The journal «ONCOSURGERY» 2013, Vol.5, No 3
Reconstructive surgery in combined modality treatment for breast cancer
Mavrodi TV
The center of women’s health MAMMAE clinic, Krasnodar, Russia
Contact: Mavrodi TV, e-mail:
The own experience of reconstructive surgery for breast cancer is represented.
Material and methods. Since June 2010 up to the pre-sent in the Department of Reconstructive surgery of center of women’s health MAMMAE clinic 92 female patients have undergone surgery. For stage of cancer distribution of patients was as following: stage 1 – 16 pts, stage 2А – 32 pts, stage 2B – 30 pts, stage 3А – 10 pts, stage 3B – 4 pts. Three patients had synchronous cancer in both breasts. Ten patients underwent 3 courses of neoadjuvant polychemotherapy with improvement. In 1 patient preoperative radiotherapy had to be performed because of need for gross tumor reduction and infeasibility of neoadjuvant polychemotherapy due to renal pathology.
Immediate TRAM-reconstruction was performed in 8 pts (1 – with venous microanastomosis, 1 – with parasternal lymph node biopsy for clinical data). The age of patients in this group varied from 43 to 64 y.o. The indications for this reconstruction included appropriate constitution and desire of patient for use autologous tissue. Immediate reconstruction with latissimus dorsi flap with volume replacement only by flap was in 3 pts, immediate reconstruction with latissimus dorsi flap with volume replacement by implant – in 11 pts. The age of patients in this group varied from 30 to 59 y.o. The indication for this technique was the need for skin-sparing mastectomy with preserving of less than 2/3 skin sheath and desire of patients for one-step surgery. The major group of 62 pts was reconstruction with immediate subcutaneous/skin-sparing mastectomy with placement of implant (48 pts), Becker tissue expander (7 pts), expander (6 pts). The age of patients in this group varied from 32 to 62 y.o.
Results. All patients had postoperative care as accepted in clinic. Overall complication rate accounted for 10.5%. 85.5% patients defined surgical outcomes as «excellent», 11.5% – as «good», 3.5% – as «satisfactory». The assessment of satisfaction was performed using Likert scale.
Conclusion. According to our experience an adequate method of breast reconstruction may be chosen for almost every patients regarding to oncological specifics. The advantage of achieving optimal esthetic result remains for one-step surgery. For appropriate tactics of combined modality treatment survival rates and quality of life satisfied for physician and patient may be achieved.
KEY WORDS: breast cancer, immediate and delayed reconstruction, indications.
References
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