Introduction: Pre-pectoral breast reconstruction using implant and acellular dermal matrix (ADM) has become one of the main techniques for immediate reconstruction after mastectomy, with variable approaches and complication rates reported in literature. This study aims to evaluate the early outcomes of this technique, at a single tertiary oncology center. Methods: We performed a retrospective analysis of a prospectively maintained database including women who underwent immediate pre-pectoral reconstruction with implant and ADM following mastectomy between January 2021 and August 2023. The primary outcome was reconstructive failure within 3 months, defined as the need for removal of the implant placed during the index surgery. Secondary outcomes included complications at 3 months and predictive factors for complications. Results: A total of 247 reconstructions were performed in 200 patients, 83.4% following oncological mastectomy and 16.6% after risk-reducing surgery. The median age was 49 (43–56) years; 15.5% of patients were obese and 26.5% were active smokers. Skin-sparing mastectomy was performed in 16.6% and nipple-sparing in 83.4%, with a Wise-pattern incision in 73.3%. Reconstructive failure occurred in 7.7%, with one case (0.4%) of total reconstruction loss. The overall complication rate was 14.6%—skin flap ischemia occurred in 12.6%, primary implant infection in 2.0% and bleeding in 0.8%. The reoperation rate was 8.4%. No predictive factors for complications were identified. Conclusions: In this series, including a high proportion of high-risk patients, immediate pre-pectoral reconstruction with implant and ADM appears safe, with a low rate of early complications. No predictive factors for complications were found, supporting widening its indications.

Background: Hand-assisted laparoscopic surgery (HALS) is a possible approach for rectal anterior resection (RAR). However, evidence supporting this technique remains limited. This study aims to evaluate the perioperative and oncological outcomes of HALS for RAR at a single tertiary oncology center. Methods: A retrospective observational study was conducted using a prospectively maintained database. Patients with primary adenocarcinoma of the rectosigmoid junction and rectum who underwent HALS for RAR between 1 January 2013 and 31 December 2022 were included. All surgeries were performed by a dedicated colorectal team composed of three surgeons. Results: Among the 1911 surgeries for primary colorectal cancer performed, 469 met the inclusion criteria. The median age was 66 (57–74) years and 63% of the patients were male. Most tumors were cT3-4 (78.9%) and cN+ (71.2%), and neoadjuvant therapy was administered in 70.0% of cases. Low RAR was performed in 73.1% of cases, and an anastomosis was constructed in 95% of cases. The median operative time was 152 (135–180) min, and the conversion rate was 3.8%. Major morbidity occurred in 10.0% of cases, with 30-day and 90-day mortality rates of 0.9% and 1.3%, respectively. The overall anastomotic leak rate was 12.1%, with 9.0% early leaks and 3.1% late leaks. A complete/near-complete mesorectal excision was achieved in 89.6% of cases and an R0 resection in 96.2% of cases. With a median follow-up of 87 months, the locoregional recurrence rate was 2.5%, whereas the distant recurrence rate was 5.9%. The 5-year overall survival was 82.6%. Conclusions: When performed by experienced teams, HALS for RAR is safe and feasible and is associated with a short operative time, low conversion rate, minimal morbidity, and optimal oncologic performance.

We report a case of a woman in her late 40s with a history of breast implant surgery following breast cancer treatment. She presented with asymmetrical breast enlargement, palpable contralateral axillary lymph nodes and cutaneous nodules on both forearms. In addition, imaging evaluation revealed intracapsular implant rupture, ipsilateral internal mammary enlarged lymph nodes and multiple mediastinal lymphadenopathies. Skin and axillary lymph node biopsy demonstrated a chronic granulomatous reaction with foreign-body giant cells related to silicone. Following surgical removal of the breast implant, cutaneous nodules disappeared, and all lymph nodes decreased in size. Systemic deposition of silicone in the form of foreign-body granulomas, also known as siliconomas, is a rare complication of breast implant rupture, which is thought to result from silicone lymphatic or hematogenous migration. In the setting of breast cancer, excluding recurrence should be a priority. While there is no standardised therapeutic approach, implant removal can be an option.