Goo-Hyun Mun

Background Although abdominal flaps remain the gold standard for autologous breast reconstruction, their use in low-BMI patients—particularly in bilateral cases or when matching a contralateral large breast—can be limited by concerns about insufficient volume. The lumbar artery perforator (LAP) flap has emerged as a potential alternative. This study evaluated its volumetric adequacy in lean patients using computed tomographic angiography (CTA)-based analysis. Methods Between 2019 and 2024, patients with BMI ≤ 25 who underwent abdominal flap-based breast reconstruction were retrospectively reviewed. Flap volumes were assessed using CTA. LAP flap volumes were compared with (1) 50% of estimated abdominal flap volume to simulate bilateral reconstruction and (2) estimated abdominal flap volumes based on inset rates from bipedicled cases. Comparisons were stratified by BMI: < 23 and 23–25. Results A total of 177 patients were included. The estimated abdominal and LAP flap volumes were 695.0 and 486.6 cm³, respectively, both positively correlated with BMI. The LAP-to-abdominal flap volume ratio increased as BMI decreased. LAP flap volume exceeded 1.0 relative to 50% of abdominal volume in over 90% of cases, especially in the BMI < 23 group. In bipedicled DIEP flap cases, the average abdominal inset ratio was 0.84; accordingly, the adjusted LAP-to-abdominal flap volume ratio was 0.87 overall and 0.92 in the BMI < 23 group. Conclusions The LAP flap volume was found to be comparable to that of the abdominal flap in a meaningful proportion of lean patients. These findings suggest it may serve as a reasonable alternative in cases requiring bilateral or bipedicled abdominal flap reconstruction. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Immediate postmastectomy breast reconstruction in patients with history of breast-conserving surgery and radiotherapy presents unique challenges owing to p

Background: While peripheral excision margins in cutaneous melanoma are well established, the optimal excision depth remains unclear. In plantar melanoma, the fat pad plays a key functional role, raising concerns about whether full excision is necessary for thin and intermediate‐thickness lesions. This study evaluated the association between excision depth and oncologic outcomes in T1–T3 plantar melanoma. Methods: Patients with primary T1–T3 plantar melanoma who underwent wide excision between 2008 and 2022 were reviewed. They were grouped by excision depth: intra‐adiposal (partial fat pad preservation) and suprafascial (complete removal). Oncologic and functional outcomes, assessed via the Foot Function Index (FFI), were compared. Results: Ninety‐four patients (40 intra‐adiposal, 54 suprafascial) were analyzed (median follow‐up, 43 months). Tumor‐free margins were achieved in all cases. Baseline characteristics were similar, except for lesion location. Recurrence rates were comparable, and excision depth was not significantly associated with recurrence‐free survival. FFI scores from 26 patients (13 per group) tended to be better in the intra‐adiposal group, though not statistically significant. Conclusions: In thin to intermediate‐thickness plantar melanoma, intra‐adiposal excision may be oncologically safe if tumor‐free margins are achieved, potentially offering functional benefits without compromising oncologic outcomes.

Computed tomography angiography (CTA) offers substantial benefits for reconstructive surgeons in preoperative planning for abdomen-based flap procedures in breast reconstruction. The abdominal perforator-based autologous breast reconstruction has become the gold standard due to its superior cosmetic outcomes and high patient satisfaction. Meticulous preoperative planning is crucial for the success of deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. In this context, CTA, recognized as the gold standard for perforator mapping, provides crucial insights into patient anatomy, optimizing flap design and elevation. This study aims to go beyond the role of CTA for perforator mapping and summarize the wealth of information that can be obtained from preoperative imaging tools for abdomen-based flaps in breast reconstruction. Such information not only aids in assessing the risk of postoperative complications but also supports the design of various flaps beyond DIEP. Furthermore, we will introduce the latest methods for utilizing this information to assist during preoperative planning and intraoperative decision making.

Yoo JW, et al. J Breast Cancer. 2025 Oct;28:e35. https://doi.org/10.4048/jbc.2025.0053