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Dermatofibrosarcoma protuberans (DFSP) is a soft tissue tumor with high propensity for local recurrence. We present a case of a 53-yearold woman with a recurrent DFSP of the clavicular region. The patient underwent extensive local excision including the external cortical bone of the left clavicle. The resulting large defect was reconstructed using pedicled Latissimus Dorsi myocutaneous flap. The histopathological examination confirmed dermatofibrosarcoma protuberans with clear surgical margins and the patient was satisfied with the final aesthetic result.

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How to cite this article: Longo B, D'Orsi G, Pistoia A, et al. T-inverted shaped rectus abdominis myocutaneous (Ti-RAM) flap for chest wall reconstruction.

Background: Autologous fat transfer can be safely offered for total breast reconstruction after nipple-sparing mastectomy. The aim of this study was to extend a fat transfer protocol to smokers and compare the long-term results among them and irradiated and nonirradiated patients. Methods: One hundred seventeen breasts after nipple-sparing mastectomy were prospectively enrolled and stratified in group A (25 irradiated), group B (21 smokers), or group C (71 controls). A standardized fat transfer protocol was used. Data collected were patient demographics, surgery information, and aesthetic analysis. Continuous and categorical variables were analyzed with the Kruskal-Wallis test, and the Cohen Kappa test was used to test interrater variability for the aesthetic analysis. Results: Groups were homogeneous for demographics (p > 0.05) but significantly different in number of fat transfer sessions (p < 0.001), mean volume of the first two treatments (p = 0.003), and mean total volume of injected fat (p = 0.002). Volume, shape, position of the breast mound, inframammary fold, and scar location subscales obtained high score evaluations without a significant difference among groups (p > 0.05), whereas skin texture subscale showed a lower score evaluation in group A (p = 0.003). Although a significant difference for total subscales was worse in group A (p = 0.004), the global score had a high rate evaluation in all groups (p = 0.145). Interrater reliability showed substantial agreement among all categories. Conclusion: Although further investigation is required, the authors confirm the efficacy of their fat transfer protocol for both irradiated and nonirradiated nipple-sparing mastectomy patients and propose its indication to smokers with comparable clinical and aesthetic results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.