We examined the usefulness of a nomogram for predicting the surgical margin status during breast-conserving surgery. The subjects were 138 patients with T1/2 breast cancer treated between January 2010 and December 2013. We retrospectively analyzed risk values for positive surgical margins using the web-based nomogram prepared by Groningen University, and compared the values between a positive and a negative margin group. In addition, an optimal cut-off value was calculated using ROC analysis because intraoperative pathological examination for marginal status may be omitted in patients with a lower risk value than the cut-off value. The median age was 59.5 years, and the median tumor diameter was 14.5 mm. The rate of a positive margin on the intraoperative examination was 15.2%. The median risk values in the positive and negative margin groups were 23.0 and 7.0%, respectively, demonstrating a significant difference. The optimal cut-off value was 14.0%, and 96 (69.6%) of the 138 patients had a risk value of <14%. Of these, only 3 were diagnosed as positive with the permanent pathological examination. Based on these data, a prospective clinical study is needed to validate the usefulness of the nomogram.

In breast reconstruction by prosthesis, several management methods have been reported and argued in case of prosthesis infection. We have accordingly devised different methods for infection.

We examined cases of infection following breast reconstruction by prosthesis for 15 years to determine the appropriate management method for prosthesis infection. Over these 15 years, 70% of cases of expander infection were salvaged without removal (mild infection, 100% ; severe infection, 45.4%) . For silicone implant infections, 88.2% of cases were salvaged (mild infection, 100% ; severe infection, 81.8%) .

For severe infections, there was a difference between the expander and silicone implants.

We performed salvage in four ways : (1)antibiotics only, (2)retrograde irrigation through drainage tube + antibiotics, (3)wound drainage + antibiotics, and(4)capsule debridement/ retention of prosthesis after irrigation + antibiotics.

There was a significant difference in the successful salvage rate by wound drainage between expander and silicone implant infection (p = 0.043) . This is the cause of the difference in salvage rate. No significant risk factors were found to be associated with salvage failure. Our data suggest that controlling prosthesis infection is possible without removal.

In breast reconstruction with implants, rotation may occur. We examined the relationship between the tissue expander and silicone breast implant in rotation cases. One hundred forty-eight patients 153 breasts were included in this study. Tissue expanders were divided into three types of products : smooth anatomical type, smooth round type, and textured anatomical type. The two types of Breast implant are used were made by Allergan or Mentor.

The mean duration of follow-up was 72.4 months. Twenty-one of 153 cases exhibited rotation. Rotation of the breast implant was found at a mean of 31.2 months.

All cases with rotation were reconstructed using a smooth type expander, and all cases demonstrated inward rotation. The cases with breast implants were made by Mentor using the smooth type tissue expander cases had a significantly higher rate of rotation than implants made by Allergan with the smooth type tissue expander.