Background: Autologous fat grafting (AFG) has emerged as a useful technique in breast reconstruction. Utilizing a patient’s own fat from areas like the abdomen or thighs, AFG serves various reconstruction needs. Nevertheless, the oncological safety of AFG in breast cancer patients has become a contentious issue. Concerns about its influence on cancer recurrence and detention have led to significant clinical debate and the need for thorough investigation. Methods: To determine the impact of autologous fat grafting (AFG) on loco-regional recurrence (LRR) in breast cancer survivors undergoing reconstruction, a comprehensive search of databases including PubMed, Medline, Web of Science, and Cochrane libraries was conducted from November 2023 through March 2024. This search adhered to the PRISMA guidelines and aimed to identify all the relevant studies on AFG in the context of breast reconstruction post cancer treatment. A meta-analysis was performed. Results: Out of the studies reviewed, 40 met the inclusion criteria, with a total patient cohort of 14,078. The analysis revealed that AFG had no significant association with increased rates of LRR. Conclusions: According to the available literature, AFG is a safe reconstructive option for breast cancer patients and does not increase the risk of loco-regional recurrence. Nevertheless, further well-structured long-term prospective studies are required, since heterogeneity of available studies is high and requires standardization.

Two-stage implant-based breast reconstruction remains the most commonly used technique for rebuilding a breast. Subpectoral implant placement minimizes complications, such as capsular contracture, implant visibility, malposition, and extrusion. Nevertheless, it is associated with high animation deformity (AD). Prepectoral reconstruction eliminates AD but is subject to a higher risk of implant extrusion and visibility. In this prospective, single-center study we present a new technique aimed to create a new hybrid pocket in which the upper portion of the implant is placed subcutaneously, whereas its inferior pole is still covered by a pectoralis muscle sling reducing implant lower pole visibility and palpability. In each case, the prosthesis was removed and a new hybrid pocket was created by splitting the muscle into two portions, separating its cranial part from the overlying subcutaneous tissue and anchoring it back to the chest wall. The caudal muscle sling was left adherent to the subcutaneous tissue of the central part of the breast. Patient outcomes were evaluated with a BREAST-Q questionnaire preoperatively and 1 year after surgery. Forty-eight patients with severe postoperative breast animation were enrolled (8 bilateral and 40 unilateral). No major complications occurred. After a 1-year follow-up, the aesthetic and functional satisfaction rate was high and a good implant coverage was achieved. No residual AD of the breast was observed. Changing the implant placement from the subpectoral to a partially subcutaneous plane, both severe AD and implant extrusion can be avoided, expanding the indications for safe prosthetic breast reconstruction. Level of evidence IV.

Background: Despite its many advantages, the deep inferior epigastric artery perforator flap requires fascial incision and intramuscular dissection, which can lead to pain and weakening of the abdominal wall. The superficial inferior epigastric artery (SIEA) flap offers an alternative to avoid this damage but is often considered unreliable due to its variable anatomy. In this study, we report our experience in autologous breast reconstruction using either the superficial branch of the superficial circumflex iliac artery (SCIA-SB) or the SIEA as the sole flap pedicle. Methods: A retrospective study was conducted from August 2022 to December 2023. A total of 17 patients underwent breast reconstruction with 18 flaps (1 bilateral and 16 unilateral reconstructions). The SCIA-SB (14 flaps) or SIEA (4 flaps) served as the exclusive arterial sources. Preoperative vessel identification was performed using color-coded duplex sonography, and the flap design was adjusted accordingly. Intraoperative flap perfusion was assessed via indocyanine green angiography. Demographic, intraoperative, and postoperative data were recorded. Results: The mean follow-up was 5.7 months (range: 3–17 mo). Of the 18 flaps, 1 was lost due to arterial insufficiency. Partial flap necrosis requiring revision occurred in 1 case, whereas minor complications (seroma, wound dehiscence, mastectomy skin necrosis, and infection) were observed in 7 patients. Conclusion: In our experience, either the SCIA-SB or SIEA can be successfully used as a pedicle in autologous breast reconstruction, provided that the abdominal flap design is modified to include their functional angiosomes.

Floppy Eyelid Syndrome (FES) is an underdiagnosed ocular condition characterized by the abnormal laxity of the upper eyelids, often leading to chronic eye irritation and redness. This review provides an in-depth examination of FES, covering its pathophysiology, clinical presentation, and diagnostic and therapeutic approaches. We discuss the potential etiological factors, including genetic predispositions and associations with ocular and systemic conditions such as obesity, obstructive sleep apnea, keratoconus, and glaucoma. Diagnostic strategies are outlined, emphasizing the importance of thorough clinical examinations and specific tests for an efficacious grading and assessment of FES. Management of FES ranges from conservative medical treatments to surgical interventions for more severe cases and should be driven by a comprehensive and multidisciplinary approach. Herein, we illustrate the practical aspects of diagnosing and managing this condition. This comprehensive review aims to enhance the recognition and treatment of FES, ultimately improving the quality of life for affected patients.

Background: Several studies have reported preliminary experiences with the anterior intercostal artery perforator (AICAP) flap for treating partial breast defects or breast implant exposure following reconstruction. As radiotherapy is commonly administered for breast cancer, some patients may present with heavily damaged skin flaps and chronic radiodermatitis. We describe new applications of a de-epithelialized AICAP flap, used in combination with an implant, for breast reconstruction when other treatment options are unavailable. Methods: A retrospective study was conducted, including all patients who underwent implant-based breast reconstruction with the aid of an AICAP flap. A literature review was also performed. Results: Between November 2022 and August 2023, four pedicled AICAP flaps were harvested in four patients. The indications were breast implant coverage in cases of chronic dermatitis of the mastectomy skin flaps (two unilateral flaps) and inferolateral coverage of partially submuscular expanders for immediate breast reconstruction (two unilateral flaps). All four flaps were based on one perforator. The mean harvesting time was 40 minutes. Complete flap survival was achieved, with no complications at the donor site. Conclusions: The AICAP flap is a safe and reliable technique for difficult cases of breast reconstruction when no other options are available. Moreover, this technique can easily provide additional coverage for the breast implant when needed.

Background: Cutaneous squamous cell carcinoma (SCC) is the most common primary malignant tumor of the hand, and its aggressive nature can lead to significant morbidity, particularly when affecting critical structures like the thumb. SCC in this location may arise in the periungual area or the pulp and frequently presents with non-specific symptoms such as swelling, nail deformity, or discharge, features that closely mimic common benign conditions. Methods: A retrospective study analyzed patients with neglected or misdiagnosed SCC of the thumb treated at the Hand and Microsurgery Unit of the Jewish Hospital, Rome, between 2015 and 2025. Patient demographics, duration from symptom onset to diagnosis, initial misdiagnoses, and imaging findings (X-rays, MRI, CT scans, lymph node sonography) were reviewed. Surgical interventions, histopathological grading, and postoperative management were documented, with long-term follow-up focusing on disease progression and patient survival. Results: Sixteen patients were included in the study. The mean age at surgery was 73.6 years (range: 55–93 years), with a mean delay of 8.2 months from symptom onset to diagnosis in 87.5% of cases. Initial misdiagnoses included verruca vulgaris, onychomycosis, paronychia, and osteomyelitis. Imaging consistently revealed soft tissue involvement, bony invasion, and occasional metastasis. Surgical approaches ranged from wide resection to amputation, with thumb reconstruction in selected cases and hand amputation in severe presentations. Long-term follow-up (mean 4.6 years) showed high morbidity, a reduction in hand function and QoL, and a 50% mortality rate, with two cases due to metastatic disease (12.5%). Conclusions: Thumb SCC presents diagnostic and therapeutic challenges, exacerbated by late diagnosis and initial misdiagnoses. Multidisciplinary management involving early recognition, comprehensive imaging, appropriate surgical interventions, and vigilant follow-up is crucial for optimizing outcomes.