated with B3 lesions may exhibit more favorable tumor biology and prognostic features.
Introduction: The development of oncoplastic surgical techniques has reshaped the management of multifocal and multicentric breast cancers. Previously treated mainly with mastectomy due to concerns about positive margins and local recurrence, these cases can now be safely managed with breast-conserving surgery (BCS) through advances in imaging, adjuvant therapy, and surgical methods. Method: We retrospectively reviewed the data from 2,155 patients who underwent breast cancer surgery at a tertiary surgical oncology center between October 2022 and May 2025. A total of 246 patients were identified as having multicentric or multifocal disease. While 68 patients underwent BCS, 178 received mastectomy. Demographic, radiological, histopathological, and surgical data were evaluated. Complications were categorized as minor or major, and aesthetic satisfaction was assessed using a structured questionnaire. Results: Among 1,253 BCS patients, 5.4% (n = 68) had multifocal or multicentric disease. The median age was 55 years. Negative surgical margins were achieved in 90% of patients during the initial surgery. Re-excision was performed in 5 patients (7.4%), and completion mastectomy was required in 2 patients (2.9%). The overall complication rate was 19%, with reoperation due to complications required in only one patient (1.5%). Of 46 patients evaluated, 90% rated their aesthetic outcome as “excellent” or “good.” Conclusion: Oncoplastic BCS is a safe and effective option for well-selected patients with multifocal or multicentric breast cancer. With modern imaging, multidisciplinary evaluation, and experienced surgical teams, high rates of negative margins and satisfactory cosmetic outcomes can be achieved.
Introduction:Nipple sparing mastectomy (NSM) can improve domains of body image and sexuality, but preservation of the nipple-areola complex (NAC) does not guarantee sensory maintenance. NAC neurotization/reinnervation techniques have been proposed to restore sensitivity and optimize quality of life. The aim was to synthesize evidence on ACN reinnervation after NSM with immediate reconstruction, including techniques, objective measures, PROs, and complications. Methods:This is a systematic review according to PRISMA (CRD420261331412). We searched PubMed/MEDLINE, Embase, and Cochrane, without date restriction, for terms related to NSM, NAC, neurotization/cooptation/neural grafts, and sensory evaluation. Included were studies on NSM with immediate reconstruction that described reinnervation/preservation directed at the NAC and reported objective sensory outcomes and/or BREAST-Q. Results:Overall, 411 records were identified and 12 studies were included. There was a predominance of series and cohorts in implant-based reconstruction, often pre-pectoral. The techniques were convergent, with intercostal branches (mainly 4th; 3rd-5th) and, in the majority, processed allografts (∼7 cm) directed to the subareolar plexus/areolar dermis; there were variations with autologous graft and delayed neurotization. Objective measures (PSSD, monofilaments, and two-point discrimination) suggested improvement throughout follow-up, with gains in the first 6-12 months. In a comparative prospective cohort, neurotization was associated with better psychosocial and sexual well-being scores and greater perception of nipple sensation. Major complications were uncommon and no persistent neuromas or dysesthesias were reported; oncological outcomes were poorly reported. Conclusion:NAC reinnervation after NSM is feasible and demonstrates progressive sensory recovery, with emerging evidence suggesting benefits in patient-centered outcomes, including psychosocial and sexual well-being. Current evidence also highlights the clinical relevance of sensory preservation as part of a more functional and humanized reconstructive approach. However, important gaps remain due to heterogeneous methodologies, non-randomized designs, and limited oncological reporting, reinforcing the need for standardized prospective studies.
Introduction:Pre-pectoral implant-based breast reconstruction (IBR) has emerged as a promising alternative to conventional subpectoral approaches following nipple- or skin-sparing mastectomy. However, long-term oncological safety, complication profiles, and outcomes in specific subgroups, such as patients receiving radiation therapy (RT), remain under investigation. Contemporary evidence is mainly derived from retrospective studies with limited follow-up, reporting heterogeneous results. The I-PREPARE trial (EUBREAST-11R) was initiated by the EUBREAST (European Breast Cancer Research Association of Surgical Trialists, https://www.eubreast.org/) in order to provide high-quality data on the outcomes of pre-pectoral IBR in terms of oncological safety, complications, aesthetic results, and patient-reported outcomes, with particular attention to the impact of RT. Methods:The I-PREPARE trial is a prospective, international, observational cohort study assessing outcomes of IBR after therapeutic mastectomy. Adult women undergoing nipple- or skin-sparing mastectomy followed by pre-pectoral IBR (with or without synthetic/biologic mesh) are eligible. Primary endpoint is implant loss at 3 months; secondary endpoints include early and late onset complications, reoperations (≤24 months), quality of life (6, 12, and 24 months), and time to start of adjuvant treatments. Tertiary endpoints will address oncological outcomes (loco-regional recurrence, disease-free survival, breast cancer specific survival, distant-disease-free survival, overall survival, implant-associated anaplastic T-cell non-Hodgkin lymphoma). The evaluation of these endpoints will be undertaken only subject to the availability of additional dedicated funding. Data are collected via a secure eCRF and the EUBreast patient App for smartphones (https://apps.apple.com/it/app/eubreast/id6469623234; https://play.google.com/store/apps/details?id=com.brightfish.appstore.eubreast.patient&hl=it&pli=1). The study plans to enrol 1,236 patients across multiple centres and countries. The study was registered on ClinicalTrials.gov under the Trial Registration Number NCT05817175. Conclusion:The I-PREPARE trial (EUBREAST-11R) aims to generate high-quality real-world evidence on the safety, efficacy, and patient-reported outcomes of pre-pectoral IBR. This initiative will address current knowledge gaps on the outcomes of pre-pectoral IBR and could help clinical decision-making for patient selection, surgical planning, and multidisciplinary care in breast reconstruction.
Background: Superparamagnetic iron oxide (SPIO) tracers offer a radiation-free technique for sentinel lymph node biopsy (SNB) in early breast cancer (eBC). However, the data on optimal administration in daily practice, such as the optimal tracer volume and injection method, are still lacking. Methods: In this real-world data analysis, patients with clinically node-negative eBC who underwent SNB with SPIO (Magtrace®) between January 2020 and December 2022 were included. Primary endpoint was the impact of tracer volume on the detection rate. Secondary endpoints evaluated number of removed sentinel lymph nodes, surgical time and the impact of tracer timing and body mass index (BMI) on detection rate. Results: A total of 456 patients were included in the study. 223 patients received 1 mL and 232 patients 2 mL of SPIO. The median time of tracer application was 4 days. Detection rates were similar between both groups (95.5% for 1 ml vs. 96.1% for 2 ml; p=0.707), with a median of 2.0 sentinel nodes removed in both groups (p=0.205). The median time of surgery was 70 minutes in the 1 ml group and 72 minutes in the 2 ml group, p=0.972. The detection rate was 97.3% and 95.3% when tracer was injected before and after the median time of application, respectively (p=0.286). BMI of 25 kg/m² led to a detection rate of 94.9% in the 1ml group and 94.2% in the 2 ml group (p=0.520). Conclusions: In this large real-world analysis 1ml and 2 ml were similar in the clinical performance of SNB in eBC. High detection efficacy was found regardless of tracer timing and BMI. This real-world analysis reinforces SPIO’s role as an effective and adaptable alternative to conventional tracers in SNB for eBC.
Introduction:Breast-conserving surgery (BCS) is traditionally avoided in multifocal or multicentric (MF/MC) breast cancer due to concerns about oncologic outcomes. Recent evidence suggests BCS may be feasible in selected cases. This study compared outcomes of BCS in MF/MC versus unifocal (UF) breast cancer. Methods:This retrospective cohort included women with stage I-II breast cancer treated with BCS at a single institution in Argentina (2000-2023). Patients with prior neoadjuvant chemotherapy, pathogenic germline mutations, or extensive nodal disease were excluded. Outcomes were locoregional recurrence (LRR), distant recurrence (MTS), and overall survival (OS), analyzed with Kaplan-Meier estimates and Cox regression. Results:Of 1,188 patients undergoing BCS, 91 (7.7%) had MF/MC and 1,097 (92.3%) UF tumors. Median follow-up was 4.9 years. The 5-year cumulative probability of LRR was 3.8% overall; 3.3% in MF/MC; and 5.9% in UF patients (HR 1.04, 95% CI: 0.33-3.33; p = 0.94). Distant recurrence occurred in 3.3% of MF/MC and 4.8% of UF cases (HR 1.16, 95% CI: 0.36-3.73; p = 0.80). Five-year OS was 98.6% in MF/MC and 97.3% in UF patients (HR 1.25, 95% CI: 0.30-5.20; p = 0.76). Conclusion:In this large single-institution cohort, BCS achieved comparable oncologic outcomes in MF/MC and UF breast cancer, supporting its feasibility in appropriately selected patients. These results provide real-world evidence from South America and highlight the need for prospective studies to refine patient selection.
Introduction:Triple-negative breast cancer (TNBC) represents a biologically aggressive subtype characterized by the absence of estrogen receptor, progesterone receptor, and HER2 expression. TNBC accounts for approximately 15% of all breast cancers and represents a heterogeneous group of diseases. The aim of this thesis was to investigate the sociodemographic, clinical, pathological, and radiological characteristics of patients with TNBC, their response to neoadjuvant chemotherapy (NACT) regimens, the factors influencing this response, and the disease-related variables affecting disease-free survival (DFS) and overall survival (OS). Methods:The study consisted of 90 female patients, age between 30 and 65 years, diagnosed with stage IIA-IIIB TNBC, between December 2012 and September 2017. All patients received treatment protocols starting with NACT and subsequently underwent surgery performed in the same clinic. Results:Postmenopausal status and high ki-67 values at biopsy were found to be the strongest predictors of achieving a pathological complete response (pCR). Magnetic resonance imaging (MRI) performed after NACT and prior to surgery had the highest predictive value in assessing pCR (p = 0.027, p = 0.036, and p = 0.0001, respectively). Pretreatment tumor size, presence of pCR, and post-surgical ki-67 values were statistically associated with 5-year OS. Presence of pCR, pathological nodal stage, necrosis, and post-surgical ki-67 values were significantly correlated with 5-year DFS. Conclusion:In patients with TNBC, achieving pCR after NACT and detecting low ki-67 values in residual tumors were associated with improved DFS and OS.
Introduction:Male breast cancer (MBC) is a rare disease, and its management has historically been extrapolated from data on female breast cancer. Evidence regarding the efficacy of neoadjuvant therapy in men and possible gender-based differences in treatment response remains limited. This study aimed to compare neoadjuvant therapy efficacy between men and women using a large, population-based database. Methods:Data from the Surveillance, Epidemiology, and End Results (SEER) database (2010-2022) were analyzed. Patients with early-stage breast cancer who received neoadjuvant therapy were identified. Propensity score matching (PSM, 1:4 ratio) was performed to balance demographic and clinicopathological variables between male and female patients. Objective response rate (ORR) and overall survival (OS) were compared using χ2 tests and Kaplan-Meier analyses, respectively. Results:Among 55,549 eligible patients, 224 were male and 55,325 were female. After PSM, baseline characteristics were well balanced. Male patients demonstrated a significantly lower ORR compared with female patients (82.1% vs. 87.7%, p = 0.028), with the greatest disparity observed in the HER2-positive subgroup (84.2% vs. 94.6%, p = 0.003). However, among patients who achieved an objective response, OS did not differ significantly between genders (median OS 137 months vs. not reached, p = 0.228). Conclusion:Men with early-stage breast cancer exhibit lower responsiveness to neoadjuvant therapy than women, particularly in human epidermal growth factor receptor 2-positive (HER2+) disease. However, survival equivalence among responders underscores the continued value of neoadjuvant therapy in MBC.
Introduction:Risk-reducing mastectomy (RRM) is safe and effective in preventing breast cancer (BC) in BRCA mutation carriers. Nipple-sparing mastectomy (NSM) has become the new standard due to better esthetic result and comparable efficacy profile. After RRM, the risk of developing BC still exists though hardly quantifiable due to few data in literature. Case Presentation:We describe the case of a 70-year-old woman who was found to harbor a BRCA2 mutation after diagnosis of ovarian cancer (OC) in her sister, underwent prophylactic surgery for BC and OC, as per international guidelines, and 4 years after was diagnosed with BC, metastatic to the ipsilateral axillary lymph nodes. Conclusion:This case highlights the importance of going on with active surveillance after RRM and the need of developing dedicated protocols about follow-up and breast imaging for these patients.
The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2026 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer.
Background:Gynecomastia can cause significant psychological distress, affecting the patient's self-esteem and quality of life, particularly in young adults. The treatment of gynecomastia encompasses simple observation and various surgical options. The surgical modalities of gynecomastia range from liposuction alone to subcutaneous gland excision and skin reduction. The study aimed to evaluate clinical presentation, surgical intervention modality, aesthetic outcomes, and patient satisfaction following gynecomastia surgery. Methods:This retrospective, cohort, hospital-based study included patients with gynecomastia who met our inclusion criteria from June 2023 to December 2024. Patients with incomplete records, with abnormal hormonal assays, diagnosed with fatty breast, or who needed skin excision were excluded from the study. Results:Seventy-one patients who underwent breast liposuction with glandular excision were included in the study. The mean age of the participants was 24 ± 3.9 years, and the mean BMI was 26.3 ± 2.6. Most participants (n = 55, 77.5%) were diagnosed with gynecomastia grade II. The average operation time was 45.6 ± 4.7 min, with a range of 32-58 min. All procedures were completed without complications. Postoperative complications were reported in 12.7% of the participants, including superficial skin necrosis, seroma, ecchymosis, and hematoma. Most of the participants (87.3%) rated their satisfaction as very good. A significant association was noticed between high BMI and postoperative complications (p = 0.030), as well as a low level of satisfaction (p = 0.029). Conclusions:Breast liposuction and glandular excision are effective and safe surgical procedures for gynecomastia surgery. The result yields high patient satisfaction and a low complication rate. BMI is considered a crucial factor that influences surgical outcomes.
Background:Neoadjuvant therapy with dual human epidermal growth factor receptor 2 (HER2) blockade using trastuzumab and pertuzumab combined with chemotherapy is the standard of care for patients with locally advanced HER2-positive breast cancer. However, responses vary among patients, particularly based on hormone receptor (HR) status. This study aimed to evaluate the predictive value of HR status for achieving pathological complete response (pCR) in this patient population. Methods:We conducted a multicenter, retrospective cohort study of patients with stage II-III HER2-positive breast cancer who received neoadjuvant trastuzumab and pertuzumab plus chemotherapy between January 2018 and December 2022. The primary endpoint was the pCR rate (ypT0/is ypN0). Secondary endpoints included breast conservation surgery (BCS) rate, objective response rate, and safety. Multivariate logistic regression analyses were performed to identify independent predictors of pCR, adjusting for potential confounders including chemotherapy regimen type. Event-free survival (EFS) was analyzed using the Kaplan-Meier method. Results:A total of 293 patients were included in the final analysis, with 170 (58.0%) being HR-positive (HR+) and 123 (42.0%) being HR-negative (HR-). The overall pCR rate was 48.1%. Patients in the HR-group achieved a significantly higher pCR rate than those in the HR+ group (65.0% vs. 35.9%; p < 0.001). The distribution of chemotherapy regimens (anthracycline-free vs. anthracycline-containing) was balanced between groups. In the multivariate analysis, HR- status (odds ratio [OR] = 3.10, 95% confidence interval [CI]: 1.82-5.30; p < 0.001), Ki-67 index >20% (OR = 2.01, 95% CI: 1.15-3.48; p = 0.012), and negative nodal status (OR = 1.85, 95% CI: 1.07-3.20; p = 0.026) were independent predictors of pCR. Chemotherapy regimen type was not a significant predictor. At a median follow-up of 36 months, the HR- group showed a trend toward better EFS (p = 0.043). Conclusion:HR status is a strong and independent predictor of pCR in HER2-positive breast cancer patients receiving neoadjuvant dual blockade. Patients with HR- disease derive the most benefit from this regimen, highlighting the need for tailored therapeutic strategies to improve outcomes for the HR+ subgroup.
