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Highlights54 year old lady presenting with breast erythema and raised inflammatory markers.Initially managed with IV antibiotics but deteriorated with worsening erythema a few days into her admission.CT thorax showed a large volume of interstitial gas in the breast with histological samples confirming necrotising fasciitis.We propose the use of cross-sectional imaging to investigate potential cases of necrotising fasciitis of the breast.

HighlightsIn patients with history of Invasive lobular cancer of breast with positive faecal occult blood with or without bowel symptoms should have high clinical suspicion of bowel metastasis.Breast cancer is the second most common cancer to metastasise to anywhere along the gastrointestinal tract from oropharynx to anus.

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BackgroundAcellular dermal matrices (ADM) such as StratticeTM are increasingly used in UK during implant-based reconstruction. However, there are mixed opinions regarding the compatibility of radiotherapy treatment in pre- and post-reconstructed breasts. The aims of this study are to audit the rates of radiation induced complications in patients who underwent breast reconstruction using StratticeTM and establish whether there is an association between timing of radiotherapy and complication rates.MethodsRetrospective data collection was performed for all patients who underwent skin-sparing mastectomy and immediate or delayed StratticeTM-based reconstruction, and received pre- or post-reconstruction radiotherapy from July 2010 to November 2014.ResultsThe age ranged from 33 to 78 years (mean age 51 ± 10.6) with a mean follow-up time of 21 months. There were 25 StratticeTM-based reconstructions performed. Sixteen had delayed reconstruction, and 9 had skin-sparing mastectomy and immediate reconstruction. There were 4 (16 %) abandoned procedures due to inability to stretch the mastectomy flap secondary to poor skin compliance. Two women (8 %) presented 4 and 9 months later with wound breakdown. One case (4 %) developed severe capsular contracture following radiotherapy post-reconstruction and 1 case (4 %) of implant rupture. There were no episodes of extrusion or implant infection. Overall complication rates were 32 %. The majority (75 %) of complications occurred in breasts reconstructed post-radiotherapy; however, this is not significant when analysed using chi-square (p = 0.43).ConclusionsOur evidence suggests that there is no difference in complication rates in pre- and post-radiation individuals; this would suggest that implant-based reconstruction using StratticeTM should not be an absolute contraindication in pre- or post-radiotherapy patients. However, when planning these procedures, it is paramount that the increased risks are emphasised to patients in order to better manage patient expectation in cases where complications arise.Level of Evidence: Level III, risk / prognostic study.