Breast reconstruction following mastectomy plays a vital role in many individuals’ recovery, symbolizing a shift from loss back to wholeness. Yet, this path can be complex, particularly in instances involving complicating factors such as radiotherapy and significant breast size. In such scenarios, often viewed as suboptimal for implant-based breast reconstruction, prioritizing the patient’s preferences is crucial. This article showcases the experience of a 50-year-old Caucasian woman who came to our department with a breast lump, later diagnosed as invasive mammary carcinoma of no specific type (NST) via percutaneous biopsy. Post a radical mastectomy of the left breast, left axillary lymphadenectomy and the placement of an expander beneath the pectoralis major muscle, she underwent radiotherapy following the tumor board’s advice due to positive lymph nodes. Patient opted not to have autologous breast reconstruction and we proceeded with the second phase, exchanging the expander for a breast implant and adding Acellular Dermal Matrix (ADM) in the infero-lateral pole of the breast for essential support and stability. Despite the challenges faced, our case successfully illustrates that with careful surgical planning and a patient diligently following postoperative care, implant-based breast reconstruction with ADM’s support can be effectively and safely achieved, even in less-than-ideal situations, fulfilling patient expectations.

Second Opinion is a difficult problem for every doctor put in this situation. In this position, we must not let ourselves be influenced, in any way, by the judgment of the first clinician, who formed a diagnosis. But not judging the “evidence” that led to the formation of the first diagnosis is difficult. This case presentation reveals the influence of a diagnosis assumed to be correct from the first interpretation. The patient, from the rural area, presents herself to the doctor following a trauma from falling down the stairs. A soft tissue ultrasound is performed and it is interpreted to be a hematoma. Afterwards, the lesion stagnates in size without progressing towards resorption. After repeating the ultrasound, its interpretation is influenced by the first ultrasound investigation supporting the same diagnosis. As a result, the patient is not guided to make a radical therapeutic decision. The presentation in our clinic was decided by the patient for a “second opinion” and, as a result, all the investigations carried out did not take into account the results previously stated by the patient during the clinical examination in the specialized outpatient clinic. The tumor was one with unimpressive dimensions but disturbing in appearance, without influencing the functionality of the forearm. The patient does not complain of pain or paresthesia in the area occupied by the tumor. She was clinging to deep plans and immovable in front of them.

Breast cancer is the most common type of cancer found in women after skin cancer. It is also the second cause of cancer death in women after lung cancer. The incidence of breast cancer has decreased in the last decade due to the discontinuation of hormone replacement therapy in postmenopausal women The majority of women with breast cancer are in an early stage at the moment of detection and are eligible for breast conservation therapy and receive some form of systemic or local adjuvant therapy like chemotherapy or radiotherapy depending on the histological type of the tumor.
Acellular dermal matrices or ADM for short are processed dermis that can be used as an adjuvant to local flap reconstruction or as the primary material for reconstruction of the nipple. In this article we discuss the case of a 42 year old woman with breast carcinoma who underwent mastectomy and breast reconstruction with silicone gel implant and ADM and answered a set of questions created to optimize the patient journey from diagnosis to reconstruction and follow-up.

The following article represents a clinical case study of a synchronous breast cancer in a 47 year old woman with no prior significant comorbidities. Up to 10% of all breast cancers can be synchronous (usually found with the help of breast MRI). The occurrence of bilaterally is considerable with invasive lobular carcinoma. The patient observed
after self-palpating her breast a nodule in the infero-external quadrant of the right breast. During almost 4 months the patient underwent punch biopsy of the right breast, lumpectomy and finally double mastectomy with immediate reconstruction using Mentor implants and AMD. The histopathological result showed ductal carcinoma in situ in the right breast and lobular carcinoma in situ in both breasts. Postoperatively the patient is free of cancer, but under clinical and imagistic surveillance.

Almost known in the literature and underdiagnosed even in the obvious cases, Wartenberg syndrome is most often treated, superficially and as a result, with direct consequences on its evolution. These elements ultimately lead to loss of cases and reporting in the literature as a rarity or other condition of the radial nerve, superficial branch. It must be understood at first that the radial nerve is susceptible to compression in different ways along the anatomical path. Causes are all common in the upper limb, compression and trauma. The two elements (compression and trauma) affect the superficial branch of the radial nerve at the time of its passage between the brachioradial muscle and the supinator muscle, as a result the patients complain of ‘’hand pain‘’. They describe only sensitive disorders but not motor disorders. The pain is described distally by the radial foramen and is accompanied by paresthesia on the dorsal side of the hand. The present case shows a female person working in a car parts factory where they have to pick up considerable parts to inspect them. The pieces are positioned on different side, as a result he must use the muscles of the forearm to turn them.

This article completes the problem of nerve regeneration on the allograft model harvested from the same type of individual (in this case the Wistar laboratory mouse).The approach to major trauma produced by various mechanisms and the development of a well-established algorithm, applied in a multidisciplinary team, results in a distinctly different result, both sensory and motor recovery, depending on the operative technique, the operative logistics and the type of graft. The article explains the experimental model, the subjects that were previously prepared for the operating time, the type of anesthesia that was administered, explaining why dosages and administered substances were used, the techniques used in the two batches that are totally different anatomic approach path, different as a bed of nerve regeneration but with operating technicians that do not differ in the two batches. The results are visibly different and are compared by the fi ngerprint sample. The regeneration times are different, the sensitive recurrence, the resumption of motor activity differs very little in the variables of each lot but are appreciable and different as the dynamics and value from one batch to the other.