Breast augmentation and reconstruction utilizing implants are among the most common plastic surgery procedures performed in the United States. A small proportion of these implants are removed each year. We report 2 cases where routine pathologic evaluation of capsulectomy specimens revealed squamous cell carcinoma associated with the breast implant capsule and discuss the possible pathogenesis of this unusual entity. Both patients had long-standing implants (>10 years) and presented with acute unilateral breast erythema and swelling. Intraoperatively, the capsules for both cases appeared thickened and calcified, containing extensive granulomatosis and keratinaceous debris invading into the chest wall. Extensive workup failed to find an occult primary. One patient died from a malignant pleural effusion secondary to tumor invasion during chemotherapy, and the second patient obtained stabilization of the mass after 5 weeks of chemotherapy but subsequently declined further surgical intervention. A thorough literature review was performed, and 5 similar reports were identified, involving 6 patients. All patients presented with similar clinical presentations as ours and had poor outcomes. The mean reporting age at diagnosis was 60 years, and the average time from initial implant to diagnosis was 25 years. Due to the small numbers of squamous cell carcinomas associated with breast implant capsules, the true association between the 2 is unknown. It is postulated that chronic inflammation/irritation from the breast implant and epithelialization of the capsule play a significant role in the disease process. This may represent a new entity of “chronic inflammatory capsular malignancies.” Increased awareness of this entity may allow for earlier suspicion, diagnosis, and management.

BACKGROUND: Technologic advances have led to increasing collaboration in global surgery. With increasing data on perceptions from High Income Countries (HIC), little has been written about perceptions from Low and Middle Income Countries (LMIC). We hypothesized that collaborations have increased in diversity but lack long term structure. This survey provides a snapshot of perspectives from LMIC surgeons. METHODS:A survey was distributed to surgeons from LMIC worldwide to assess the nature and perception of collaborations, funding, benefits, communication, and the effects of Covid-19 on partnerships. RESULTS:We received responses from LMIC representatives in 12 countries on 3 continents. The majority (83%) had participated in collaborations within the past 5 years. 39% of collaborations were facilitated virtually. Clinical and educational partnerships (39% each) were ranked most important by LMIC respondents. Sustainability of the partnership was most achieved in domains of education/training (78%) and research (61%). 77% of LMIC respondents reported expressing their needs before HIC team arrival. However, 54% of respondents were the ones to initiate the conversation. Only 47% said HIC partners understood the overall environment well at arrival to LMIC. The majority, 95%, of participants felt a formal process of collaboration/ structured partnership would benefit all parties in assessing needs. During the Covid-19 pandemic, 87% reported continued collaborations. 44% of partners felt that relationships were weaker, 31% felt relationships were stronger, and 25% felt they were unchanged. CONCLUSION:Our study provides a worldwide snapshot of LMIC surgeon's perspectives on collaboration in global surgery. Independent of location, LMIC partners cite inadequate structure for long-term collaborations. We propose a formal pathway and initiation process to assess resources and needs at the outset of a partnership.

Background Breast reconstruction (BR) has documented psychological benefits following mastectomy. Yet, racial/ethnic minority groups have lower reported rates of BR. We sought to evaluate the rate, type, and outcome of BR in a racially and ethnically diverse population within a safety-net hospital system. Methods All patients who underwent mastectomy between October 2015 and July 2019 at Harbor-UCLA Medical Center were retrospectively examined. Rates and type of BR were analyzed according to patient characteristics (race/ethnicity, age, and body mass index), smoking status, cancer stage, and presence of diabetes mellitus. Breast reconstruction outcomes were also assessed. Results Of the 259 patients that underwent mastectomy, 87 (33.6%) received BR. Immediate BR was performed in 79 (30.5%) patients and delayed BR in 8 (3.1%). Of the 79 patients with immediate BR, 58 (73.4%) received implant-based BR and 21 (26.5%) autologous tissue. The BR failure rate was 10%, all implant-based. Increasing age and smoking negatively impacted BR rates. Black ( P =.331) and Hispanic ( P =.132) ethnicity were not independent predictors of decreased breast reconstruction. Conclusion This study demonstrated that the rate, type, and quality of BR in this integrated safety-net hospital within a diverse population are comparable to national rates. When made available, historically underrepresented minority patients of Black and Hispanic ethnicity utilize BR.

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