The optimal surveillance interval of breast ultrasound for ipsilateral breast tumor recurrence（IBTR）after breast-conserving surgery（BCS）is currently unknown. We compared the IBTR-free survival and the pathological size of invasive lesions of IBTR in two groups of patients who underwent BCS for breast cancer at our hospital：107 patients who underwent ultrasound every six months and 206 patients who underwent ultrasound every year. There was no difference between the 2 groups（8-year IBTR-free survival, 97.5 vs 98.9％；p ＝ 0.7). An increase in the frequency of ultrasonography as a screening test after BCS does not appear to be recommended.

In primary two-staged breast reconstruction, appropriate positioning of the tissue expander is important. Fixation of its lower edge at the correct level, to regulate the inframammary fold, is critical. We describe a novel, reliable method for determining the lower point of the inframammary fold on the thorax by palpating the most prominent part of the rib cage between the inframammary fold and costal margin with the patient in a standing position preoperatively, and defining the height of the inframammary fold relative to this location on the rib cage. Eight patients successfully underwent immediate implantation of the tissue expander by this method after mastectomy.

The latissimus dorsi flap has advantages, such as not requiring microsurgery and allowing for quick and easy flap elevation. However, regarding total breast reconstruction after mastectomy, one frequent drawback is an insufficient tissue volume. The fat-augmented latissimus dorsi flap is a technique that increases the flap volume by performing immediate fat grafting into the flap. This method makes it possible to achieve total breast reconstruction even in cases where the breast size is beyond the capability of a conventional latissimus dorsi flap or in underweight patients who are not suitable for traditional flap reconstruction. Furthermore, in situations where skin replenishment is unnecessary, such as after nipple-sparing mastectomy or when skin expansion is carried out with a tissue expander, it is possible to avoid back incisions by elevating the flap as a muscle flap. This paper discusses important points when performing total breast reconstruction using the fat-augmented latissimus dorsi flap.

Breast reconstruction using autologous flaps can offer a soft and natural outcome. Another major advantage is that, unlike implant-based reconstruction, the need for maintenance is reduced. However, it may not be suitable for specific patient physiques, and the presence of long scars at the donor site could pose challenges. Fat grafting can be used in conjunction with autologous flaps to address many of these issues. Specifically: (1) areas that cannot be reconstructed with flaps can be supplemented with fat grafting; (2) insufficient flap volume can be supplemented with fat grafting; and (3) scarring at the donor site can be avoided by combining latissimus dorsi muscle flap use with fat grafting. In this article, we present specific cases to illustrate the usefulness of combining autologous flaps with fat grafting for breast reconstruction.

Autologous fat grafting（AFG）is not a common option for total breast reconstruction, and there have been few reports of immediate reconstruction with AFG. This is because it is off-label, and the volume in a single procedure by AFG is limited. On the other hand, AFG requiring only a few-millimeter pinhole incision can maximize the benefits of minimally invasive mastectomy.
There are some concerns regarding the oncological safety or that there is an insufficient volume for total breast reconstruction. However minimal invasive mastectomy followed by immediate AFG reconstruction can help to minimize the skin incision, time needed, and complications. We believe that this new technique is important and it could provide a new option for mastectomy followed by immediate reconstruction.