Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast. This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed. Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients. Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast.

Background: Diabetic mastopathy is an unusual fibroinflammatory breast lesion that characteristically presents in premenopausal women with long-standing type 1 diabetes mellitus with multiple microvascular complications. The pathogenesis of this condition is believed to involve an autoimmune reaction to the accumulation of abnormal matrix induced by hyperglycemia. Clinicopathologic features include the development of dense keloidlike breast masses that are often recurrent or bilateral or both. Clinical distinction from a malignancy can be difficult. However, the benign nature of this lesion is easily recognized on histologic examination, and it is not associated with an increased incidence of epithelial or stromal neoplasia.Hypothesis: A constellation of histopathologic and clinical features is necessary to make the diagnosis of diabetic mastopathy. Unnecessary surgery can be avoided in the clinical follow-up of patients with multiple, bilateral, and recurrent lesions.

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Purpose: Cyclooxygenase-2 (COX-2) expression has been shown to be associated with radiation resistance, which theoretically could be overcome with the use of COX-2 inhibitors. The purpose of this study was to assess the prognostic significance and clinical correlations of COX-2 expression (COX) in a cohort of patients treated with radiation for postmastectomy chest wall relapse. Experimental Design: Between 1975 and 1999, 113 patients were treated for isolated postmastectomy chest wall relapse. All patients were treated with biopsy and/or excision of the chest wall recurrence followed by radiation therapy. Median follow-up was 10 years. All clinical data, including demographics, pathology, staging, receptor status, HER-2/neu status, and adjuvant therapy, were entered into a computerized database. Paraffin-embedded chest wall recurrence specimens were retrieved from 42 patients, of which 38 were evaluated, created into a tissue microarray, stained by immunohistochemical methods for COX, and graded 0 to 3+. A score of 2 to 3+ was considered positive. Results: Overall survival from original diagnosis for entire cohort was 44% at 10 years. Survival rate after chest wall recurrence was 28% at 10 years.The distant metastasis-free survival rate after chest wall recurrence was 40% at10 years. Local-regional control of disease was achieved in 79% at 10 years after chest wall recurrence. COX was considered positive in 13 of 38 cases. COX was inversely correlated with estrogen receptor (P = 0.045) and progesterone receptor (P = 0.028), and positively correlated with HER-2/neu (P = 0.003). COX was also associated with a shorter time to postmastectomy chest wall relapse. The distant metastasis-free rate for COX-negative patients was 70% at 10 years, compared with 31% at 10 years for COX-2^positive patients (P = 0.029). COX positive had a poorer local-regional progression-free rate of 19% at 10 years, compared with 81% at 10 years for COX negative. This was of high statistical significance with a P value of 0.003. Conclusions: Outcome following radiation therapy for postmastectomy chest wall relapse is relatively poor. Positive COX correlated with other markers of poor outcome, including a shorter time to local relapse, negative estrogen receptor/progesterone receptor, and positive Her-2/neu status. Positive COX correlated with higher distant metastasis and lower local-regional control of disease. If confirmed with larger studies, these data have implications with respect to the concurrent use of COX-2 inhibitors and radiation for postmastectomy chest wall relapse.Despite the increasing use of breast-conserving surgeries for breast cancer, mastectomy still plays a large role in primary and salvage treatment. Unfortunately, despite the attempted removal of all breast tissue during a mastectomy, local-regional recurrences still occur. About 10% to 20% of all patients develop a local recurrence, mostly within the boundaries of the chest wall, within a 10-year period despite achieving negative surgical margins (1 -8). Pr...