To understand recent trends in breast reconstruction surgery, we analyzed NDB open data to visualize changes in reconstruction rates and regional disparities, which contribute to medical disparities. Additionally, we analyzed the results of a questionnaire survey on the actual condition of patients conducted by NPO E-BeC, and discussed the results based on previous studies.　
In Japan, implant use comprises the predominant reconstruction technique；however, the use of autologous tissues has recently gained attention. By prefecture, the Tokyo metropolitan area was responsible for approximately 30％ of all reconstructive surgeries. Furthermore, the overall reconstruction rate was low, at 12.5％, when the number of total resections was used as the denominator. Although reconstructive surgery differs from the treatment of general diseases, psychological care of patients with cancer following mastectomy is essential. Reported hurdles to reconstructive surgery were：“lack of hospitals nearby” and “cost,” indicating a close relationship. It has been suggested that the improvement of reconstructive techniques and correction of “economic disparity,” “regional disparity,” and “information disparity” are necessary for the spread of reconstructive surgery.

Oncoplastic surgery（OPS）has evolved globally as a surgical approach that combines oncologic safety with esthetic outcomes in breast cancer treatment. However, significant regional disparities in OPS availability persist in Japan, especially in smaller regional hospitals, where patients often lack access to appropriate breast surgery and reconstruction. A key contributing factor is the uneven distribution of trained medical professionals. Additionally, insurance regulations prohibit breast surgeons from performing implant-based breast reconstruction, further compounding challenges in regional healthcare. Achieving equitable access to OPS requires the development of “true oncoplastic breast surgeons” skilled in both cancer resection and reconstruction techniques. This study reviews current OPS training systems in Japan and abroad, incorporating insights from the author’s overseas training and clinical experience. To ensure equitable healthcare delivery, it is essential to establish a long-term, public-interest-driven OPS training system in collaboration with relevant academic societies.

Ultrasound and magnetic resonance imaging（MRI）are commonly used techniques for diagnosing silicone breast implant（SBI）rupture. However, we have encountered false-positive cases in which no rupture was found during surgery even when it was suspected based on US and MRI findings. The aim of this study was to evaluate the accuracy of preoperative ultrasound and MRI in patients who had undergone SBI removal or replacement. The sensitivity, specificity, and positive predictive value of ultrasonography were 57.1, 11.4, and 50.0％， respectively, and those of MRI were 75.0, 44.4, and 42.9％， respectively. It is important to recognize that the presence of typical imaging findings previously reported as suggestive of SBI rupture does not guarantee that it is actually present. Accordingly, patients should be informed that false-positive imaging results before surgery are possible. The condition of the reconstructed breast and patient’s wishes should be considered before making subsequent treatment decisions based on ultrasound and MRI findings.

Radiotherapy for breast cancer effectively prevents local recurrence; however, it also causes acute toxicities such as erythema and erosion, as well as late complications including refractory ulcers, tissue atrophy, and contracture. These radiation-induced disorders impair patients’ quality of life （QOL） and adversely affect outcomes following breast reconstruction. Thus, minimizing both acute and late toxicities without compromising the antitumor efficacy of radiotherapy remains an important challenge. We conducted a series of basic studies on radiation-induced tissue damage and applied the findings to breast reconstruction strategies. Late radiation-induced injury of the skin and subcutaneous tissue is closely associated with the depletion of adipose-derived stem cells （ASCs） following repeated irradiation. Recent findings suggest that fat grafting and administration of ASCs or adipose tissue may represent effective therapeutic and preventive strategies that mitigate such radiation-induced complications.