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Breast-conserving surgery (BCS) with chest wall perforator flap (CWPF) based partial breast reconstruction (PBR) enables wide oncologic excisions while preserving excellent aesthetic outcomes, even in challenging clinical scenarios. The SCARABEO project aims to evaluate the surgical and oncological outcomes of these procedures in a large international cohort.

This retrospective multicentric international study included patients who underwent BCS with CWPF based PBR for stage 0-III breast cancer. Patients were treated between 2014–2025 in 9 Breast Units located in Italy, Brazil, USA, India, Singapore, and UK.

641 women (median age 57 years) were included. Median tumor diameter was 26 mm (IQR 18-32) and 28.2% of the cases were multifocal. The majority of patients would have traditionally been candidates for mastectomy. PBRs were performed using LICAP (52%), AICAP (16%), MICAP (11%), LTAP (15%), TDAP (2%), and combined flaps (4%). Symmetrization surgery was required in 2.2% of cases. Median operative time was 125 minutes (IQR 105–155) and 47.9% were Day Surgery cases. Pedicle mapping with Power Color Doppler was performed in 27% of cases Median flap volume was 87.5 cm³ (IQR 60–120) and specimen volume was 81.4 cm³ (IQR 63.7–110.1), accounting for 26.3% of breast volume (IQR 18.9–36.4) with a specimen-to-ORV ratio of 1.10 (IQR 0.9–1.5). Overall positive margin rate was 14.6%, leading to re-excisions in 83.1% and completion mastectomy in 10.1% of the cases. Adjuvant radiotherapy was administered in 94.4% of patients, with no flap-related late effects observed. The overall complication rate was 21.9%, with seroma being the most common (10.4%) and flap loss occurring in 2 cases (0.3%); 83.7% were managed in an outpatient setting. Age, BMI, smoking habit, neoadjuvant chemotherapy, CWPFs type, CWPFs’ and specimens’ volume were associated with a higher risk of post-operative complications. At a median follow-up of 34 months (IQR 12-51), local recurrence occurred in 2.3% of patients, distant recurrence in 2.6% and breast cancer–related death in 1.1%.

In this large series, BCS with CWPF based PBR achieved excellent surgical outcomes and favorable short-term oncologic results, effectively expanding the boundaries of BCS in patients with high tumor-to-breast volume ratios. Longer follow-up and prospective validation are warranted.

After unilateral immediate breast reconstruction, contralateral symmetrization is frequently required and can be performed immediately during the same operation or delayed as a separate procedure. When comparing these two techniques, evidence remains conflicting regarding satisfaction, revision rates, and operative time, while standardized aesthetic assessments are scarce and Swiss cost data are lacking. This study aims to address these gaps.

This retrospective single-center analysis included all patients who underwent unilateral oncoplastic breast reduction (OBR) or mastectomy (MA) with immediate reconstruction and had at least 6 months of follow-up after immediate (IM) or delayed (DL) symmetrization between September 1, 2018, and September 1, 2024. Patients were grouped by symmetrization timing (IM vs DL), with subgroup analyses by oncologic breast surgery type (OBR vs MA). Patient characteristics, postoperative outcomes, and healthcare costs were analyzed. Postoperative photographs obtained >=6 months after symmetrization were independently rated by four blinded board-certified plastic surgeons using the Kroll scale.

A total of 67 patients were included. IM contralateral symmetrization was performed in 47 patients, including 8 MA and 39 OBR, whereas 20 patients underwent DL symmetrization, including 18 MA and 2 OBR.
Regarding aesthetic outcomes, the IM group showed better scores compared with the DL group. In contrast, the MA subgroup showed better scores with the DL strategy.
Postoperative patient satisfaction was high overall, but higher in the DL strategy in both subgroups. Operative time was longer in the DL strategy in both subgroups. Revision rates (number of revision procedures per patient) were also higher in the DL group, both for the total revisions and for complication-related revision rates.
Costs were higher with the delayed strategy in both subgroups, both when private insurance physician fees were included and when they were excluded.

Delayed contralateral symmetrization was associated with higher revision rates, longer operative times, increased costs, and lower rater-based aesthetic outcomes. Patient satisfaction was higher, presumably related to a longer period of asymmetry. Our data support immediate symmetrization; a prospective randomized study is planned to verify these results.

Inflammatory breast cancer (IBC) is a rare, aggressive subtype with poor survival and high locoregional and systemic recurrence. Immediate breast reconstruction (IBR) was historically discouraged due to oncologic safety concerns. With recent improvements in oncologic outcomes through multimodal therapy, IBR warrants reconsideration. This study aims to evaluate the oncologic and surgical safety of IBR in patients with IBC.

A systematic review was conducted per PRISMA guidelines. MEDLINE, EMBASE, and Cochrane databases were searched. All studies evaluating IBR among patients with IBC were included. Assessed outcomes comprised survival, recurrence, surgical complications, adjuvant therapy timing, and patient-reported outcomes. Risk of bias was evaluated using the JBI Critical Appraisal Tools. Descriptive statistics were conducted.

Eleven retrospective studies involving 1,192 patients were included. Most patients received trimodal therapy with neoadjuvant chemotherapy (91%), mastectomy with immediate reconstruction (100%), and adjuvant radiotherapy (91%). IBR included autologous reconstruction (30%), implant-based reconstruction (16%), combined techniques (5%), and unspecified approaches (49%). The mean length of follow-up was 54 months. Survival was similar between IBR patients and those without reconstruction. By the last follow-up, 62% of patients were alive, while 38% had died. Locoregional recurrence occurred in 8 patients (7%), whereas distant metastases occurred in 19 patients (44%). Low rates of surgical complications were observed, including autologous tissue loss (2%), partial flap necrosis (5%), infection (7%), implant-related complications (7%), and tissue expander removal (13%). 26 patients required revision surgery, most commonly for elective aesthetic optimization (50%), followed by expander to permanent implant exchange (27%), and surgical complications (23%). IBR did not delay adjuvant therapy, with radiotherapy initiated within 49–52 days. Patient-reported outcomes demonstrated high satisfaction and improved quality-of-life among all patients.

In carefully selected patients with IBC, IBR can be safely integrated into multimodal therapy, offering improvements in quality of life without affecting oncologic outcomes. Our findings favor individualized decision-making rather than universal avoidance of IBR in patients with IBC.

Triple-negative breast cancer (TNBC) is associated with the poorest prognosis of all breast cancer subtypes. Establishing a genetic predisposition, associated with the BRCA1/2 genes, is critical for choosing treatment strategies, including the use of PARP inhibitors, and for organizing preventive family monitoring. The aim is to assess the frequency and spectrum of germline mutations in the BRCA1 and BRCA2 genes in a cohort of patients with TNBC in the Republic of Belarus.

A single-center study included 114 patients with pathologically confirmed TNBC (mean age 47 years, range 27-70 years). Genotyping of the most common pathogenic variants of the BRCA1 and BRCA2 genes in the population was performed using PCR. Stage, Ki-67 index, differentiation degree and family history were analyzed as well.

Pathogenic germline mutations of the BRCA1 gene were detected in 38 patients, representing 33.3% of the entire cohort. Mutations in the BRCA2 gene were not detected. The predominant mutation was 5382insC (exon 20), detected in 68.4% of carriers. Other variants were less common: 4153delA (exon 11) – 16.0%, 300T>G (exon 5) – 13.0%, 3875del4 (exon 11) – 2.6%. The average age of patients with BRCA1-associated TNBC was 47.1 years. Mutation carriers were more often diagnosed with stage IIB (34.2%) and stage III (25.0%) disease. A positive family history of breast or ovarian cancer was observed in 52.6% (20 of 38) of patients with the mutation. In the overall cohort, tumors were characterized by a high proliferative index (mean Ki-67 60.5%) and poor differentiation (G3 in 54.2% of cases).

The study revealed an exceptionally high prevalence (33.3%) of germline BRCA1 mutations in Belarusian patients with TNBC. The prevalence of a specific variant, 5382insC (68.4%), determines the algorithm for targeted genetic testing. The obtained data substantiate the need for routine genetic screening (for key mutations, including 185delAG, 4153delA, 5382insC, 300T>G, 6174delT, and 3875delGTCT) for all patients with TNBC, regardless of age and stage. This is a prerequisite for the prescription of personalized targeted therapy and the organization of preventive measures for family members.