Plastic Surgery

Nipple-sparing mastectomy with reconstruction after neoadjuvant therapy linked to better long-term survival

This SEER-based cohort of 9,968 women receiving neoadjuvant therapy compared nipple-sparing mastectomy (NSM) with reconstruction, total mastectomy (TM) with reconstruction, and TM alone. TM with reconstruction showed similar overall and breast cancer-specific survival to TM alone, suggesting no oncologic survival advantage from reconstruction itself. NSM with reconstruction was associated with substantially better overall and breast cancer-specific survival versus TM alone, with hazard ratios around 0.3–0.6 across models. The survival benefit of NSM with reconstruction was more pronounced in patients younger than 65 years and with earlier-stage disease. These data support NSM with reconstruction as an oncologically acceptable, and potentially advantageous, option after neoadjuvant therapy in appropriately selected patients. 1

Free flap maxillary reconstruction leaves lasting functional deficits despite acceptable psychosocial outcomes

This systematic review and meta-analysis included seven studies with 196 patients undergoing free flap reconstruction for maxillary defects due to tumors or osteoradionecrosis. Across UW-QoL and EORTC QLQ-H&N35 instruments, the most pronounced impairments involved chewing, dry mouth, mouth opening, speech, and social eating. Appearance and activity were also commonly reduced, whereas pain, social contact, and cancer worry were relatively less affected. FACE-Q data confirmed low scores for eating, drinking, oral competence, and salivation, highlighting persistent functional compromise after reconstruction. One study suggested virtual surgical planning improved HRQOL versus conventional planning, but overall evidence quality and sample sizes were limited. 2

NANOTEX nanocomposite scaffold safely augments fibula flaps for vertical mandibular reconstruction

This prospective pilot trial evaluated a silica-coated nanohydroxyapatite-gelatin/PLLA scaffold (NANOTEX) for vertical augmentation over fibula free flaps in ten mandibular reconstruction patients. Customized scaffolds were placed at primary reconstruction, and safety plus bone regeneration outcomes were assessed up to six months. No scaffold-related serious adverse events occurred; transient inflammation and wound dehiscence resolved without major sequelae. Mean vertical bone height increased by about 27% at six months, with greater gains in areas contacting the native mandible. Radiodensity matured from cancellous toward cortical levels, and 88.6% of implants placed at six months showed high primary stability (ISQ > 70). 3

Neoadjuvant immunochemotherapy reduces major wound complications in oral cancer surgery

This retrospective cohort of 692 locally advanced oral squamous cell carcinoma patients compared neoadjuvant immunochemotherapy, neoadjuvant chemotherapy, and upfront surgery. Major wound complications (Clavien-Dindo ≥ III) within 90 days were lowest with neoadjuvant immunochemotherapy at 9.2%, versus 17.8% with chemotherapy and 21.5% with upfront surgery. Immunochemotherapy remained independently protective in multivariable analysis, with adjusted odds ratios of 0.40 versus upfront surgery and 0.48 versus chemotherapy. Immunochemotherapy also shortened time to complete wound sealing, hospital stay, readmissions, and time to adjuvant radiotherapy. Within the immunochemotherapy cohort, poor pathological response, shorter treatment–surgery interval, heavy smoking, free flaps, and high blood loss increased complication risk. 4