Background Breast cancer patients with locally advanced breast cancer who require radical mastectomy are left with large chest wall defects. This poses a significant reconstructive challenge as many high-risk patients require timely postmastectomy adjuvant therapy. While the reverse abdominoplasty technique is commonly used for aesthetic improvement of the anterior trunk, it can be also be effectively used for closure of extensive mastectomy defects in this patient population. Methods We conducted a retrospective cohort study of all consecutive patients who underwent an extensive radical mastectomy followed by immediate closure with the reverse abdominoplasty technique at a single tertiary cancer center from June 2017 to July 2022. Patients who had concurrent skin grafting or breast mound flap reconstruction were excluded. Demographic, medical, oncologic, and reconstructive data were collected. Results Six patients were treated with reverse abdominoplasty for 9 chest wall defects after surgical excision of locally advanced breast cancer. The median tumor size was 10.7 cm (range, 6.7–10 cm) and the median mastectomy weight was 865.7 g (range, 356.4–1247.7 g). On average, the operation length was 191 minutes (range, 86–257 minutes) and the postoperative length of stay was 2.2 days (range, 1–5 days). All patients underwent systemic adjuvant therapy and the median time from surgery to initiation of therapy was 44.5 days (range, 32–75 days). Conclusions Reverse abdominoplasty is a simple and safe technique to reliably close large defects after locally advanced breast cancer excision. It has a short operative time, hospital stay, and turnaround time to initiation of adjuvant therapy.

Background: Monobloc advancement with distraction is a holistic approach to treat the sequelae of syndromic craniosynostosis. These osteotomies create a communication between the nasal cavity and anterior cranial fossa that must be surgically obliterated to limit the infectious risks. In light of mandatory COVID-19 testing protocols amidst the pandemic, we aim to identify the specific challenges in management and present our strategy to overcome them. Case presentation: We report 2 cases of syndromic craniosynostosis treated with monobloc distraction during the COVID-19 pandemic and highlight safety concerns and our approach to managing these patients by avoiding nasopharyngeal swabs that may potentially penetrate the cranial base and place the patient as risk for iatrogenic injury. Discussion/conclusion: In patients undergoing surgical procedures that create a cranial base defect, caution must be exercised when attempting to test for COVID-19 which may be a source of potential iatrogenic injury. We propose a new algorithm for COVID-19 screening/surveillance following frontofacial advancement. Patients must be screened via alternative testing methods or treated as potential asymptomatic carriers of COVID-19 until postoperative imaging demonstrates complete ossification of the cranial base.