Background: Poland’s syndrome is a rare congenital non-inherited anomaly that usually manifests itself during adolescence and is characterized by absence or deficient development of one of the breasts. To our knowledge, no case of breastfeeding after reconstruction surgery in patients with Poland’s syndrome has been described. Case Report: A 22-year-old female patient with Poland’s syndrome underwent breast reconstruction. The procedure performed consisted of rotation of a myocutaneous flap harvested from the ipsilateral latissimus dorsi muscle, which was subsequently attached to the anterior thoracic wall to create a pouch and place a 300-ml round textured cohesive silicone gel-filled breast implant. 5 years later the patient got pregnant, and 1 year after delivery she is still breastfeeding normally with both breasts. Conclusion: Reconstruction surgery with the latissimus dorsi muscle and a prosthesis was shown to be a potential and safe solution to achieve improvement of breast symmetry and to provide confidence and comfort in relation to self-image and, moreover, the ability to breastfeed.

Introduction: It is known that one of the most commonly used breast reduction surgeries is the inverted-T scar (Wise pattern). Numerous reports have established its efficacy in oncoplastic procedures and its aesthetically pleasing shape. However, it has some disadvantages and limitations, such as extensive scar pattern, risk of dehiscence, and its difficulty in reductions in larger and ptotic breasts (removal >800 g per side). As an alternative, the “No-Vertical-Scar” reduction mammoplasty has been proposed in plastic surgery for breasts in which a massive mass excision is required and where marked ptosis exists. Although this technique has not been frequently described and performed in oncoplastic surgeries, it has many advantages in breast cancer patients involving technique, feasibility, and convenience. Objective: The aim of this study was to describe the critical technical points, adjustments, and safety for oncoplastic surgery of the classic horizontal breast reduction, designated as modified “No-Vertical-Scar” reduction mammoplasty, allowing for the elimination of the vertical scar and axillary approach through the same incision. Methods: This is a single-center case-series study. We included patients with a breast cancer diagnosis who underwent surgical treatment between 2020 and 2021. Patients were selected for this technique if they had large and ptotic breasts (grade 2 or 3 according to Regnault classification) and a minimum distance of 27 cm between the mid-clavicle and the superior aspect of the areola. Clinical and anatomopathological data were collected. Results: A total of 25 patients underwent this modified oncoplastic mammoplasty. Preoperative skin markings were made with the patient in the standing position. The proposed new nipple position was determined based on a distance between 18 and 23 cm from the breast midline and the sternal notch. The lower edge of the “apron” flap was then marked at a distance of 5–6 cm below the inferior aspect of the new areola, and it needed to be located above the superior aspect of the original areola. An important step was to delineate the new lateral border of the breast, especially in wide-based breasts. This modified step is crucial to narrow the transverse base of the new breast and to provide a more natural silhouette. The areolated or nonareola pedicle was then selected and designed in accordance with the tumor location. In all patients, axillary surgery (sentinel lymph node biopsy or lymphadenectomy) was performed through the same breast incision. After flap development, lumpectomy, and axillary approach, the superior “apron” flap was then brought down over the remaining breast tissues and sutured in place. A free nipple complex graft or inferiorly pediculated nipple complex was then brought to the new areola site. The volume of removed tissue in each breast varied from 700 to 2,000 g. The complication rate was low (20%, 5 patients) and included minimal dehiscence that resolved in 2–3 weeks (2 patients), nipple epidermolysis (2 patients), and surgical site infection (1 patient). There were no cases of fat necrosis, nipple-areola complex necrosis, or other major complications. Patients were satisfied with the results in 96% of cases. Conclusion: The modified “No-Vertical-Scar” reduction mammoplasty has been shown to be a safe, easy, and cosmetic alternative in patients with very large and ptotic breasts. It has the advantage of eliminating the vertical scar present in both the inverted-T (Wise pattern) and vertical scar techniques, a low risk of complications and the ability to perform axillary staging through a single incision. It can also result in an “unoperated” look after surgery with good patient satisfaction. Once learned, it is fairly easy to perform, and the results are reproducible and free of major complications.

Objective: To evaluate the association between metabolic syndrome (MetS) and the immunohistochemical profile of breast cancer (BC) in postmenopausal women.Methods: This cross-sectional cohort study included 189 women, aged 45-75 years and amenorrhea > 12 months, with newly diagnosed BC and no previous cancer treatment. Clinical, anthropometric and biochemical (total cholesterol, HDL, LDL, triglycerides, and glucose) data were collected, as well as data on BC (histopathology, grade, tumor stage, lymph node metastasis hormone status (estrogen receptor, ER; progesterone receptor, PR; human epidermal growth factor receptor 2, HER-2), and epithelial proliferative activity (Ki-67). Tumors were divided into five subtypes: luminal A, luminal B HER-2 negative, luminal B HER-2 positive, non-luminal HER-2, and triple negative. Women with three or more of the following criteria were diagnosed with MetS: waist circumference ≥ 88 cm; triglycerides ≥ 150 mg/dL; HDL-cholesterol < 50 mg/dL; blood pressure ≥ 130/85 mmHg; glucose ≥ 100 mg/dL. The Student t-test, gamma distribution (asymmetric variables), chi-square test, and logistic regression (odds ratio, OR) were used for statistical analysis.Results: Sixty-three (33.3%) of the 189 patients had MetS at the time of diagnosis. The mean age, time since menopause and BMI were 59.0 ± 10.6 years, 11.4 ± 9.6 years and 28.5 ± 5.5 kg/m2, respectively, without difference between women with and without MetS (control). Women with MetS had a higher frequency of tumors ≤ 2 cm than women without MetS (49.2% vs 31.8%) (p=0.038). There were no differences in histological grade, staging, or axillary lymph node metastasis (p>0.05). The proportion of PR-positive (p=0.006), HER-2-negative (p=0.034), and luminal B HER-2-negative tumors was higher among patients with MetS (p=0.038) compared to women without MetS (79.4% vs 61.8%, 89.9% vs 78.6% and 44.5% vs 27.8%, respectively). Multivariate analysis adjusted for age, time at menopause and BMI showed a higher risk for luminal B HER-2-negative tumors among women with MetS (OR 2.00, 95% CI 1.03-3.89), obese patients (OR 2.03, 95% CI 1.06-3.90), and women with abdominal obesity (OR 1.96, 95% CI 1.01-4.03). The other BC subtypes were not associated with MetS or its components.Conclusion: In postmenopausal women with newly diagnosed BC, the presence of MetS was associated with a more favorable immunohistochemical profile of BC, such as a smaller tumor size, PR-positive and HER-2-negative status, and the luminal B tumor subtype. Citation Format: Andre Hideo Motoki, Daniel de AraujoBrito Buttros, Ana LuisaCamolezi Gaspar, Eduardo Carvalho Pessoa, Benedito de Sousa Almeida Filho, Jorge Nahas Neto, Heloisa de Luca Vespoli, Eliana AguiarPetri Nahas. Association between metabolic syndrome and immunohistochemical profile at breast cancer diagnosis in postmenopausal women [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-76.

Introduction: It is known that breast cancer is the type of cancer that mostly affects women in the world, both in the developing and developed countries, with about 2.3 million new cases in 2020, comprising 25% of all cancers diagnosed in women. Vitamin D concentration has been studied as a risk and prognostic factor in women with breast cancer; its deficiency is common in women with postmenopausal breast cancer, and some evidence suggests that low vitamin D status increases the risk for disease development. The impact of vitamin D at the time of diagnosis on the outcome of patients with breast cancer is less well understood. In view of the increasing number of breast cancer survivors and the high prevalence of vitamin D deficiency among patients with breast cancer, an evaluation of the role of vitamin D in prognosis and survival among patients with breast cancer is essential. Objective: The aim of this study was to evaluate the association between serum vitamin D (VD) levels at diagnosis and overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) in postmenopausal women treated for breast cancer. Methods: This is a single-center prospective cohort. The study included patients newly diagnosed with invasive breast cancer between 2014 and 2016, aged ≥45 years, and in amenorrhea for ≥12 months, and VD assessment at the time of diagnosis, before any cancer treatment. Patients were classified into three groups according to serum levels of 25-hydroxyvitamin-D [25(OH)D]: sufficient (≥30 ng/mL), insufficient (between 20 and 29 ng/mL), and deficient (<20 ng/mL). Clinical and anatomopathological data were collected. The primary outcome was OS and secondary outcomes were DFS and CSS. Kaplan-Meier curve and Cox regression model were used to assess the association between 25(OH)D levels and OS, DFS, and CSS. Differences in survival were evaluated by hazard ratios (HRs). The study was approved by the Ethics Committee (CAAE: 71399117.2.0000.5411). Results: The study included 192 women with a mean age of 61.3±9.6 years at diagnosis, mean 25(OH)D levels of 25.8 ng/mL (ranging from 12.0 to 59.2 ng/mL), and follow-up period between 54 and 78 months. Sufficient VD levels were detected in 65 patients (33.9%), insufficient in 92 (47.9%), and deficient in 35 (18.2%). Patients with 25(OH)D insufficiency and deficiency had a larger proportion of high-grade tumors, locally advanced and with distant metastasis, positive axillary lymph nodes, negative estrogen receptors (ER), and progesterone receptors (PR), and higher Ki67 index (p<0.05 ). The mean OS time was 54.4±20.2 months (range 9–78 months), and 51 patients (26.6%) died during the study period. Patients with VD deficiency and insufficiency at diagnosis had significantly lower OS, DFS, and CSS compared to patients with sufficient values (p <0.0001). After the adjustment for clinical and tumoral prognostic factors, patients with serum 25(OH)D levels considered deficient at the time of diagnosis had a significantly higher risk of global death (HR=4.65, 95%CI 1.65–13.12), higher risk of disease recurrence (HR=6.87, 95%CI 2.35–21.18), and higher risk of death from the disease (HR=5.91, 95%CI 1.98–17.60) than the group with sufficient 25(OH)D levels.

Objective: The aim of this study was to assess the occurrence of metabolic syndrome (MetS), obesity, and abdominal obesity during the first year after a diagnosis of breast cancer. Methods: This prospective observational study included women with a recent diagnosis of breast cancer. Women aged ≥40 years, with a recent diagnosis of breast cancer, were included. The clinical, anthropometric, and biochemical analyses were performed. Women with three or more diagnostic criteria were considered with MetS as follows: waist circumference (WC) > 88 cm; triglycerides (TG) ≥150 mg/dL; high-density lipoprotein 30 kg/m2 and abdominal obesity with WC >88cm. The measurements were carried out in three moments: first medical assessment (T0m), six months (T6m), and 12 months later (T12m). All patients underwent the interdisciplinary assessment (i.e., nutritional and psychological) at T0m. For statistical analysis, the ANOVA with repeated measures and the chi-square test of trend were used. Results: A total of 72 women with breast cancer were included, with a mean age of 58.4±10.7 years. In the assessment of MetS, BMI, and WC, no difference was observed in the occurrence between the three moments. When comparing the individual metabolic syndrome criteria between the three moments, there was only a statistical difference in the TG and glycemia criteria. The analysis of blood glucose showed a decrease in mean values, with a value of 106.6 mg/dL-T0m, 100.46 mg/dL-T6m, and 98.96 mg/dL-T12m (p=0.004). Regarding TG, an increase in mean values was observed, with a value of 121 mg/dL-T0m, 139.4 mg/dL-T6m, and 148.46 mg/dL-T12m (p=0.003). No cancer treatment showed an impact on the measured criteria. Conclusion: The interdisciplinary approach on the breast cancer survivors demonstrated a positive impact on the control of metabolic syndrome, obesity, and abdominal obesity on the first year of follow-up. Additionally, glycemic indices showed a significant decrease, but an increase in TG values was observed.