Background: Among breast reduction mammoplasty, the inferior pedicle-based (IFP) technique is considered the most performed by plastic surgeons. A growing interest for the supero-medial based pedicle (SMP) mammoplasty technique has been documented in literature and clinical practice. However, no real evidence exists on the superiority of one technique over another. Methods: This study represents a retrospective multimodal analysis, using a prospectively maintained database, comparing wise pattern breast reduction techniques (IFP vs. SMP) over a 24-month follow-up. From January 2015 to July 2017, all patients undergoing wise pattern bilateral reduction mammoplasty, using either an IFP or a SMP technique, were included in the study and divided in two groups. Pre-operative breast measurements included sternal notch-to-nipple distance (SN-N), infra-mammary fold to inferior border of Nipple Areolar Complex (NAC) distance length and ptosis. The same measurements were recorded at 2 weeks, 6 months and 24 months post-op. Complications were recorded and aesthetic outcomes were evaluated. Results: A total of 58 patients were included in the study, among which 36 (62%) were treated with a SMP technique and 22 (38%) with an IFP technique. At the 24-month follow-up timepoint, the SN-N distance was significantly shorter (*P<0.05) in the SMP group, with a significantly smaller elongation of the lower pole arc (29.5% increase in length in the SMP group and 40.9% in the IFP group). Aesthetic result gave significantly higher mean VAS score for SMP patients compared to IFP patients. Conclusions: The SMP technique provides stable and satisfactory results in term of breast shape, overcoming some of the major concerns related to the use of an IFP technique (lower pole elongation and ptosis recurrence), maintaining a superimposable complication rate.

(1) Background: The superior gluteal artery perforator (SGAP) flap is a prominent technique for autologous breast reconstruction. Unlike other commonly used techniques, current literature on the safety and efficacy of the SGAP flap is heterogenous and limited. The aim of this article was to perform a systematic literature review and meta-analysis of postoperative outcomes and complications associated with SGAP flap autologous breast reconstructions. (2) Methods: A systematic literature search of multiple databases was performed using the PRISMA guidelines. We included articles evaluating SGAP flaps in autologous breast reconstruction. Outcomes and complications were recorded and analyzed. Proportions and their 95% confidence intervals (CIs) were calculated in a random-effects meta-analysis. (3) Results: Fourteen studies meeting inclusion criteria, representing a total of 667 SGAP flaps, were included. The total flap loss rate was 1% (95% CI 0–3%), partial flap loss rate was 1% (95% CI 0–3%), hematoma rate was 3% (95% CI 1–6%), emergent surgical re-exploration rate was 5% (95% CI 2–9%), and overall donor-site complications were 12% (95% CI 4–23%). (4) Conclusions: This systematic review and meta-analysis provide comprehensive knowledge on the efficacy and safety of the SGAP flap in autologous breast reconstruction. It demonstrates its overall safety and low complication rate, validating its important role as an effective option in breast reconstruction.

(1) Background: Spiradenocarcinoma is an extremely rare malignant adnexal tumor and there are only few studies on survival outcomes. Our aim was to perform an analysis of the demographic and pathological characteristics, treatment patterns, and survival outcomes of patients affected by spiradenocarcinoma. (2) Methods: The Surveillance, Epidemiology, and End Results program database of the National Cancer Institute was searched for all cases of spiradenocarcinoma diagnosed between 2000 and 2019. This database is considered representative of the US population. Demographic, pathological, and treatment variables were retrieved. Overall and disease-specific survival were computed according to the different variables. (3) Results: 90 cases of spiradenocarcinoma (47 females, 43 males) were identified. Mean age at diagnosis was 62.8 years. Regional and distant disease at diagnosis were rare, occurring in 2.2% and 3.3% of cases, respectively. Surgery alone was the most frequent treatment (87.8%), followed by a combination of surgery and radiotherapy (3.3%) and radiation therapy only (1.1%). Five-year overall survival was 76.2% and five-year disease-specific survival was 95.7%. (4) Conclusions: Spiradenocarcinoma equally affects males and females. Regional and distant invasion rates are low. Disease-specific mortality is low and is probably overestimated in the literature. Surgical excision remains the main form of treatment.

(1) Background: Melanoma is the most common life-threatening cancer among skin cancers. Almost all locations of the skin can be affected by melanoma, and the upper limbs are one of the most frequent locations. We aimed to study the epidemiology and survival outcomes of patients with melanoma localized in the upper extremities compared with other sites. (2) Methods: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database is considered the most representative of the U.S. population; we extracted melanoma cases diagnosed between 2000 and 2019. Several characteristics, including demographical, pathological, and therapeutic, were recorded, and upper extremity melanomas and melanomas from other areas were compared. Overall survival was assessed, and the groups were compared. (3) Results: 69,436 patients had melanoma in the upper limbs and shoulders and 204,794 in other body parts. Overall, 35,267 patients with upper extremity melanoma were males, 34,169 were females, and the mean age was 60. For the rest of the body, there were 118,654 males and 86,140 females, with a mean age of 59. Surgery alone was the most commonly used treatment, while radiation therapy was the least used for all sites. Women appear to have better survival than men. Superficial spreading melanoma is the least lethal subtype, while nodular melanoma is the most dangerous. (4) Conclusion: Women under 50 are more at risk than men of the same age. The trend reverses after age 50 where men are at greater risk. In addition to gender and age, disease stage and major histologic subtypes influence survival.

Background: While radiotherapy (RT) and chemotherapy (CT) significantly improve breast cancer outcomes, they may affect breast reconstruction by causing vascular damage and delayed wound healing. This retrospective study evaluates how preoperative RT, CT, or the combination of both impacts intraoperative and postoperative outcomes in immediate or delayed deep inferior epigastric perforator (DIEP) flap breast reconstructions. Methods: We conducted a single-center review of all patients undergoing autologous DIEP flap reconstruction after mastectomy between 2018 and 2024. Patients were divided into four groups: RT only, CT only, a combination of RT and CT, and a control group with no preoperative therapies. Intraoperative and postoperative outcomes were then compared among these groups, with statistical significance defined as p < 0.05. Results: We included 114 patients representing 141 DIEP-flap breast reconstructions. Flap survival rate was 98.5%. In the univariate analysis, total microvascular recipient site complications were significantly higher in the RT + CT group (14.0%, p = 0.021). Donor-site complication rates differed significantly among the four groups (p = 0.025), with the highest rate observed in the RT + CT group (44.7%). In the logistic regression analysis, ischemia time was found as an independent risk factor for total recipient site complications, but not for microvascular complications (OR = 1.019, 95%-CI = 1.004–1.035, p = 0.014). Conclusions: Combined RT + CT significantly increased microsurgical complications. Ischemia time correlated with higher odds of total recipient site complications. Individualized patient management and diminished ischemia time are likely to improve flap survival.