Gland surgery最新文献

{"title":"When and how can in-hospital deaths following pancreaticoduodenectomy be prevented?","authors":"Akihiro Cho, Yukiko Niwa, Takeshi Ishita, Toshihiko Mori, Moe Tanemura, Atsushi Oda, Ryota Higuchi, Masaho Ota, Satoshi Katagiri","doi":"10.21037/gs-2026-0318","DOIUrl":"10.21037/gs-2026-0318","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"244"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of menstrual cycle on the safety of elective thyroid surgery.","authors":"Lei Zhang, Jia Liu","doi":"10.21037/gs-2026-0231","DOIUrl":"10.21037/gs-2026-0231","url":null,"abstract":"<p><strong>Background: </strong>The potential impact of the menstrual cycle on perioperative bleeding and surgical outcomes remains a topic of debate, yet limited evidence exists specifically for thyroid surgery in women of reproductive age. This study aimed to investigate the influence of menstrual cycle phase on the safety of routine thyroid surgery in women of reproductive age to provide evidence-based guidance for optimal surgical timing.</p><p><strong>Methods: </strong>This retrospective descriptive study involved 318 women of reproductive age with regular menstrual cycles who underwent thyroid surgery. Patients were stratified by surgical extent into unilateral thyroid lobectomy and total thyroidectomy groups. Based on their menstrual cycle phase at the time of thyroid surgery, patients were further categorized into menstrual, follicular, and luteal phase groups. Clinical data were collected and analyzed to compare surgical safety outcomes across the different menstrual phases.</p><p><strong>Results: </strong>Baseline characteristics were largely comparable among the menstrual phase groups. While triiodothyronine levels, white blood cell counts, and absolute monocyte counts differed significantly among the menstrual phase groups (P<0.05), all values remained within the normal clinical reference ranges. In the total thyroidectomy group, 24-hour postoperative drainage volumes differed significantly across the menstrual phases (P<0.05). However, the absolute magnitude of this difference was small (median: 40 mL for all three groups), and no other intraoperative or postoperative variables differed significantly among groups (P>0.05). Multivariate analysis identified operative time as the sole independent risk factor for increased 24-hour postoperative drainage volume (β=1.33, 95% confidence interval: 0.61-2.06, P<0.001); notably, menstrual phase was not an independent predictor.</p><p><strong>Conclusions: </strong>The menstrual cycle phase does not exert a clinically significant impact on the safety of routine thyroid surgery in women of reproductive age. These findings support that, under standard perioperative conditions including strict aseptic technique and meticulous surgical execution, performing thyroid surgery during menstruation is both safe and feasible.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"226"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors and nomogram for predicting central lymph node metastasis in papillary thyroid carcinoma based on gasless transaxillary endoscopic thyroidectomy.","authors":"Yifan He, Yawen Bai, Jianfeng Sheng","doi":"10.21037/gs-2026-0228","DOIUrl":"10.21037/gs-2026-0228","url":null,"abstract":"<p><strong>Background: </strong>Gasless transaxillary endoscopic thyroidectomy (GTET) offers superior cosmetic outcomes for patients with unilateral papillary thyroid carcinoma (PTC). Accurate preoperative prediction of central lymph node metastasis (CLNM) risk is crucial for determining the extent of central lymph node dissection in this minimally invasive approach. This study aims to develop and validate a nomogram for predicting CLNM in patients with PTC undergoing GTET.</p><p><strong>Methods: </strong>A total of 377 PTC patients who underwent GTET in the past four years were included, comprising 260 patients without CLNM and 117 patients with CLNM. Independent risk factors were identified via least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses to construct a nomogram model. Internal validation was performed using bootstrap resampling. Model discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, the concordance index (C-index), calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Younger age, prolonged operative time, larger tumor diameter, a greater number of dissected lymph nodes, and higher preoperative free thyroxine (FT4) levels were identified as independent risk factors for CLNM. The model yielded a C-index of 0.797 [95% confidence interval (CI): 0.758-0.847], which remained robust at 0.787 (95% CI: 0.740-0.834) following bootstrap validation. The calibration curve demonstrated high concordance between predicted probabilities and actual incidences. Furthermore, the DCA curve indicated that the model offers a favorable clinical net benefit across a threshold probability range of 5% to 80%.</p><p><strong>Conclusions: </strong>This study presents a predictive model for evaluating CLNM risk in PTC patients undergoing GTET. This tool facilitates the advancement and broader adoption of this surgical approach and provides an objective rationale for clinical decision-making regarding central lymph node dissection within this surgical context.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"228"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid metastasis from lung adenocarcinoma: diagnostic pitfalls and individualized management in a six-patient case series and literature review.","authors":"Yan Liu, Dongqiang Yang, Yanzhao Wu, Ping Shi","doi":"10.21037/gs-2026-0256","DOIUrl":"10.21037/gs-2026-0256","url":null,"abstract":"<p><strong>Background: </strong>Clinically recognized thyroid metastasis from lung adenocarcinoma is rare and may mimic a primary thyroid malignancy because imaging, cytologic, and immunophenotypic findings overlap. We aimed to characterize the diagnostic pitfalls, management, and outcomes of 6 consecutive patients and to define the limited circumstances in which thyroid-directed treatment may be reasonable.</p><p><strong>Case description: </strong>Six patients with pathologically confirmed thyroid metastasis from lung adenocarcinoma were treated at an academic tertiary cancer hospital between September 2018 and September 2023. The cohort included 4 men and 2 women, with a mean age of 57 years. Of the 6 patients included in this case series, 2 underwent surgical resection after their primary lung lesions were identified. One of these 2 patients experienced postoperative recurrence with subsequent bone metastasis, and the other developed multiple intrapulmonary metastases and thyroid metastasis after surgery. The remaining 4 patients already had advanced-stage disease at initial detection and were not eligible for surgery, so they received systemic anti-tumor therapy. Thyroid metastasis was detected in all 6 cases during tumor staging or post-treatment follow-up. At the time of examination, 5 patients had no specific clinical symptoms, while 1 patient presented with a palpable neck mass. All patients underwent neck ultrasound and computed tomography (CT) scanning. The diagnosis was confirmed by ultrasound-guided fine-needle aspiration biopsy in 5 patients (Cases 1 and 3-6). In the remaining patient (Case 2), cytological findings were suggestive of primary medullary thyroid carcinoma, and the diagnosis of metastatic lung adenocarcinoma was established by postoperative histopathology following thyroidectomy, which was also performed to prevent local functional impairment. As of the data cutoff date, 1 patient was still alive with disease, 4 patients died from metastatic disease, and 1 patient was lost to follow-up.</p><p><strong>Conclusions: </strong>A new thyroid lesion in a patient with current or previous lung adenocarcinoma should prompt consideration of metastatic disease and tissue confirmation with a focused immunohistochemical panel. Systemic therapy remains the main treatment for most patients. Thyroidectomy should not be routine and may be considered only after multidisciplinary assessment for truly isolated/oligometastatic disease amenable to complete local control or for imminent airway, swallowing, or laryngeal morbidity. No survival benefit from surgery can be inferred from this small series.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"239"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway stenosis following immediate bilateral recurrent laryngeal nerve reconstruction: report of two cases successfully treated with laser submucosal intermediate transverse resection of the arytenoid cartilage.","authors":"Koji Matsushima, Fumi Saito","doi":"10.21037/gs-2026-0257","DOIUrl":"10.21037/gs-2026-0257","url":null,"abstract":"<p><strong>Background: </strong>While the usefulness of immediate intraoperative reconstruction of the unilateral recurrent laryngeal nerve (RLN) has been reported, there are few reports of bilateral reconstruction. Furthermore, detailed evaluation of laryngeal function before and after surgical treatment for airway compromise caused by bilateral RLN paralysis remains limited. This report aimed to highlight a preventable complication of immediate bilateral RLN reconstruction and a salvage treatment option.</p><p><strong>Case description: </strong>We report two women who underwent immediate bilateral RLN reconstruction during surgery for benign thyroid tumors at another hospital and subsequently developed airway stenosis. Both patients underwent intraoperative tracheostomy and were referred to our institution for tracheostomy closure. Laryngeal electromyography revealed thyroarytenoid muscle activity during inspiration and reduced activity during phonation, indicating nerve misinnervation. Respiratory, swallowing, and voice functions were evaluated before and after surgery. The laser submucosal intermediate transverse resection of the arytenoid cartilage (LSITRA) technique was performed to enlarge the posterior glottis. In both cases, respiratory function improved after surgery, tracheostomies were successfully closed, and no restenosis was observed during more than 1 year of follow-up after decannulation.</p><p><strong>Conclusions: </strong>LSITRA was effective for treating airway stenosis caused by bilateral RLN paralysis, with minimal adverse effects on voice and swallowing function. Although immediate RLN reconstruction is effective for unilateral nerve injury, bilateral reconstruction should be avoided because misinnervation may result in airway compromise. In benign thyroid disease, a two-stage surgical approach should be considered when loss of signal is detected on one side.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"241"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a SEER-based prognostic nomogram for overall survival in elderly Asian American women with breast cancer.","authors":"Fei Xu, Yong-Miao Lin, Yu-Ling Zhang, Wen Xia, Xin-Qiao Cheng, Sha-Sha Du, Xin Huang, Xin Hua","doi":"10.21037/gs-2026-0260","DOIUrl":"10.21037/gs-2026-0260","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common malignancy among Asian American women. Although Asian American patients as a group often have favorable survival outcomes, elderly Asian American women may face distinct prognostic challenges. General prognostic models for breast cancer may have reduced accuracy in elderly Asian American women, who have distinct tumor biology, treatment patterns, and social contexts. No population-specific prognostic nomogram exists for this understudied intersectional group. The present study aimed to establish and validate a prognostic nomogram to predict overall survival (OS) in elderly Asian American breast cancer patients.</p><p><strong>Methods: </strong>Cases were identified via the International Classification of Diseases for Oncology, 3^rd edition (ICD-O-3) morphology and topography codes in Surveillance, Epidemiology, and End Results (SEER) [2000-2021], and Asian ethnicity was defined per SEER race/ethnicity classification. The median follow-up time was 50 months. Patients were randomly split into training (70%) and validation (30%) cohorts. Of 109,317 Asian female patients initially identified from the SEER database, 11,968 eligible patients aged ≥65 years with stage I-III primary breast cancer were included after applying exclusion criteria for secondary tumors, missing data, and other ineligible conditions. Univariable and multivariable Cox regression identified independent prognostic factors, which were incorporated into a nomogram predicting 1-, 3-, and 5-year OS probabilities. The nomogram's performance was evaluated using calibration, time-dependent receiver operating characteristic (tROC) curves, concordance index (C-index), and decision curve analysis (DCA).</p><p><strong>Results: </strong>Most patients had stage I disease (69.0%), hormone receptor (HR)⁺/human epidermal growth factor receptor 2 (HER2)^- subtype (81.4%), and were aged 65-74 years (68.0%). A total of 11,968 individuals were enrolled, with 8,380 patients in the training cohort and 3,588 in the validation cohort. The nomogram incorporated age, tumor grade, marital status, tumor-node-metastasis (TNM) stage, molecular subtype, surgery, and radiotherapy. It demonstrated moderate-to-good discriminative ability, with C-indices of 0.779 and 0.763 in the training and validation cohorts, respectively, outperforming the traditional TNM staging system. Calibration plots showed strong agreement between predicted and observed survival. tROC curves and DCA confirmed the nomogram's superior predictive accuracy and clinical utility over TNM staging.</p><p><strong>Conclusions: </strong>This nomogram provides a tailored risk stratification tool to support clinical decision-making for elderly Asian American breast cancer patients. External validation is required to confirm its generalizability before clinical implementation.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"222"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the efficacy and safety of breast augmentation using implants combined with autologous fat grafting: a retrospective study of 219 cases.","authors":"Phung Van Nguyen, Van Thanh Nguyen","doi":"10.21037/gs-2026-0389","DOIUrl":"10.21037/gs-2026-0389","url":null,"abstract":"<p><strong>Background: </strong>Hybrid breast augmentation-silicone gel implant placement combined with autologous fat grafting-is increasingly used in women with a thin soft-tissue envelope, yet large series from centers outside the groups that first described the technique remain limited. We evaluated the volumetric efficacy, safety, and aesthetic outcomes of hybrid augmentation, and examined whether the size gain explained patient-reported satisfaction.</p><p><strong>Methods: </strong>We retrospectively reviewed 219 women who underwent primary hybrid breast augmentation, with complete 12-month follow-up. Outcomes were the change in breast circumference, patient-reported satisfaction (BREAST-Q Augmentation module, version 2.0; Satisfaction with Breasts domain, scored 0-100), a surgeon-rated aesthetic score, and postoperative complications. Data were analyzed in SPSS version 26.0 using paired t-tests, Fisher's exact test, univariate logistic regression, and Pearson correlation.</p><p><strong>Results: </strong>Breast circumference increased by a mean of 12.6±1.3 cm at 6 months and remained augmented at 12 months (mean gain 10.3±2.5 cm; both P<0.001). BREAST-Q satisfaction rose from a preoperative baseline of 54.4±5.9 to 80.9±5.7 at 6 months and 82.2±5.4 at 12 months (mean improvement +27.8 at 12 months; 95% confidence interval: 26.9-28.8; P<0.001), and surgeon aesthetic scores were consistently high. The overall complication rate was low (5.9%; 13/219); all events were minor, and no Baker grade IV capsular contracture occurred. Patient satisfaction was not explained by the magnitude of the size gain: BREAST-Q was not associated with the increase in circumference at either time point (r=0.05 at 6 months and r=0.06 at 12 months; both P>0.3). No complication occurred among the 33 patients with a smoking history (P=0.23), and body mass index (BMI) was not associated with complications (odds ratio 1.02; P=0.92).</p><p><strong>Conclusions: </strong>Hybrid breast augmentation provided substantial and durable enlargement with a low, exclusively minor complication profile in thin-tissue patients. Because satisfaction was largely independent of the degree of size increase, these findings support prioritizing soft-tissue quality and natural contour over volume alone. In the absence of an implant-only comparison group, these findings characterize outcomes after hybrid augmentation rather than establishing its superiority or the independent contribution of fat grafting.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"209"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant melanoma presenting as a thyroid mass with synchronous retroperitoneal metastases in a 55-year-old male: a case report.","authors":"Yifan He, Yawen Bai, Jianfeng Sheng","doi":"10.21037/gs-2026-0270","DOIUrl":"10.21037/gs-2026-0270","url":null,"abstract":"<p><strong>Background: </strong>Malignant melanoma (MM) is an aggressive tumor characterized by a high tendency for early metastasis. Although most cases have identifiable primary sites, melanoma of unknown primary (MUP) presents as metastatic disease without detectable primary lesions. MM presenting as a thyroid mass with concurrent metastasis to the spleen-kidney interspace is extremely rare, and the occult nature of the primary lesion also poses a significant diagnostic challenge, often leading to confusion with aggressive primary thyroid malignancies.</p><p><strong>Case description: </strong>A 55-year-old male with an unremarkable medical history presented with a 3-month history of a rapidly enlarging, painless left neck mass. Physical examination revealed a firm 5-cm mass in the left thyroid lobe and a similarly sized palpable mass in the right supraclavicular region. No suspicious lesions were noted on the skin or mucous membranes. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) identified multifocal hypermetabolic lesions involving the left thyroid lobe, right supraclavicular fossa, and splenorenal recess. To improve surgical precision, patient-specific three-dimensional (3D) printing technology was used preoperatively to depict the spatial relationship between the cervical masses and adjacent neurovascular structures. The patient subsequently underwent total thyroidectomy, cervical lymph node dissection, and resection of the retroperitoneal lesion. Postoperative histopathological examination confirmed metastatic melanoma at all sites, and molecular analysis identified the BRAF V600E mutation. The patient successfully initiated targeted therapy with dabrafenib and trametinib and remains stable during follow-up.</p><p><strong>Conclusions: </strong>Advanced melanoma should be included in the differential diagnosis of rapidly expanding, atypical thyroid masses, even in the complete absence of a known primary lesion. Clinicians must utilize fine-needle aspiration cytology and a targeted immunohistochemical panel to differentiate metastatic melanoma from primary anaplastic or medullary thyroid carcinomas early. Whole-body ¹⁸F-FDG PET/CT is crucial for detecting occult systemic metastases, while patient-specific 3D printing provides substantial practical value for complex head-and-neck operative planning.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"242"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nipple-areolar complex neurotization in implant-based breast reconstruction: a narrative review.","authors":"Daniel Maliszewski, Wiktoria Stańkowska, Artur Bocian, Joanna Kufel-Grabowska, Julian Krul, Sylwia Jałtuszewska, Radosław Tarkowski, Wojciech Jan Makarewicz","doi":"10.21037/gs-2026-0298","DOIUrl":"10.21037/gs-2026-0298","url":null,"abstract":"<p><strong>Background and objective: </strong>Nipple-sparing mastectomy with implant-based breast reconstruction preserves the visible nipple-areolar complex (NAC) but commonly disrupts protective, tactile, thermal, and erogenous sensation. Clinical interest has expanded, while donor selection, recipient targeting, bridge choice, implant-pocket constraints, outcome measurement, and candidacy remain unsettled. This narrative review addresses when native nerve preservation or reconstruction is anatomically credible, how implant-specific constraints affect operative planning, what the available outcomes support, and when selective non-use is appropriate.</p><p><strong>Methods: </strong>PubMed was the primary indexed database; Google Scholar and reference chaining were supplementary discovery methods. English-language, peer-reviewed sources relevant to predefined clinical questions were considered from database inception through 15 May 2026. Publications used for substantive claims were assessed in full text. Evidence was organized by directness and synthesized narratively according to study design, consistency, applicability, outcome methodology, and follow-up. No formal risk-of-bias instrument, quantitative pooling, dual independent systematic-review screening, or duplicate extraction was performed.</p><p><strong>Key content and findings: </strong>The direct evidence consists predominantly of technical reports and small single-center observational cohorts, with limited comparative and randomized evidence. Follow-up is generally short, sensory instruments and testing zones are inconsistent, and many reports do not provide denominators for planned, attempted, modified, or abandoned neurotization. The T3-T5 lateral intercostal corridor, particularly T4, is the principal donor region; safely preservable superficial branches may remain in continuity when oncologic resection and flap perfusion are uncompromised. Implant base width, donor length, route feasibility, and coaptation sequencing are supported technical considerations, whereas validated thresholds for acellular dermal matrix or capsule interfaces, compression, tissue expansion, route vascularity, or protected slack are absent. Subareolar stumps, retroareolar or subdermal NAC fields, posterior areolar tissue, and nipple-base targets have been used, without evidence of target superiority. Processed allograft has the strongest implant-based precedent, while direct repair, branch elongation, and autograft are anatomy-dependent alternatives; comparative biological and economic superiority is unestablished.</p><p><strong>Conclusions: </strong>NAC neurotization is selectively feasible and may improve sensation, but the evidence is heterogeneous and insufficient for firm technique or patient-selection recommendations. The proposed conditional framework supports clinical reasoning and transparent reporting; it is not a validated guideline.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"236"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of fat grafting to attenuate radiation damage: a narrative review.","authors":"Amy Skarsfeldt, Katharina S Berryman, Kento Takaya, Ivy J Stejskal, Kellen Chen, Geoffrey C Gurtner","doi":"10.21037/gs-2026-0230","DOIUrl":"10.21037/gs-2026-0230","url":null,"abstract":"<p><strong>Background and objective: </strong>Radiation-induced fibrosis (RIF) remains a progressive complication of cancer therapy that compromises tissue quality and reconstructive outcomes. Autologous fat grafting (AFG) has emerged as a regenerative strategy to mitigate radiation damage. However, clinical outcomes remain variable, and efforts to enhance outcomes have largely focused on improving graft survival, angiogenesis, and reduction of fibrotic remodeling. This review aims to highlight recent advances in fat grafting to resolve fibrosis and new evidence for closely related adverse conditions.</p><p><strong>Methods: </strong>In this narrative review, an overview of existing knowledge and recent research in the use of fat grafting to attenuate RIF is presented. The article is based on a literature search in PubMed with the keywords \"fat graft\" and \"adipose\" in addition to the senior authors' clinical experience in breast reconstruction.</p><p><strong>Key content and findings: </strong>Research continues to evaluate specific adipose-derived stem cell (ADSC) populations to improve graft survival with limited progress towards clinical application. In addition, several pharmacological strategies combined with AFG have been evaluated in murine models to mitigate RIF and improve fat graft outcomes. Emerging data on decellularized adipose matrix (DAM) shows promise and may be ideal for patients with insufficient adipose tissue. Given the ADSC population variability between donors, research studies could benefit from analyzing the adipose tissue as this remains poorly characterized. Most strategies involved in AFG enrichment involve procedures that would require Good Manufacturing Practice (GMP) handling or use of medicines outside of their indications, which would be considered burdensome in a clinical setting.</p><p><strong>Conclusions: </strong>This review examines current cellular therapy, pharmacologic treatments, and prophylactic strategies aimed at enhancing fat graft survival and discusses applications beyond attenuating fibrosis with specific indications focused on resolving secondary lymphedema, neuropathic pain, and wound healing with promising though limited clinical evidence.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"237"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}