Mastectomy In Breast Cancer Patients Research Articles

Predictors of mastectomy in breast cancer patients with complete remission of primary tumor after neoadjuvant therapy: A retrospective study

IntroductionNeoadjuvant therapy (NAT) should increase the rate of breast-conserving surgery (BCS) in non-metastatic breast cancer (BC) patients, especially in those achieving tumor shrinkage. Still, the conversion from a pre-planned mastectomy to BCS in patients responding to NAT is not a widespread standard. We aimed to identify factors influencing surgical choices in this setting. Materials and methodsWe retrospectively collected data of BC patients with complete remission of primitive tumor (ypT0) after NAT, treated with BCS or mastectomy in two Italian breast units. Predictors of mastectomy were explored using logistic regression. Distant recurrence and event-free survival were assessed in the BCS and mastectomy cohort. Results243 patients were included, 147 (60.5 %) treated with BCS and 96 (39.5 %) treated with mastectomy. In the mastectomy group, there were more centrally-located, multiple and larger tumors. At univariate regression analysis, central location, baseline tumor extension on ultrasound (US) and magnetic resonance imaging (MRI), multiple foci and clinical stage were significantly associated with the chance of receiving mastectomy. At multivariate analysis, only baseline focality on US and extension on MRI retained significance as predictors of mastectomy. Distant recurrence and event-free survival were significantly longer in patients undergoing BCS. ConclusionBaseline tumor extension and focality were the main predictors of mastectomy in patients with ypT0 after NAT. However, BCS did not negatively affect survival outcomes in our cohort. An effort should be made to avoid potentially unnecessary mastectomy in this population, aiming at minimizing surgery-associated toxicities and improving patients’ quality of life.

Unveiling perceptions regarding post mastectomy breast reconstruction: A questionnaire-based survey of patients from central India.

Post mastectomy breast reconstruction uptake remains low in the developing countries. We examined patient perspectives about it in a cohort of Indian breast cancer patients. This prospective study was conducted at a tertiary care center in central India. All post mastectomy patients for breast cancer were interviewed via a survey questionnaire to assess their perspective regarding post mastectomy breast reconstruction. None of the 192 patients underwent immediate or delayed reconstruction by the end of 24months follow-up. Age, education level, occupation and marital status did not affect the uptake of post mastectomy breast reconstruction. The most common patient-reported reasons for not having reconstruction were the desire to avoid additional surgery and the belief that it was not important (80% for each). System related factors such as additional cost of surgery and additional length of stay were reported to be important by 55% and 65% patients respectively. Our survey of 192 post mastectomy breast cancer patients showed that none opted for post mastectomy reconstruction, suggesting significant barriers to it. Understanding and addressing these barriers are crucial to ensuring comprehensive care for these breast cancer patients.

Immediate Latissimus Dorsi Flap Reconstruction: Assessing Aesthetic Outcomes Following Mastectomy in Breast Cancer Patients.

Breast Cancer has now become the leading cause of cancer-related deaths among women. In a traditional radical mastectomy, there can be complications that may affect the physiological characteristics of the breast and subsequently cause profound psychological stress to the patients. Hence, latissimus dorsi (LD) flap reconstruction provides an aesthetic approach in patients undergoing mastectomy. The goal is to maximize the flap's soft tissue coverage while minimizing the magnitude of donor site defect and complication. A prospective observational study was conducted in the Department of General Surgery, Safdarjung Hospital, New Delhi, India, where 30 breast cancer patients were enrolled and had undergone mastectomy with immediate LD flap reconstruction. Cosmetic assessments using BREAST-Q questionnaires were conducted postoperatively at various intervals starting from postoperative day one, week two, and week six. The subjective evaluation was done by the patient, while a blinded nurse and surgeon did the objective assessment. The majority (n=23, 76.7%) were aged 31-50 years. Initial postoperative BREAST-Q scores declined but significantly improved by week six, attributed to gradual wound healing over time, resulting in improved breast shape and contour. The objective scoring done by the blinded surgeon and nurse improved at six weeks compared to two weeks postoperatively. Almost similar outcomes were observed between preoperative and six-week postoperative scores with a significant overall p-value of <0.001. No significant statistical differences were noted between blinded surgeons and nurses for objective scoring. The rising trend of breast cancer in younger demographics emphasizes the importance of balancing cosmetic satisfaction with oncological outcomes. Immediate LD flap breast reconstruction provides a reliable means for soft tissue coverage with acceptable perioperative morbidities for patients undergoing mastectomy. Complication rates were acceptable, with donor site seroma, surgical site infection (SSI), and shoulder weakness among them. They could be prevented or treated (prolonged drain in situ, quilting sutures, and seroma aspiration) or resolved with time (SSI and shoulder function).

ENDOSCOPIC DRAINAGE FOR THE MANAGEMENT OF INFECTED SUBCUTANEOUS COLLECTIONS FOLLOWING DIEP FLAP RECONSTRUCTION TECHNIQUE: A CASE REPORT

Abstract Aim The deep inferior epigastric perforator (DIEP) flap procedure is a widely accepted method for immediate breast reconstruction following skin-sparing mastectomy in breast cancer patients. While complications are infrequent, challenges may arise, including surgical wound infection, skin necrosis, seroma, or hematoma. Methods We present the case of a 68-year-old woman with multifocal infiltrating carcinoma of the right breast (T1cN0M0) who underwent DIEP flap breast reconstruction one month before presenting to the emergency room. Her symptoms included a fever of 38°C, abdominal filling in the DIEP scar region, an elevated leukocyte count (23.01 × 10E3/microL), and a C-reactive protein level of 470 mg/L. Abdominal CT revealed a collection in the infraumbilical anterior abdominal wall extending through the subcutaneous cellular tissue of both iliac fossae. The patient underwent surgical intervention, including endoscopic drainage with lavage and drain placement under direct visualization. Results Following surgery, the patient responded positively to intravenous Meropenem, with the resolution of fever and improvement in local cellulitis. She was discharged on the 6th postoperative day with both drains, removed 10 and 15 days after surgery in an outpatient setting. Conclusions In cases where immediate percutaneous drainage is not feasible, endoscopic drainage emerges as an effective strategy for managing extensive infectious collections. This technique, involving lavage, debridement, and drain placement under direct vision, eliminates the need to reopen substantial surgical wounds. Notably, this approach aids early recovery in patients undergoing active chemotherapy, preventing delays in chemotherapy administration.

Abstract PO4-12-05: Immediate breast reconstruction is associated with reduced incidence of ipsilateral lymphedema in breast cancer patients undergoing mastectomy

Abstract Purpose: The number of patients undergoing immediate breast reconstruction after mastectomy is increasing. A study of ipsilateral lymphedema after immediate breast reconstruction is also needed.This retrospective study aimed to identify the risk factors associated with lymphedema incidence after mastectomy in breast cancer patients, particularly focusing on the impact of the immediate breast reconstruction. Methods: A retrospective analysis was conducted on 6,105 patients who underwent mastectomy for breast cancer with or without immediate breast reconstruction from Jan 2012 to Dec 2022 at Seoul National University Hospital to identify the potential risk factors for developing ipsilateral lymphedema. Results: A total of 6,105 breast cancer patients with a mean age of 50.1 years were included in this study, with a median follow-up period of 52.0 months. In univariate analysis, the incidence of lymphedema was significantly lower in the immediate breast reconstruction group (4.47%) compared to the no reconstruction group (9.15%) (p &amp;lt; 0.001). Other significant risk factors included the number of dissected axillary lymph nodes, number of metastatic lymph nodes, body mass index (BMI) over 25 kg/m2, the use of neo-adjuvant chemotherapy or adjuvant radiation therapy, and older age at the time of operation. In multivariate analysis, the immediate breast reconstruction remained to be an independent predictor of developing lymphedema (OR: 0.71, 95% CI: 0.55-0.91, p = 0.008), along with the number of dissected lymph nodes (OR: 1.06, 95% CI: 1.05-1.08, p &amp;lt; 0.001), neoadjuvant chemotherapy (OR: 1.83, 95% CI: 1.44-2.33; p &amp;lt; 0.001), adjuvant radiation therapy (OR: 6.77, 95% CI: 5.16-8.96, p &amp;lt; 0.001), BMI &amp;gt;25 kg./m2 (OR: 1.58, 95% CI: 1.26–1.97, p &amp;lt; 0.001) and older age at surgery (OR: 1.01, 95% CI: 1.00-1.02, p = 0.007). Conclusion: Our data demonstrates significantly lower rates of ipsilateral lymphedema for the patients undergoing immediate reconstruction after mastectomy when compared to that of the mastectomy alone. While these observations require further validation, our study provides useful information for the surgical decision making in patients who are considering the option of immediate reconstruction after mastectomy. Citation Format: Jin Young Byeon, Ik Beom Shin, Hawjeong Lee, Eunhye Kang, Ji-Jung Jung, Changjin Lim, Wonshik Han, Hong-Kyu Kim, Han-Byoel Lee, Hyeong-Gon Moon. Immediate breast reconstruction is associated with reduced incidence of ipsilateral lymphedema in breast cancer patients undergoing mastectomy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-12-05.

Comprehensive analysis of risk factors for postoperative wound infection following radical mastectomy in breast cancer patients.

Surgical site infections (SSIs) following radical mastectomy in breast cancer patients can significantly affect patient recovery and healthcare resources. Identifying and understanding the risk factors for postoperative wound infections (PWIs) are crucial for improving surgical outcomes. This retrospective study was conducted from June 2020 to June 2023, including 23 breast cancer patients who developed PWIs post-radical mastectomy and a control group of 46 patients without such infections. Comprehensive patient data, including variables such as intraoperative blood loss, hospital stay duration, body mass index (BMI), operation time, anaemia, drainage time, diabetes mellitus, cancer stage, white blood cell (WBC) count, serum albumin levels and preoperative neoadjuvant chemotherapy, were meticulously gathered. Statistical analyses, including univariate and multivariate logistic regression, were performed using SPSS software (Version 27.0). The univariate analysis identified several factors significantly associated with an increased risk of PWIs, including preoperative neoadjuvant chemotherapy, low serum albumin levels, advanced cancer stage, diabetes mellitus and reduced WBC count. Multivariate logistic regression highlighted anaemia, prolonged drainage time, diabetes mellitus, advanced cancer stage, reduced WBC count, hypoalbuminemia and preoperative neoadjuvant chemotherapy as significant contributors to the increased risk of PWIs. Anaemia, extended drainage time, diabetes mellitus, advanced cancer stage, low WBC count, hypoalbuminemia and preoperative neoadjuvant chemotherapy are key risk factors for SSIs post-radical mastectomy. Early identification and proactive management of these factors are imperative to reduce the incidence of postoperative infections and enhance recovery outcomes in breast cancer patients.

12 Oral - Drivers of choice and outcomes of breast-conserving surgery versus mastectomy in breast cancer patients with complete response following neoadjuvant therapy: a retrospective analysis from the EUSOMA database

12 Oral - Drivers of choice and outcomes of breast-conserving surgery versus mastectomy in breast cancer patients with complete response following neoadjuvant therapy: a retrospective analysis from the EUSOMA database

Oncologic Safety of One-Stage Implant-Based Breast Reconstruction in Breast Cancer Patients With Positive Sentinel Lymph Nodes: A Single-Center Retrospective Study Using Propensity Score Matching

ObjectiveThe purpose of this study is to evaluate the oncologic safety of one-stage implant-based breast reconstruction (OIBR) following mastectomy in breast cancer patients with positive sentinel lymph nodes (SLNs). MethodsWe collected clinical and pathological data from breast cancer patients with positive SLNs who underwent OIBR or not after mastectomy between January 2015 and December 2018. A total of 194 patients were included, with 130 patients undergoing mastectomy alone (MA) and 64 patients receiving OIBR after mastectomy. The clinical and pathological features, as well as the postoperative oncologic outcomes, of the 2 groups were retrospectively analyzed. Propensity score matching (PSM) was employed to mitigate the effects of data bias and confounding factors. ResultsThe median follow-up time was 66 months for the OIBR group and 64 months for the MA group after PSM. The majority of reconstructive surgeries use an approach of prosthetic implantation (52.0%). This is followed by prosthetic implantation combined with a latissimus dorsi (LD) flap (32.0%), and acellular dermal matrix (ADM)-assisted implant placement (16.0%). During the follow-up period, a local recurrence was observed in 1 case, regional recurrence in 3 cases, and distant metastasis leading to death in 3 cases among the OIBR group patients. No significant difference was found between the OIBR and MA groups in disease-free survival (DFS) (P = .66), distant metastasis-free survival (DMFS) (P = .91), locoregional recurrence-free survival (LRRFS) (P = .44), and overall survival (OS) (P = .57). ConclusionOIBR is a safe option for breast cancer patients with positive SLNs and does not negatively impact cancer recurrence or overall survival.

Additional intraoperative subpectoral plane block vs conventional pain control: A comparison of shoulder movement in patients with mastectomy

PurposeShoulder pain is common among mastectomy patients, with limiting shoulder mobility and negatively affecting their quality of life. Pectoral nerve blocks (PECs) have demonstrated efficacy in providing postoperative analgesia. We hypothesized that these nerve blocks could improve shoulder movement in patients undergoing mastectomy. MethodsThis prospective, randomized, double-blind controlled trial enrolled female participants diagnosed with breast cancer and scheduled for mastectomy. Participants were randomly assigned to either the conventional analgesia group or the intervention group. In the intervention group, a PECs II block was applied prior to skin closure following a mastectomy. This study's primary outcome was the assessment of shoulder movement ratios in 5 different positions (forward elevation, external rotation, arm abduction, internal rotation, and cross-body adduction), which were recorded before surgery, at 24-h, 48-h, and 72-h intervals postoperatively, with follow-up at 1 month, 2 months, 3 months, and 6 months. ResultsA total of 59 participants were included in the final analysis. Patients who underwent mastectomy with PECs II block exhibited better shoulder movement in terms of external rotation and arm abduction from the early post-surgery up to 6 months postoperatively. Shoulder forward elevation also showed superior gains during the early postoperative period, with statistical significance observed after 1 month following the surgery. However, no significant differences were found between the two groups in terms of internal rotation and adduction movements of the shoulder. ConclusionsCompared to conventional analgesia, intraoperative pectoral nerve block under direct vision enhances shoulder mobility in forward elevation, external rotation, and arm abduction after mastectomy in breast cancer patients.

Intraoperative ultrasound margin evaluation as a tool to reduce positive superficial margins in nipple and skin sparing mastectomy in breast cancer patients

BackgroundIntraoperative ultrasound (IOUS) guided conservative surgery has been shown to reduce rates of positive margins in breast cancer. The aim of the study is to evaluate the feasibility of using IOUS to assess superficial/anterior margins in nipple and skin sparing mastectomy (NSM/SSM) and its impact on reducing rates of positive margins. MethodsThis prospective study includes all breast cancer patients who had an indication for NSM/SSM at our Institution. Superficial margin width was measured by IOUS before surgery and the area marked on the skin. Same measurement was performed afterwards in the mastectomy specimen. Any superficial margin < 5 mm was re-excised intraoperatively following the mark on the skin. ResultsFifty-nine patients were included, 47 patients (79.7%) underwent NSM, and 12 patients (20.3%) a SSM. Of the 59 patients, 23 (38.98%) had margins ≥5 mm and 36 patients (61.02%) had margins of ≤5 mm. Of the 36 patients with superficial margins ≤5 mm, 20 had margins <2 mm, and 6 of them had intraoperative involved superficial margins in final pathology. However, after IOUS-guided re-excision, final pathology showed no involved margins. A 2 mm margin was set as the cut-off point for performing an intraoperative re-excision. IOUS guided re-excisions for intraoperative margins ≤2 mm significantly reduced the risk of close/positive margins in final pathology, p < 0.0001. ConclusionThe results showed that IOUS margin evaluation significantly reduced the rate of superficial positive margins in NSM/SSM. It is feasible and effective and may avoid challenging reoperations and/or additional radiation therapy for positive margins.

Can the size of chest wall recurrence after mastectomy in breast cancer patients predict the presence of systemic metastasis?

One of the manifestations of recurrence after mastectomy is the presentation of chest wall lesion. However, it is unclear if the size of the chest wall recurrence (CWR) is related to the presence of simultaneous systemic metastasis in these patients. We aimed to determine if the size of the CWR could affect the outcome in these patients. Stage I-III breast cancer patients who underwent mastectomy and developed invasive ipsilateral CWR were included. Patients with bilateral mastectomy were excluded. Demographic, radiologic and pathological data were analysed between patients with CWR and simultaneous systemic metastasis versus those with isolated CWR. Of the 1,619 patients treated with mastectomy, 214 (13.2%) patients developed recurrences. 57/214 (26.6%) patients had invasive ipsilateral CWR. 48 patients were analysed after exclusion of patients with missing data. Mean age at diagnosis of first cancer and at recurrence were 55.2 years (32-84 years) and 58.5 years (34-85 years) respectively. 26/48 (54.2%) had CWR with simultaneous systemic metastasis. Mean CWR size was 30.7 mm (6-121 mm) and 21.4 mm (5.3-90 mm) for the patients with simultaneous systemic metastasis and those without respectively (P=0.441). Grade (P=0.0008) and nodal status (P=0.0009) at primary diagnosis, grade (P=0.0011) and progesterone receptor (PR) status (P=0.0487) at recurrence were statistically significant for systemic metastasis in patients with CWR. Biologic factors such as grade of primary and recurrent cancer, PR status of recurrent cancer and nodal status at primary diagnosis, instead of CWR size, were associated with simultaneous systemic metastasis in patients with CWR.

ASO Visual Abstract: Survival After Breast-Conserving Surgery Compared with that After Mastectomy in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

ASO Visual Abstract: Survival After Breast-Conserving Surgery Compared with that After Mastectomy in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

Is Breast Conserving Surgery Efficacious in Breast Cancer Patients with BRCA1 or BRCA2 Germline Mutation?

The optimal surgical therapy for newly diagnosed breast cancer with germline mutations in susceptibility genes is still uncertain for many physicians. In this study, we aimed to determine the efficacy of breast conserving surgery (BCS) in breast cancer patients with BRCA1 or BRCA2 mutation by assessing its outcomes and locoregional recurrence (LR) rates. Seventy-five patients operated with BCS or mastectomy for breast cancer between 2006 and 2017 and had BRCA1 or BRCA2 mutation were included in the study. Effects of the performed breast surgery and clinicopathological characteristics on surgical outcomes, LR rates and survival were analyzed with showing the distribution of BRCA1 and BRCA2 germline mutations. The median age of the patients was 42 years (20-77). BRCA1 mutations were found in 46 (61.3%) patients and BRCA2 mutations in 29 (38.7%) patients. Compared to BRCA2 carriers, BRCA1 carriers were more likely to have higher tumor grade (84.8% vs 44.8%; p = 0.001) and non-luminal subtype tumors (67.4% vs 13.8%; p = 0.001). A total of 44 (58.7%) patients underwent unilateral mastectomy and 31 (41.3%) patients underwent BCS. At a median follow-up time of 60 (12-240) months, LR was observed in 6 patients equally divided in both BCS and mastectomy groups. LR rates were slightly higher after BCS versus mastectomy (9.7% and 6.8%, respectively). Additionally, there were no statistically significant differences in disease-free survival (DFS) and disease-specific survival (DSS) rates after 10 years in the BCS group versus the mastectomy group (p = 0.117 and 0.109, respectively), but in fact, the rates were better in the BCS group. Our findings indicate that BCS may serve as an efficacious alternative to mastectomy for breast cancer patients with BRCA1 or BRCA2 mutation. Additionally, tumor size, lymph node positivity, and TNM stage should be taken into consideration for a better surgical decision-making.

The use of intraoperative ultrasound reduces the risk of positive superficial margin in nipple and skin sparing mastectomy in breast cancer patients

The use of intraoperative ultrasound reduces the risk of positive superficial margin in nipple and skin sparing mastectomy in breast cancer patients

Deep Inferior Epigastric Perforator Flap for Immediate Breast Reconstruction following Mastectomy in Breast Cancer Patients: An Initial Experience in Vietnam.

Breast reconstruction in breast cancer patients is an optional surgery that improves the quality of life while preserving the efficacy of chemotherapy and radiotherapy. Deep inferior epigastric perforator (DIEP) flap is a new but reliable and safe technique for autologous breast reconstruction. After mastectomy, immediate reconstruction is the preferred method because of its aesthetic result and convenience. This study is aimed at summarizing our experience in DIEP flap for immediate breast reconstruction. A prospective study was performed on 30 breast cancer patients who underwent intermediate breast reconstruction for DIEP flap after mastectomy from June 2019 to June 2021 in Hanoi Medical University Hospital. Clinicopathology characteristics, tumor stage, treatment, and complications were evaluated. The mean age of patients was 44.9 (range: 29-73 years). 86.7% of patients were in stages I and II. Five patients (16.7%) received neoadjuvant chemotherapy. 20 patients (66.7%) underwent nipple-sparing mastectomy (NSM) procedures. The mean operating time was 341 minutes. The mean time to receive chemotherapy was 34.68 days. The mean number of perforators was 1.30. The overall flap success rate was 90%. Twelve patients (40%) experienced complications. Four patients (13.3%) returned to the operating room due to venous congestions. Two patients (6.67%) had complete flap loss. Other complication: fat necrosis (6.7%), seroma (13.3%), partial flap loss (3.3%), abdominal wound dehiscence (6.7%), pneumonia (3.3%), and pulmonary embolism (6.7%). After one-month postoperation, 88.9% of patients were satisfied with their breasts, and 74.07% were satisfied with the operation. DIEP flap is a new but reliable and safe technique for autologous breast reconstruction. Though patients opting for breast reconstruction still have a low risk of complication and reconstruction failure, this procedure should be used more frequently in appropriate patients to improve their quality of life.

Complications Including Capsular Contracture in Direct-to-Implant Breast Reconstruction With Textured Anatomical Versus Smooth Round Implants: A Single Center Retrospective Analysis.

Implant-based breast reconstruction is the most common reconstruction method used after mastectomy in breast cancer patients. Many studies have compared the smooth round implants and textured anatomical implants. This study aimed to compare the complications, including capsular contracture, between these two implants used in direct-to-implant (DTI) breast reconstruction. This retrospective chart review was performed using a prospectively maintained database from a single center. We identified patients who underwent mastectomy with DTI single-stage breast reconstruction at our hospital between August 2011 and June 2021. The overall complications, including capsular contracture, postoperative infection, seroma, hematoma, implant rupture, implant exposure, rippling, implant malposition, and nipple necrosis, were analyzed. In total, 340 breasts of 323 patients were reconstructed by the DTI approach using either textured anatomical (n = 203) or smooth round (n = 137) implants. The incidence of overall complications and capsular contracture was significantly lower with smooth round implants than with textured anatomical implants. Multivariate analysis showed that smooth round implants were associated with a reduced risk of overall complications (odds ratio [OR], 0.465; 95% confidence interval [CI], 0.265-0.813) and capsular contracture (OR, 0.475; 95% CI, 0.235-0.962). Particularly, smooth round implants were associated with a decreased risk of overall complications in patients not receiving adjuvant chemotherapy and a decreased risk of capsular contracture in patients with body mass index < 25 kg/m² and in those not receiving adjuvant radiotherapy. Smooth round implants demonstrated a decreased risk of overall complications and capsular contracture when compared with textured anatomical implants. These results may be utilized in counseling patients regarding the advantages and disadvantages of smooth round implants in DTI breast reconstruction.

Correlation Between Preoperative Serum Albumin Levels And Post-Operating Seroma Incidence Of Modified Radical Mastectomy In Breast Cancer Patients

Background: Surgical therapy is still the mainstay of therapy for breast cancer, and modified radical mastectomy (MRM) is the most frequently performed procedure. Seroma formation after breast surgery is a complication that is often found due to the formation of dead space anatomically. A low albumin level indicates an ongoing systemic response and is a one of marker for a seroma. Aim To determine the postoperative complications of modified radical mastectomy in breast cancer patients, namely the incidence of postoperative seroma with preoperative serum albumin levels. Methods: An analytic observational study using a cross sectional study design conducted at the medical record of Prof. Dr. IGNG Ngoerah Denpasar Hospital in January 2019-December 2021. The research subjects were all patients with breast cancer underwent MRM. This study’s data analysis consisted of univariate and bivariate analysis using IBM SPSS version 23. Results: 128 subjects divided into two groups, 30 subjects with seroma and 98 subjects without seroma. Low albumin levels &lt;3.5 gr/dl in the seroma group were found in 18% case and in the group without seromas 39.1%, normal albumin levels &gt; 3.5 gr/dl with seromas occurring in 5.5% respondents and normal albumin levels without seroma found 37.5% respondents. The RR value was 2.4 (CI 95% 1.14-5.34) with a p-value of 0.013. Conclusion: Pre-operative low albumin level &lt; 3.5 gr/dl correlated to high seroma formation after modified radical mastectomy.

Latissimus dorsi flap (LD-flap) or endoprosthesis for breast reconstruction? Which is optimal for immediate reconstruction after a nipple-sparing mastectomy in breast cancer patients?

The article analyzes two methods of breast reconstruction: breast reconstruction with an implant or an LD‑flap after a subcutaneous nipple‑sparing mastectomy in the case of complex treatment of stage I — III breast cancer. In many works, the advantages and disadvantages of different types of reconstruction are indicated and contradictions can often be found, although most prefer reconstruction with implants.&#x0D; Objective — to compare the results of immediate breast reconstruction using an implant or an ­LD‑flap after a subcutaneous nipple‑sparing mastectomy in patients with I — III stages of breast cancer.&#x0D; Materials and methods. We conducted a comparative study of the results of immediate reconstruction of the mammary gland after a subcutaneous nipple‑sparing mastectomy using the method of putting a silicone implant (endoprosthesis) or the method of LD‑flap reconstruction. Randomization was not carried out. The results of operative interventions were retrospectively and parallelly compared in two groups: reconstruction of the mammary gland with an implant (1) or LD flap (2). In both groups of 30 patients, all patients were diagnosed with stage I — III breast cancer and in most cases (80 — 83 %) received preoperative chemotherapy for regression and reduction of the stage of the process. The evaluation of the treatment result was carried out according to aesthetic indicators, oncological survival indicators, and the subjective evaluation of the aesthetic result by patients.&#x0D; Results. During the observation period since 2018, the analysis of the frequency of development in the groups of relapses and metastases during the 4‑year observation period (since 2018), the frequency of development of local complications in both groups: hematomas, skin necrosis, implant extrusions, seromas, lymphorrhea, capsular contractures, liponecrosis, lymphostasis of the upper extremity on the side of the operation, the degree and duration of the pain syndrome in the postoperative area, and the possibility of a full course of treatment did not show significant differences during the observation period. The quality of life in both groups, according to the Spitzer scale, was comparable (in the first group, 64 %, and in the second group, it was 63 %). Only the duration of postoperative bed rest was longer in the LD flap reconstruction group.&#x0D; Conclusions. The results of the analysis of the study’s data showed that there are advantages and disadvantages to both methods. According to the findings, it is difficult to conclude which of the methods is more optimal, but it is necessary to choose the technique based on the constitutional characteristics of the patient and the size and shape of the mammary gland. An individualized and comprehensive approach is important.&#x0D;

Survival After Breast-Conserving Surgery Compared with that After Mastectomy in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

Breast-conserving surgery (BCS) plus radiotherapy (BCS + RT) has been shown to improve survival compared with mastectomy in patients with early breast cancer; however, whether this superiority is maintained in breast cancer patients receiving neoadjuvant chemotherapy (NCT) is unclear. We evaluated and compared the survival outcomes after BCS + RT and mastectomy in Korean women with breast cancer treated with NCT. We evaluated 1641 patients who received NCT before surgery (BCS or mastectomy). We performed propensity score matching to minimize potential bias due to factors other than the surgical method and compared the 5-year, disease-free survival (DFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates before and after exact matching. Among the 1641 patients, 839 (51.1%) underwent BCS + RT and 802 (48.9%) underwent mastectomy. Patients who underwent mastectomy had larger tumors and more frequently had positive nodes. For BCS+RT and mastectomy, the unadjusted 5-year DFS, 5-year DMFS, and 5-year OS rates were 87.0% and 73.1%, 89.5% and 77.0%, and 91.8% and 81.0%, respectively (all p < 0.05 = 0.000). After PSM, 5-year DFS, 5-year DMFS, and 5-year OS rates for BCS + RT and mastectomy were 87.6% and 69.1%, 89.7% and 76.0%, and 89.1% and 75.7%, respectively (all p < 0.05). In both unadjusted and adjusted analyses accounting for various confounding factors, BCS + RT was significantly associated with improved DFS (p < 0.05), DMFS (p < 0.05), and OS (p < 0.05) rates compared with mastectomy. BCS + RT does not impair DFS and OS in patients treated with NCT. Tumor biology and treatment response are significant prognostic indicators. Our results suggest that BCS + RT may be preferred in most breast cancer patients when both BCS and mastectomy are suitable.

Postoperative Analgesic Efficacy of Intraoperative Pectoral Nerve Block for Modified Radical Mastectomy: a Double-Blind Prospective Randomised Interventional Study.

Severe acute postoperative pain following breast surgery increases the risk of persistent pain and affects the recovery of patients. Recently, pectoral nerve (PECs) block has gained significance as a regional fascial block that can provide adequate postoperative analgesia. This study aimed to evaluate the safety and efficacy of PECs II block, which was given intraoperative under direct vision after performing modified radical mastectomy for breast cancer patients. This prospective randomised study was comprised of a PECs II group (n = 30) and a control group (n = 30). Group A patients received 25ml of 0.25% bupivacaine for PECs II block intraoperatively after the surgical resection was done. Both groups were compared with respect to the demographic and clinical parameters, total intraoperative fentanyl dose, total duration of surgery, postoperative pain score (Numerical Rating Scale) and the analgesic requirement, postoperative complications, postoperative duration of hospital stay, and the outcome. Intraoperative PECs II block was not associated with any increase in the duration of surgery. The postoperative pain scores were significantly higher in the control group till 24h after the surgery, and so was the postoperative analgesic requirement. Patients in the PECs group were found to have rapid recovery and decreased postoperative complications. Intraoperative PECs II block is not only safe, time-saving procedure but also significantly reduces the postoperative pain and analgesic requirement in breast cancer surgeries. It is also associated with a faster recovery, decreased postoperative complications, and better patient satisfaction.