Totally implanted venous access ports (TIVAPs) have been established as effective and safe devices for oncologic patients. In breast cancer setting, the implant of the reservoir at mid-arm allows the absence of additional scars on the chest and the easier access to the port with significant cosmetic and psychological advantages. In the last decades, breast surgery has made great progresses to ameliorate the cosmetic results even in mastectomy techniques. In fact, many studies have demonstrated that negative body image perception affects physical and psychological wellbeing of survivors. Despite this evidence, limited importance is still reserved to TIVAPs placement site, which is traditionally the chest. It is not unusual to see patients after a nipple-sparing mastectomy with excellent cosmetic result who show a disfiguring scar on their upper chest due to TIVAP placement. We report the case of a young woman with BRCA2-related breast cancer who underwent bilateral nipple sparing mastectomy with immediate reconstruction and adjuvant chemotherapy. Her TIVAP was located at the mid-arm, which is still an uncommon site compared to the upper chest. An optimal cosmetic result was obtained both in breast reconstruction and in the arm site of port, with high-rate patient satisfaction. This case presentation aims to raise awareness towards women’s body image preservation, particularly in the choice of TIVAP placement: in most cases neckline and upper chest should be avoided for a better patient related outcome.

In the last years 3D printing has progressively gained widespread interest for its several applications in many medical fields. Among the most common diagnostic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) allow only two-dimensional images to obtain information on different pathologies. This requires excellent visualization skills from not specialized medical doctors. The 3D printing has been developed to overcome the current disadvantages of conventional imaging techniques. The 3D models are created from the diagnostic studies of the patient (MRI, CT, PET or a combination of those) with a process that fuse advanced medical imaging algorithms and medical image processing, which are supervised by specialized radiologists. Hereby we describe the cases of two patients with giant incisional hernias. The patients underwent 3D study before botulinum toxin treatment and another 3D model a months after the botulin toxin. With the 3D model we calculated the abdominal cavity volume before and after the treatment with botulinum toxin. Six weeks after the toxin we planned the surgery. The operation time was 180 min and 150 min respectively. The patient's diet was resumed on the first day postsurgery, and the postoperative hospital stay was five days. Our experience gives an overview of the current use of 3D-techniques, more specifically in the field of abdominal wall defect.

Background: Thanks to the introduction of radiomics, 3d reconstruction can be able to analyse tissues and recognise true hypertrophy from non-functioning tissue in patients treated with major hepatectomies with hepatic modulation.The aim of this study is to evaluate the performance of 3D Imaging Modelling in predict liver failure. Methods: Patients submitted to major hepatectomies after hepatic modulation at Sanchinarro University Hospital from May 2015 to October 2019 were analysed. Three dimensional reconstruction was realised before and after surgical treatment. The volumetry of Future Liver Remnant was calculated, distinguishing in Functional Future Liver Remnant (FRFx) i.e. true hypertrophy tissue and Anatomic Future Liver Remnant (FRL) i.e. hypertrophy plus no functional tissue (edema/congestion) These volumeswere analysed in patients with and without post hepatic liver failure. Results: Twenty-four procedures were realised (11 ALPPS and 13 PVE followed by major hepatectomy). Post hepatic liver failure grade B and C occurred in 6 patients. The ROC curve showed a better AUC for FRFxV (74%) with respect to FRLV (54%) in prediction PHLF>B. The increase of anatomical FRL (iFRL) was superior in the ALPPS group (120%) with respect to the PVE group (73%) (p=0,041), while the increase of functional FRFX (iFRFx) was 35% in the ALLPS group and 46% in the PVE group (p>0,05), showing no difference in the two groups. Conclusion: The 3D reconstruction model can allow optimal surgical planning, and through the use of specific algorithms, can contribute to differential functioning liver parenchyma of the FLR.