Purpose Women with different BMI, age and comorbidities seek for breast reconstruction. It is critical to understand the risk associated with each technique to ensure the most appropriate method and timing is used. Outcome after reconstructions have been studied, but consensus is lacking regarding predictive risk factors of complications. The authors present their experience of different autologous and alloplastic reconstructions with an emphasis on predictors of complications. Methods Prospectively maintained reconstruction database from 2008 to 2019 was reviewed. Factors associated with complications were identified using logistic regression, multinomial logistic regression and risk factor score to determine predictors of complications. Results A total of 850 breast reconstructions were performed in 793 women, including 447 DIEP, 283 LD, 12 TMG and 51 implant reconstructions. Complications included minor (n = 231, 29%), re-surgery requiring (n = 142, 18%) and medical complications (n = 7, 1%). Multivariable analysis showed that complications were associated independently with BMI > 30 (OR 1.59; 95% CI 1.05-2.39, p = 0.027), LD technique (OR 4.05; 95% CI 2.10-7.81, p < 0.001), asthma or chronic obstructive pulmonary disease (OR 2.77; 95% CI 1.50-5.12, p = 0.001) and immediate operation (OR 0.69; 95% CI 0.44-1.07, p = 0.099). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the risk score increased (35%, 61%, 76% and 100% for 1, 2, 3 and 4 risk scores, respectively, p < 0.001). Conclusions The rate of complication can be predicted by a risk-scoring system. In increasing trend of patients with medical problems undergoing breast reconstruction, tailoring of preventive measures to patients' risk factors and careful consideration of the best timing of reconstruction is mandatory to prevent complications and costs.

SIGNIFICANCE Cutaneous squamous cell carcinoma is one of the most common cancers of the skin. A more precise and timely knowledge of these tumours is needed in order to provide optimal care. This study describes the epidemiology of cutaneous squamous cell carcinomas in a patient cohort in Finland, analysing the anatomical distribution, histopathological features and treatment modalities to reflect the typical day-today clinical practice. The incidence of cutaneous squamous cell carcinoma is increasing worldwide. In most epidemiological studies, only the first case of cutaneous squamous cell carcinoma is registered, underestimating the burden of the disease. To determine the frequency and detailed characteristics of cutaneous squamous cell carcinoma in a Finnish patient cohort, we performed a retrospective 10-year study taking into account multiple tumours in one patient. On the pathology database search and medical record review we identified 774 patients with a total of 1,131 cutaneous squamous cell carcinomas. The crude incidence increased from 18.6/100,000 persons in 2006 to 28.1 in 2015. The location of tumours differed between men and women: the greatest difference concerned cutaneous squamous cell carcinoma of the ear, with 93% of cases occurring in men. One fourth (24%) of patients had more than one tumour. A small shift from poorly to well-differentiated tumours was seen. In conclusion, the incidence of cutaneous squamous cell carcinoma increased, with many patients presenting with multiple tumours.

Recent data have demonstrated no survival benefit to immediate completion lymph node dissection (CLND) for positive sentinel node (SN) disease in melanoma. It is important to identify parameters in positive SNs, which predict prognosis in melanoma patients. These might provide prognostic value in staging systems and risk models by guiding high-risk patients' adjuvant therapy in clinical practice. In this retrospective study of university hospital melanoma database we analyzed tumor burden and prognosis in patients with positive SNs. Patients were stratified by the diameter of tumor deposit, distribution of metastatic focus in SN, ulceration and number of metastatic SNs. These were incorporated in Cox proportional hazard regression models. Predictive ability was assessed using Akaike information criterion and Harrell's concordance index. A total of 110 patients had positive SN and 104 underwent CLND. Twenty-two (21%) patients had non-SN metastatic disease on CLND. The 5-year melanoma specific survival for CLND-negative patients was 5.00 years (IQR 3.23-5.00, range 0.72-5.00) compared to 3.69 (IQR 2.28-4.72, range 1.01-5.00) years in CLND-positive patients (HR 2.82 (95% CI 1.17-6.76, p = 0.020).The models incorporating distribution of metastatic focus and the largest tumor deposit in SN had highest predictive ability. According to Cox proportional hazard regression models, information criterions and c-index, the diameter of tumor deposit > 4 mm with multifocal location in SN despite of number of metastatic SN were the most important parameters. According to the diameter of tumor deposit and distribution of metastatic focus in SN, adequate stratification of positive SN patients was possible and risk classes for patients were identified.

Background: The latissimus dorsi (LD) flap is still a popular choice for breast reconstruction. Plain LD provides a good option for women with small breasts, but with bigger breasts, the problem is insufficient volume. Traditionally, implants have been inserted to improve the volume, but because of problems associated with them, the use of fat grafting has gained popularity. Increased numbers of reports considering also immediate lipofilling have been published. This study aimed to evaluate and compare different techniques in LD reconstruction in association with complications, number of further operations, and duration of reconstructive process. Methods: A retrospective review of patients who had undergone LD reconstruction between 2008 and 2019 was performed. Demographic and operative features, complications, and the duration of reconstruction process were analyzed. Results: A total of 291 LD flaps were performed in 283 women, including 161 (55%) implant enhanced, 73 (25%) immediate lipofilled, and 57 (20%) plain flaps. Of these, 84% were delayed reconstructions. The median volume of immediately injected fat was 155 mL (range, 50-296 mL) and inserted implant 185 mL (range, 80-420 mL). Of plain LDs, 75% did not need further operations compared with 63% of implant and 49% of lipofilling groups (P < 0.001). The median duration of reconstructive process was 10 months (range, 4-86 months) in plain, 13 months (range, 5-58 months) in implant, and 18 months (range, 5-80 months) in lipofilling group (P < 0.002). No significant differences were observed in overall complication rates between groups (P = 0.228). Most of the complications were minor, seroma being the most common. Of major complications, plain flaps were most commonly associated with donor site problems, lipofilling group with partial flap necrosis, and implant enhanced with deep infections in the breast. Shoulder problem was observed in 21 patients (7%) with no significant difference between groups (P = 0.395). Conclusions: Latissimus dorsi flap is a versatile and safe breast reconstruction method, because it is associated most commonly only with minor complications. Careful patient selection is important when choosing between different techniques. This can have an impact on the number of further operations needed and the duration of reconstruction process. Immediate lipofilling is a safe technique to avoid the use of implant and allow fully autologous reconstruction.

Background: Reduction mammoplasty can be performed in several different techniques. Understanding the complication profile and risk factors in different reduction methods can help in choosing a technique, which serves the patient best. The authors present their experience of three different reduction techniques [superomedial pedicle (SMP), superior pedicle (SP) and inferior pedicle (IP)] with an emphasis on predictors of complications. Methods: A retrospective review of a prospectively maintained database of breast reductions between 2014 and 2020 was performed. Patient's demographics [age, body mass index (BMI), comorbidities, smoking, nipple to sternal notch distance (N-SN)], operative details (pedicle, tissue resected, drains, operating surgeon) and complications according to Clavien-Dindo classification were assessed. Study variables were compared against overall complication rates for the three techniques.Results: In total, 760 patients underwent reduction mammoplasty, including 578 (76%) bilateral and 182 (24%) unilateral operations. Of patients, 477 (63%) were operated with SMP, 201 (26%) with IP and 82 (11%) with SP. An average weight of resected tissue per breast was 460 g. Overall complication rate was 38%. The rate was higher in IP group (50%) compared to SMP (36%) and SP (22%) groups (P<0.001). Complications were mainly minor and related to delayed wound healing. The rate for major complications was 4%. Multivariable analysis showed that complications were associated independently with IP [odds ratio (OR) 1.89, 95% confidence interval (CI): 1.33-2.69], age <50 years (OR 1.87, 95% CI: 1.32-2.65), bilateral operation (OR 1.67, 95% CI: 1.00-2.76) and resected tissue weight ≥650 g per breast (OR 2.02, 95% CI: 1.36-2.99). Each factor contributed 1 point in the creation of a risk-scoring system. The overall complication rate was increased as the presence of statistically significant risk factors (IP, age <50, bilateral operation and/or resected tissue ≥650 g per breast) increased (31%, 38%, 59% and 90% for number of 1, 2, 3 and 4 risk factors respectively, P<0.001). Conclusions:The rate of complication can be predicted by a risk-scoring system. In increasing variety of patients undergoing reduction mammoplasty, careful consideration of the best operation technique is important to prevent complications and costs.