Is aortic knob width a novel predictor of mortality in hemodialysis patients?

OBJECTIVE: Identifying reliable predictors of mortality in end-stage renal disease patients is crucial for patient outcomes. Aortic knob width is a radiographic parameter used to assess cardiovascular diseases and atherosclerosis. This study investigated the association between aortic knob width and mortality in hemodialysis patients. PATIENTS AND METHODS: The study included data collected between 2007 and 2022 from 103 patients aged between 18 and 85 who had been undergoing hemodialysis treatment for at least one year. Patients were divided into two groups: survivors and deceased. The aortic knob width was measured using a posterior-anterior chest radiograph after midweek hemodialysis. The relationship between aortic knob width and mortality was investigated. RESULTS: Deceased patients had significantly larger aortic knob widths compared with survivors. The deceased group's hemodialysis (HD) duration was shorter, median age was older, Kt/V, hemoglobin, and albumin levels were lower, and the frequency of patients with hypertension, diabetes, and aortic wall calcification was higher. Aortic knob width greater than 37.98 mm was identified as a predictor of mortality in hemodialysis patients. Survival rates for aortic knob width <37.98 mm are 98.1% for 1 year and 64.9% for 15 years. For aortic knob width larger than 37.98 mm, survival rates are 88% for three years, 68% for five years, 45.2% for ten years, and 25% for fifteen years. The most important risk factors for increased aortic knob width were age, male sex, aortic calcification, and hypertension. CONCLUSIONS: Age, male gender, aortic calcification, and hypertension are the primary risk factors for increased aortic knob width in hemodialysis patients. Aortic knob width greater than 37.98 mm, which can be measured simply and rapidly using posterior-anterior chest radiography, may be a predictor of mortality.

Graphical Abstract

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UK Haemoglobin Disorders Peer Review: A Quality Standards-based review programme for sickle cell disease and thalassaemia

We evaluated the impact of peer reviews in driving improvement in healthcare quality for people with haemoglobinopathy in the United Kingdom. We analysed compliance to four Quality Standards (QS)-based peer reviews from 2010 to 2020 to evaluate its impact in driving healthcare quality. Seventeen paediatric and 29 adult haemoglobinopathy centres were reviewed in 2010/11 and 2012/13 respectively; 33 paediatric and 33 adult centres were reviewed in 2014/16, and 32 paediatric and 32 adult centres were reviewed in 2018/2020. Compliance with QS and participant feedback were analysed to assess the impact of peer review programmes to drive improvement in quality of care. We noted that haemoglobinopathy centres significantly improved their compliance to QS between the first two review programmes, but not in the final review programme. In comparison to other disease-group reviews, the haemoglobinopathy departments were less able to address critical peer review recommendations in their own institutions. The peer review programme was unable to drive sustained improvement in healthcare quality, underscoring the need for sustained development and support for haemoglobinopathy services in the National Health Service. Further work is needed to understand why disparities exist among peer review-driven improvement initiatives within different disease groups.

The XRCC1 and TP53 gene polymorphisms are associated with advanced-stage disease and early distant metastasis at diagnosis in non-small cell lung cancer

Background

Studies on single nucleotide polymorphisms (SNPs) in non-small cell lung cancer (NSCLC) suggest that DNA repair capacity may have prognostic implications for disease recurrence and survival. However, there is no study investigating the relationship between SNPs and the risk of metastasis at the time of initial diagnosis in patients with NSCLC.

Objective

This study aimed to investigate the potential predictive value of SNPs in detecting the risk of metastasis at the time of initial diagnosis and poor prognosis in patients with NSCLC.

Material and Methods

In this prospective cohort study, we evaluated 275 patients with NSCLC. Analysis of SNPs from peripheral blood cells was performed by a polymerase chain reaction. Excision repair cross-complementing group 1 (ERCC1)- Asn118Asn, excision repair cross-complementing group 2 (ERCC2)-Lys751Gln, X-ray repair cross-complementing group 1 (XRCC1)-Arg399Gln, and tumor protein 53 (TP53)-Arg72Pro polymorphisms were evaluated in conjunction with the development of metastasis.

Results

The ERCC1 normal genotype, ERCC2 heterozygote genotype, XRCC1 normal genotype, and TP53 normal genotype were associated with a higher stage and more advanced-stage disease at the time of initial diagnosis (P = 0.027, 0.005, <0.001, and 0.006, respectively). Also, XRCC1 normal genotype and TP53 normal genotype were associated with the risk of metastasis at the time of initial diagnosis (P = <0.001 and 0.002, respectively). Moreover, the XRCC1 normal genotype was associated with the risk of brain metastasis at the time of initial diagnosis (P = 0.031).

Conclusions

We showed that SNPs are related to a higher stage and more advanced-stage disease at the time of initial diagnosis in patients with NSCLC, and XRCC1 and TP53 gene polymorphisms are associated with the risk of metastasis. These results may contribute to the identification of high-risk groups and may help to earlier diagnosis and treatment in patients with NSCLC.

Prognostic Significance of Adipose Tissue Distribution and Metabolic Activity in PET/CT in Patients with Metastatic Colorectal Cancer

PURPOSE

In this study, we aimed to evaluate the prognostic significance of adipose tissue distribution and metabolic activity in PET/CT to predict survival in patients with metastatic colorectal cancer (mCRC).

METHODS

The volume, density (HU), and FDG uptake (standardized uptake value (SUV)) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) and maximum FDG uptake of the tumor tissue were measured. Subcutaneous adipose tissue of volume-to-density ratio (SAT ratio) was calculated.

RESULTS

The median OS for the patients with SAT ratio value <  -1.1 and ≥  -1.1 were 38.5 (95% CI 31.54-45.58) and 24.5 (95% CI 14.13-34.93) months, respectively (p = 0.05). During follow-up, 69 patients experienced disease progression. The median progression-free survival (PFS) was 11.03 months (95% CI: 9.11-12.95). Median PFS for patients with tumor SUV max value < 11.5 and ≥ 11.5 were 9.2 (95% CI 7.25-11.27) and 12.6 (95% CI 10.02-15.27) months, respectively (p = 0.14). Forty-eight patients received bevacizumab therapy. VAT SUV mean (HR: 0.09; 95% CI 0.01-0.52, p = 0.008) was significantly associated with PFS in patients receiving bevacizumab. SAT ratio was the significant parameter for the OS (HR: 0.58; 95% CI 0.33-1.01, p = 0.05) and PFS (HR: 1.99; 95% CI 1.02-3.91, p = 0.043).

CONCLUSIONS

SAT ratio was an independent prognostic factor for survival in patients with mCRC. Higher SAT volume is correlated with longer survival in mCRC patients.

Risk assessment in inoperable chronic thromboembolic pulmonary hypertension

Background

Our objective was to investigate an abbreviated version of the the current European PH guidelines, noninvasive French model, an abridged version of the REVEAL 2.0 risk score calculator, REVEAL Lite 2, and a refined 4-strata risk assessment model, COMPERA 2.0 for inoperable chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

We enrolled inoperable CTEPH patients from 8 PAH centers from December 2009 to June 2020 (n=123). 70% of patients were treated with PAH therapies. Noninvasive French model comprising WHO functional class (FC), 6-minute walk distance (6 MWD), and N-terminal pro–brain natriuretic peptide (NT-pro BNP) or BNP was used for 63 patients. REVEAL Lite 2 including FC, systolic blood pressure, heart rate, 6MWD, BNP/NT-pro BNP, and estimated glomerular filtration rate was used for 71 patients. COMPERA 2.0 including FC, 6MWD and BNP/NT-pro BNP was used for 71 patients. Patients were grouped into three categories according to the French model and REVEAL Lite 2 scores, and into four categories according to COMPERA 2.0. Kaplan-Meier (KM) survival was assessed in each risk group with all-cause mortality as the end point. Log-rank test was used to compare estimates.

Results

The mean age was 64±13 years at diagnosis. The median follow-up was 22.7 months. 26 patients had died. None of the patients had balloon pulmonary angioplasty. Most patients had received monotherapy (55%). 23.8% of patients were WHO FC I-II, 65.6% III, and 10.7% IV at initial evaluation (Table 1). All models discriminated risk in our cohort. Patients having none of low-risk criteria or high risk profiles by REVEAL Lite 2 and COMPERA 2.0 at follow-up had the worst survival. Figure 1 demonstrates KM survival curves for noninvasive French model (A), REVEAL Lite 2 (B), and COMPERA 2.0 (C). 37.3% of patients achieved 2 or more low risk criteria at follow-up. 44.8% of patients were in low risk at follow-up (REVEAL lite 2). 52.1% of patients were in low and intermediate-low risk at follow-up (COMPERA 2.0). The estimated survival rate at 5 years of patients meeting 2 and more low-risk criteria was 86% vs. 55% for patients meeting 0 low-risk criterion (p=0.04). The corresponding survival rate was 45% for high-risk patient, 79% for intermediate-risk patient, and 82% for low-risk patient (REVEAL lite 2) (p=0.029). The corresponding survival rates were 51.1% for high-risk patient and 91.6% for intermediate-low risk patient (COMPERA 2.0) (p=0.017). COMPERA 2.0 seems more accurate based on c-index. Survival was similar between patients treated and not treated with PAH therapies (p=0.735).

Conclusions

Noninvasive French model, REVEAL Lite 2, and COMPERA 2.0 may provide a simplified method of risk assessment for inoperable CTEPH. This analysis also supports the value of goal-oriented treatment in CTEPH. Patients who have not achieved low risk category at follow-up may benefit from escalation of their treatment regimen.

Funding Acknowledgement

Type of funding sources: None.

Imaging Features of Breast Plasmacytoma

Extramedullary plasmacytoma (EMP) occurs as a result of abnormal proliferation of plasma cells outside the bone marrow. Breast plasmacytomas are rare. Radiologically, they can be confused with benign and malignant lesions of the breast. It is important to be able to diagnose EMP in the breast since the treatment strategy is different from that of other lesions and allows for the diagnosis and early treatment of multiple myeloma (MM) relapse. We report imaging and clinicopathological findings of an EMP case in which a 65-year-old patient with MM in remission presented with breast masses.

A Rare Case of Pulmonary Alveolar Microlithiasis with Diffuse Lung Uptake on Bone Scintigraphy

Pulmonary alveolar microlithiasis is a rare disease characterized by accumulating intraalveolar small calcium phosphate stones. The disease is slow and does not show any signs in the early stages, but the shortness of breath, cough, and right heart failure may develop as it progresses. Methylene diphosphonate used in bone scintigraphy shows high uptake of calcium deposits in the alveoli and causes diffuse increased radiopharmaceutical uptake in the lungs.

Late PET/CT Findings of COVID-19 Pneumonia With 2 Different Radiopharmaceuticals in a Patient: PSMA Avidity Higher Than FDGs

ABSTRACT

We present the 68Ga-PSMA and 18F-FDG PET/CT findings comparatively of a 67-year-old prostate cancer and malignant melanoma patient who had COVID-19 pneumonia 3 months ago. In 68Ga-PSMA PET/CT, ground-glass opacities showing markedly increased PSMA uptake were observed in the patient's lungs. It was learned that the patient had COVID-19 pneumonia 3 months ago and was treated in the intensive care unit for 13 days. In 18F-FDG PET/CT, FDG uptake was minimal in the same areas. In the midterm period after COVID-19 pneumonia, lung PSMA uptake is more intense than FDG, which may help better understand the disease's healing phase.

Prostate incidentaloma on 18F-fluorodeoxyglucose positron emission tomography: Diagnostic value of volumetric positron emission tomography parameters

OBJECTIVE

To evaluate whether volumetric PET parameters such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG) contributed to maximum standardized uptake value (SUVmax) in predicting prostate carcinoma in the prostate incidentalomas (PI) in 18F-FDG PET/CT.

MATERIALS AND METHODS

This retrospective study comprised 107 patients with PI of 4723 male patients who had undergone 18F-FDG PET/CT. SUVmax and volumetric PET parameters of PIs were assessed. MTV and TLG were acquired with each SUV threshold as 2.5, 3.0, 3.5, 4.0, 4.5, and 5.0.

RESULTS

The PI incidence was 2.3%, and the malignancy ratio of PI was 15.9%. According to further analysis results, 17 patients were in the malignant group, and 46 patients were in the benign group. Malignant PIs had higher SUVmax (10.6 vs. 6.4 and p<0.01), MTV (all p < 0.01) and TLG (all p < 0.01) than benign incidentalomas. All volumetric PET parameters had higher area under the curve (AUC) than SUVmax. SUVmax AUC was 0.835 [95% confidence interval (CI): 0.728-0.942]. MTV 2.5 and TLG 2.5 had the highest performance for predicting malignant PI.MTV2.5 AUC was 0.871 (95% CI: 0.775-0.968), and TLG2.5 AUC was 0.882 (95% CI: 0.797-0.967). Using TLG 2.5 greater than 29.8 as the cut-off point, the sensitivity and specificity for malignancy prediction were 94.1% and 82.6%, respectively.

CONCLUSION

In this study, in which the effectiveness of volumetric parameters in the diagnosis of PI was evaluated for the first time, it was shown that they could potentially have clinical value along with SUVmax.

Epidemiological findings on Hepatitis C infection in a tertiary level hospital in mid-northern Anatolia in Turkey: A four-year analysis

The hepatitis C virus (HCV) is a blood-borne pathogen that causes acute or chronic infection of the liver, sometimes leading to serious liver damage and fatality. The objective of this study was to evaluate HCV prevalence in patients attending the Regional Training and Research Hospital for Medical Examination and Surgery in Samsun Province of Turkey between 2014 and 2017. Blood specimens taken from 152 596 patients were screened for HCV infection by using the anti-HCV assay. Seropositive samples were subjected to polymerase chain reaction (PCR) testing in order to determine whether the HCV infection was active. Genotyping was then performed. Overall, HCV seropositivity and active HCV infection were 2.76% and 2.05%, respectively. Foreign nationals accounted for 5.61% of the seropositive samples and 1.37% of active HCV infective samples. We further report that 2017 was the year with the highest seroprevalence which was 3.64%. HCV genotype 1 was the most common genotype detected in residents of Samsun Province at 89.86%, followed by Genotype 3 at 4.54%. This study provides important information on the levels of HCV infection in the Samsun region of Turkey. The data indicate that there was a rising trend of HCV infection between 2014 and 2017.

The preventive effects of atorvastatin and N-acetyl cysteine in experimentally induced ischemia-reperfusion injury in rats

AIM

We investigated the effects of atorvastatin and N-acetyl cysteine in decreasing ischemia-reperfusion damage after detorsion of a volvulus of the cecum and ascending colon.

METHODS

Wistar albino rats (250-300 g) were divided into four groups. A cecal-ascending colon volvulus was created by the intestinal clockwise 720° rotation. At the end of one hour, the bowel was detorsioned. Group I (n = 7) was the sham (laparotomy) group, Group II (n = 7) the control (no treatment, volvulus or detorsion), Group III (n = 7) (N-acetyl cysteine administered ) , and Group IV (n = 7) (atorvastatin administered ) group. Blood samples were collected from each group via peripheral veins and centrifuged one hour after detorsion. The parameters of ischemia including malondialdehyde, glutathione peroxidase, catalase, and superoxide dismutase were then observed in the serous fluid.

RESULTS

Malondialdehyde and superoxide dismutase increased in the control group, whereas they were reduced in the Group III and Group IV (p = 0.005; p = 0.008, respectively). The glutathione peroxidase levels revealed no significant differences (p > 0.05), whereas the catalase levels of the group III was higher than in each of the other three groups (p < 0.001). Histopathological evaluation detected reduced lesioning of the organ in the groups which were given atorvastatin and N-acetyl cysteine.

CONCLUSION

Atorvastatin and of N-acetyl cysteine have a similar preventive effect in experimental ischemia-reperfusion injury (Tab. 8, Fig. 6, Ref. 24).

EMDR therapy on trauma-based restrictive eating cases

Introduction

Eating Disorders (ED) affect an individual's physical and mental health with abnormal eating habits. Traumatic life events may underlie the development of ED as many studies document [1]. In the present study, we examined the effectiveness of EMDR therapy that was originally used to treat Post-Traumatic Stress Disorder (PTSD) [2], on restrictive eating symptoms associated with trauma. Cases B.Ö. (18) and B.S. (20) came to the clinic consecutively for resembling complaints about the sense of food sticking in their throat, breathing difficulties, raised heart beatings, unease to swallow, and choking fear. The patients revealed past traumatic events about being out of breath while swallowing their bites. Then, they have started to restrict their food intake and the types of food consumed, which led to emaciation with health problems, interrupted daily routines, and social isolation; meeting the diagnosis of avoidant/restrictive food intake disorder (ARFID) in DSM-5. Due to traumatic experiences, EMDR therapy was applied.

Discussion

After five EMDR therapy sessions, patients turned back to healthy eating habits, normal BMI, and effective daily life. As expected, EMDR therapy made significant improvements in the treatment of ARFID.

Conclusion

EMDR can be useful to treat ED with traumatic background.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Our transthoracic biopsy practices accompanied by the imaging process: The contribution of positron emission tomography usage to accurate diagnosis

OBJECTIVES

The objective of this study was to compare the results of transthoracic biopsies performed through the use of FDG PET/CT imaging with the results of transthoracic needle biopsy performed without using the FDG PET/CT imaging.

METHODS

The medical files of a total of 58 patients with pulmonary and mediastinal masses. A total of 20 patients, who were suspected of malignancy with the SUVmax value of over 2.5 in FDG PET/CT, underwent a biopsy process. Twelve patients with no suspicion of malignancy in accordance with CT images and with the SUVmax value below 2.5 underwent no biopsy procedure, and hence, they were excluded from the study. On the other hand, 26 patients directly went through a biopsy process with the suspicion of malignancy according to CT imaging, regardless of performing any FDG PET/CT imaging.

RESULTS

According to the biopsy results, the number of the patients diagnosed with cancer was 20 (43.5%), while the number of non-cancerous patients was 26 (56.5%). When these findings were considered, it was determined that the sensitivity of the whole TTNB (transthoracic needle biopsy) was 80.8%, and the specificity was found as 100%. The positive predictive value of the whole TTNB was 100%, while its negative predictive value was found to be 80%. The sensitivity in TTNB performed together with FDG PET/CT was 90.9%, whereas the specificity was 100%. The positive predictive value of TTNB with FDG PET/CT was 100%, while its negative predictive value was found to be 81.8%. The sensitivity in TTNB performed without the use of FDG PET/CT was 73.3%, whereas the specificity was determined as 100%.

CONCLUSIONS

Performing FDG PET/CT imaging process prior to a transthoracic biopsy as well as preferring FDG PET/CT for the spot on which the biopsy will be performed during the transthoracic biopsy procedure increases the rate of receiving accurate diagnosis.

Determinants of felt stigma in epilepsy

The present study aimed to determine the level of felt stigma, overprotection, concealment, and concerns related to epilepsy in different life domains by using culturally-specific scales for Turkish individuals with epilepsy. Also, it aimed to detect relations among the study variables and to determine the variables which predict felt stigma. For this purpose, felt stigma scale, overprotection scale, concealment of epilepsy scale, and concerns of epilepsy scale were administered to two hundred adult persons with epilepsy (PWE). The results showed that almost half of the participants reported felt stigma, overprotection, concealment of epilepsy, concerns related to future occupation, and concerns related to social life. Almost all the study variables show correlations with each other. Concealment of epilepsy, concerns related to social life, and concerns related to future occupation were found as the predictors of felt stigma.

The value of complete blood count parameters in predicting preterm delivery

OBJECTIVE

The association between inflammation and threatened preterm labor (TPL) is well known. The aim of this study was to investigate a possible relation between TPL and new defined systemic inflammatory markers, neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and platelet to lymphocyte ratio (PLR).

PATIENTS AND METHODS

Fifty-three healthy pregnant women as the control group and 55 pregnant women diagnosed with TPL as the study group were included in this prospective controlled study. The study group was divided into two groups according to the gestational age at delivery: pregnant with TPL who delivered < 37 weeks and pregnant with TPL who delivered ≥ 37 weeks. The clinical and laboratory data were compared among the groups.

RESULTS

LMR was found to be significantly higher in patients complicated with TPL who delivered prematurely when compared to the women whose pregnancies continued to term (p = 0.02). Furthermore, a significant negative correlation was also observed between the gestational week at delivery and LMR in women who delivered < 37 weeks.

DISCUSSION

We demonstrated that LMR was significantly increased in pregnant women with preterm birth and threatened preterm labor than healthy subjects.

CONCLUSIONS

Although increased LMR levels were demonstrated to be associated with preterm birth and threatened preterm labor to be able to extrapolate these findings into clinical daily practice, further studies are needed.

The assessment of maternal and umbilical cord homocysteine levels in obese pregnant women

PURPOSE

The aim of this study was to compare the maternal plasma and umbilical cord blood homocysteine levels in obese and non-obese pregnant women.

MATERIALS AND METHODS

One hundred-ten term pregnant women, who completed their 3711, gestational weeks and were not in active labor, were enrolled in the study. While 41 out of them were obese (BMI ≥ 30 kg/m(2)), 69 were non-obese (BMI < 30 kg/m(2)). The maternal plasma and umbilical cord homocysteine levels and umbilical cord pH values were compared between the groups. The statistical analyses were performed using t-test, Mann Whitney test, and Chi-square test. Ap < 0.05 value was set as statistically significant.

RESULTS

The mean of age was higher in obese group in borderline significance (26.8 ± 5.4 vs. 28.8 ± 5. l,p = 0.049). The mean of gestational weeks, birthweight, the mode of delivery, and umbilical cord pH values were similar between the groups (p > 0.05). The maternal plasma homocysteine levels [median (interquartile range); 7.6 (4.1) vs. 7.1 (4.9)] and umbilical cord homocysteine values were not statistically different [8.6 (4.2) vs. 8.8 (4.5)] between the groups (p > 0.05).

CONCLUSION

The maternal and umbilical cord blood homocysteine levels are not different in obese and non-obese pregnant women.

Alterations of the thioredoxin system during subarachnoid hemorrhage-induced cerebral vasospasm

BACKGROUND

The exact underlying pathogenic mechanisms and effective preventive or therapeutic interventions for cerebral vasospasm remain obscure. The thioredoxin (Trx) system performs important functions in the central nervous system including neurotrophic and neuroprotective actions. There is no study directly investigating the effects of subarachnoid hemorrhage (SAH) induced cerebral vasospasm on the Trx system in the literature.

METHODS

Sixteen male New Zealand rabbits were randomly divided into two groups of eight rabbits each: a control group and a SAH group. The control group, (n = 8) was a sham surgery group in which SAH was not induced. In the SAH group, (n = 8), the SAH protocol was used to induce cerebral vasospasm. The brain and brainstem were removed and each brainstem was cut coronally into two pieces: an anterior part that contains basilar artery and a dorsal part that contains brainstem tissue. The brainstem tissue thioredoxin-1(Trx1), thioredoxin-2 (Trx2), thioredoxin reductase (TrxR), thioredoxin reductase-1 (TrxR1), thioredoxin-interacting protein (TXNIP) levels were investigated. Total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde levels (MDA) and tumor necrosis factor alpha (TNF-alpha) levels were investigated for determining the oxidative-antioxidative status of the related brain tissues. Basilar artery segments were investigated for cross-sectional area and wall thickness measurements.

RESULTS

SAH statistically significantly reduced the tissue levels of Trx1 (p < 0.01) and TrxR (p < 0.01). Trx2 levels were not significantly altered after SAH (p > 0.05). SAH significantly reduced the expression of TrxR1 (p < 0.01) and significantly increased the expression of TXNIP (p < 0.01) when compared with controls. TOS levels and MDA levels significantly increased after SAH (p < 0.01) and TAS levels significantly reduced after SAH (p < 0.01). TNF-alpha levels significantly increased after SAH (p < 0.01). SAH-induced cerebral vasospasm significantly (p < 0.05) increased the wall thickness and reduced the mean cross-sectional area of the basilar artery (p < 0.05).

CONCLUSIONS

The Trx system seems to be negatively affected by the simultaneously interrelated enzymatic alterations during cerebral vasospasm.

Breast reconstruction

Mastectomy has been used for the treatment of breast cancer for many years, but the importance of the positive psychosocial benefits of breast reconstruction in breast cancer treatment has been recognized in the past years. Now, more women seek breast reconstruction and surgeons perform more reconstructions. A breast can be reconstructed by two methods: prosthetic implants and autologous tissue. The reconstruction can be performed immediately at the time of mastectomy or on a delayed basis. Factors associated with implant reconstruction include timing, patient selection, method of reconstruction, and filler material. The prosthetic implant reconstruction can be performed in one or two stages. The principal methods of breast reconstruction using autologous tissue include flaps from lower abdominal tissue, the latissimus dorsi musculocutaneous flap, other flaps, and the autologous fat grafting. In this article the main reconstruction methods either with implants or autologous tissue are reviewed and their advantages and disadvantages are discussed.