reast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare lymphoma associated with long-term placement of textured breast implants. [1][2][3][4] The first case of BIA-ALCL was reported in 1997 5 and, until recently, this disease process was poorly described. There have been approximately 600 to 700 documented cases worldwide, and because of the rarity of the disease, the National Comprehensive Cancer Network did not release staging guidelines until 2017 6 (most recently updated in 2019). BIA-ALCL has been the subject of avid research in plastic surgery, oncology, immunology, and cellular biology, in addition to governmental regulation; internationally, 38 countries have banned or restricted sale of Allergan Biocell (Allergan, Inc., Dublin, Ireland) textured expanders because of concern of BIA-ALCL.

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Importance Vulvar reconstruction may be required after vulvectomy or any vulvar surgery. Providers should be familiar with techniques for reconstruction to improve clinical outcomes. Objective This article reviews the different techniques for reconstruction after vulvectomy and describes the decision-making process for selection of appropriate techniques, postoperative care, and expected outcomes. Evidence Acquisition A literature search was conducted, focusing on the plastic surgery and gynecologic oncology literature, using the following search terms: “vulvar reconstruction,” “perineal reconstruction,” “vulvectomy,” and “vulvar cancer.” The search was limited to English publications. Results Reconstruction after vulvectomy can be performed using a variety of techniques ranging from simple or complex closure to adjacent tissue rearrangement to skin grafting, locoregional, and free flaps. The appropriate technique is best chosen based on the characteristics of the patient and postablative defect, as well as the reconstructive goals. Postoperative complications are usually minor. Conclusions Vulvar reconstruction techniques vary widely and offer patients improved outcomes. Relevance Knowledge of vulvar reconstruction techniques is necessary for gynecologists performing vulvar surgery to ensure optimal patient outcomes. Target Audience Obstetricians and gynecologists, Family Physicians Learning Objectives After completing this activity, the learner should be better able to describe 3 different techniques of vulvar reconstruction; explain the factors involved in choosing a technique; and identify possible complications of vulvar reconstruction.

A 14-year-old boy presented to an outside emergency department with an expanding right neck mass after he had been struck by an elbow to the neck 4 days earlier during a basketball game. On initial examination in the emergency department, a soft, minimally tender, cystic mass was visible and easily palpable in the right posterior cervical triangle. Despite considerable growth of the mass after the injury and a substantial cosmetic deformity, the patient exhibited no neurologic signs, respiratory compromise, or voice changes. Computed tomography (CT) of the neck with intravenous contrast showed a hypodense, 7.3 × 6.3 × 3.6-cm mass in the right posterior cervical space with anterolateral displacement of the sternocleidomastoid muscle (fi gure 1).A review of the patient's history revealed that when he was a young child, a mass in this area of his neck had been diagnosed; it was smaller than 1 cm at that time. The mass was believed to be benign, and further intervention was discouraged. The patient had experienced no problem related to the mass until the night of the basketball injury.In view of concern over the expanding nature of the mass, the patient was transferred to the Children's Figure 1. Contrast-enhanced CT shows the large mass in the right posterior cervical space.