Myofibroblasts represent an important prognostic factor for invasive growth that is translated into a poor clinical prognosis for patients with invasive breast cancer.

We have used an inframammary adipofascial flap for breast-conserving reconstruction in the inferior portion of the breast since 2005. The aim herein is to report this oncoplastic procedure in detail, including the long-term results. The surgical procedure was as follows: A skin incision is made at the inframammary line. After partial resection of the breast, a tongue-shaped flap of the fat and the anterior sheath of the rectus abdominis muscle are pulled up in the inframammary area. The flap is then inserted into the breast area where the tumor was removed, and it is secured with absorbable sutures to the surrounding breast tissue. When making the flap, it is very important to preserve several intercostal perforators around the inframammary line. Cosmetic results at more than 5 years after the operation in the 5 patients were assessed using photographs. The results were found to be good in 4 cases (80%) and poor in 1 case. The poor outcome was a case with 100% fat necrosis of the flap. This surgical procedure is easy to perform, and the long-term cosmetic outcomes were good, without complications. We consider this procedure to be useful for breast-conserving reconstruction after breast cancer occurring in the inferior portion of the breast.

This study showed that the performance of clinicians to diagnose non-mass lesions appearing as hypoechoic areas on breast ultrasonographic images was improved by the use of a CAD scheme.

It is often difficult for clinicians to decide correctly on either biopsy or follow-up for breast lesions with masses on ultrasonographic images. The purpose of this study was to develop a computerized determination scheme for histological classification of breast mass by using objective features corresponding to clinicians' subjective impressions for image features on ultrasonographic images. Our database consisted of 363 breast ultrasonographic images obtained from 363 patients. It included 150 malignant (103 invasive and 47 noninvasive carcinomas) and 213 benign masses (87 cysts and 126 fibroadenomas). We divided our database into 65 images (28 malignant and 37 benign masses) for training set and 298 images (122 malignant and 176 benign masses) for test set. An observer study was first conducted to obtain clinicians' subjective impression for nine image features on mass. In the proposed method, location and area of the mass were determined by an experienced clinician. We defined some feature extraction methods for each of nine image features. For each image feature, we selected the feature extraction method with the highest correlation coefficient between the objective features and the average clinicians' subjective impressions. We employed multiple discriminant analysis with the nine objective features for determining histological classification of mass. The classification accuracies of the proposed method were 88.4 % (76/86) for invasive carcinomas, 80.6 % (29/36) for noninvasive carcinomas, 86.0 % (92/107) for fibroadenomas, and 84.1 % (58/69) for cysts, respectively. The proposed method would be useful in the differential diagnosis of breast masses on ultrasonographic images as diagnosis aid.

We defined the glandular flap including fat in the subclavicular area as an extended glandular flap, which has been used for breast-conserving reconstruction in the upper portion of the breast. Indication. The excision volume was 20% to 40% of the breast volume, and the breast density was dense. Surgical Technique. The upper edge of the breast at the subclavicular area was drawn in the standing position before surgery. After partial mastectomy, an extended glandular flap was made by freeing the breast from both the skin and the pectoralis fascia up to the preoperative marking in the subclavicular area. It is important to keep the perforators of the internal mammary artery and/or the branches of the lateral thoracic artery intact while making the flap. Results. Seventeen patients underwent remodeling using an extended glandular flap. The cosmetic results at 1 year after the operation: excellent in 11, good in 1, fair in 3, and poor in 2. All cases of unacceptable outcome except one were cases with complications, and more than 30% resection of moderate or large size breasts did not obtain an excellent result for long-term followup. Conclusion. This technique is useful for performing the breast-conserving reconstruction of small dense breasts.