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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.

Introduction: Since the 90s, breast ultrasound (US) features that predict malignancy or benignity are well established, but recently Stravos and Taboul et al. brought new concepts that set out to understand lobar anatomy and its relationship with breast lesions. Nowadays we seek to understand the relationship between breast anatomy and imaging to differentiate malignant from benign lesions and to predict their biological behavior. Objectives: To correlate breast lesions morphology and tumor biology with BIRADS® ultrasound predictors. Methods: This study was performed from 2012 to 2017. A total of 1,070 breast lesions underwent US examination and anatomopathological study. Collected data included patients’ age, tumor size, presence or absence of echogenic halo and ultrasound predictors of BIRADS® 5th edition (shape, margin, surrounding tissue, presence of calcifications, echogenicity, posterior acoustic effect, lesion borders, orientation and doppler). Patients ≥18 years old with benign lesions and breast carcinomas were included. Results: When a lesion grows affronting lobar anatomy in a non-parallel manner, a malignant process is suspected. The risk of malignancy for this predictor was 7.92-times higher. Benign lesions do not infiltrate adjacent tissue, resulting in a circumscribed margin. Breast carcinomas grow infiltratively creating tissue reactions. Thus, when margins are infiltrative, there is a greater risk of malignancy – spiculated (61.4 times), angulated (24.4 times), microlobulated (9.4 times), indistinct (6.8 times). The presence of halo increased the risk by 25.3 times and thickening of the surrounding tissue by 6.7 times. In carcinomas, irregular shape is the most prevalent. But in fast growing lesions, round shape can also be found. We found a 6.27-fold increased risk in irregular tumors and 1.86-fold in round ones. Carcinomas with a large fibrous component generate posterior acoustic shadowing, a finding linked to cancer. We found a 2.56-fold increased risk. Acoustic enhancement was also observed in high cellularity tumors, such as triple negative. In our series, the risk of malignancy was 8.1 times higher. Ultrasound also contribute to the study of calcifications. Its presence within the nodule increased the risk by 3.55 times for malignancy. Heterogeneous lesions in this study showed a 5.1-fold risk. Angiogenesis is important in differentiating benign and malignant lesions, using doppler to assess this. Lesions with inner flow increased the risk by 5.39 times. Conclusions: Breast imaging, mainly with radiogenomics and radiomics development, is used to assess predictors of malignancy and benignity from a new perspective. It is important to understand the reason of a particular phenotype and its biological implications. In this context, the present study shows new data and brings a reflection on the reason for each finding, adapting the interpretation of US predictors to a new era of breast imaging.