Body image concerns often arise during and after treatment and are a major concern in up to 67% of breast cancer survivors. Negative changes in body image are a predictor of worse satisfaction with appearance and poor quality of life outcomes. Opportunities to mitigate the negative impact of cancer treatment on a patient’s body image present during preoperative education or in the neoadjuvant setting, or during surgical management, adjuvant therapy delivery, and survivorship. The surgical management of breast cancer has evolved from breast amputations to procedures that provide improved cosmesis without compromising the oncologic outcome. The advent of the sentinel lymph node biopsy and lymphatic reconstruction techniques has led to decreased axillary morbidity. Modified radiation techniques and systemic therapies tailored to subtype limit unnecessary exposure to skin and systemic toxicities. Finally, incorporating prehabilitation and survivorship support optimizes the physical and psychosocial well-being of these patients. Setting expectations, treatment de-escalation when appropriate, morbidity risk reduction and improved screening and management of psychological sequelae during survivorship can decrease breast cancer treatment’s negative impact on body image. The following review synthesizes interventions during preoperative planning, local and systemic treatment, and survivorship to prevent poor body image outcomes without compromising oncologic success.

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Introduction: Breast cancer is the most common cancer diagnosed in women in the United States with primary treatment consisting of a combination of surgery, systemic therapy, and radiation. Breast reconstruction has been shown to improve quality of life in women and utilization is increasing with time. There is a large amount of evidence demonstrating the complications of radiation therapy on implant-based breast reconstruction including but not limited to, capsular contracture, infection, and reoperation. However, the majority of these studies have examined populations consisting primarily of non-Hispanic white patients with breast cancer. In general, hispanic populations are not well represented in research studies or Phase II/III clinical trials. Therefore, the goal of this study was to analyze the impact of radiation therapy on post mastectomy implant-based breast reconstruction complications in self-identified Hispanic patients. Methods: We retrospectively reviewed patients who underwent mastectomy with implant reconstruction between January 1, 2017 and December 1, 2019. The inclusion criteria included female patients 18 years or older who self-reported as Hispanic or Latino. Exclusion criterias included patients who did not undergo mastectomy, did not undergo tissue-expander or implant reconstruction, or did not self identify as Hispanic descent. Outcomes infection needing antibiotics, capsular contracture Baker grade II-IV, and implant loss. Statistical analysis was performed using Chi-squared analysis. Results: A total of 258 patients of Hispanic or Latino women were included in the study. This included 343 total number of breasts, with 228 breasts that underwent mastectomy with reconstruction due to breast cancer and 115 breasts that underwent prophylactic mastectomy with reconstruction. The median age at time of initial mastectomy was 49 years (range 19-86). 46 total breasts received adjuvant postoperative radiation and 296 breasts did not receive radiation. Median radiation dose to the chest wall was 50 Gy (range 42.56 - 60) in 2Gy (range 1.8 - 2.66) fractions. All patients who received postoperative radiation had at least 1 complication. The rate of complications and comparison between radiated breast compared to non-radiated breasts is demonstrated in table 1. Conclusion: The goal of this study was to analyze the impact of radiation therapy complications on post-mastectomy implant-based breast reconstruction surgeries in patients of Hispanic descent. We demonstrate that the rate of capsular contracture is significantly higher after radiation therapy and the rate of overall complication after radiation therapy is higher (even though non statistically significant) compared with patients who do not undergo radiation. While these results are comparable to similar studies done in non-Hispanic groups, this is the first study to our knowledge that has looked at post-mastectomy complications focusing specifically on a Hispanic population. Mastectomy and subsequent implant reconstruction, radiation, and complications can have negative psychological effects on patients and can manifest differently with varying cultural backgrounds. It is imperative to understand the complications associated with race to better allow practitioners to cater treatment and support for a diverse patient population with breast cancer. Table 1. Complications. Citation Format: Brianna Conte, Caroline Shermoen, Danielle Cerbon, Susan Kesmodel, Caroline Fiser, sophia liu, Cristiane Takita, Jessica Meshman, John Oeltjen, Lora Wang. Post-Mastectomy Implant Complications in a Hispanic Breast Cancer Patient Population [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-03.

Retrorectal cysts are cystic lesions located in the retrorectal space and are a distinct subset of retrorectal tumours, which are often misdiagnosed due to their rarity and mimicry of symptoms caused by common diseases. We have described the presentation and management of four patients who were diagnosed with retrorectal cysts from a 10-year retrospective chart review at our institute, a tertiary care centre. In middle-aged women, the following should raise suspicion of retrorectal cyst: gastrointestinal or urinary obstructive features, mass or fullness palpable on the posterior wall on digital rectal examination, presacral dimple, perianal fistula and/or recurrent disease. Such features should prompt an MRI evaluation of the pelvis for definitive diagnosis.