Organ-preserving Surgery Research Articles

Additive manufacturing to veterinary practice: recovery of bony defects after the osteosarcoma resection in canines.

The paper outlines the achievements and challenges in the additive manufacturing (AM) application to veterinary practice. The state-of-the-art in AM application to the veterinary surgery is presented, with the focus of AM for patient-specific implants manufacturing. It also provides critical discussion on some of the potential issues design and technology should overcome for wider and more effective implementation of additively manufactured parts in veterinary practices. Most of the discussions in present paper are related to the metallic implants, manufactured in this case using so-called powder bed additive manufacturing (PB-AM) in titanium alloy Ti-6AL-4V, and to the corresponding process of their design, manufacturing and implementation in veterinary surgery. Procedures of the implant design and individualization for veterinary surgery are illustrated basing on the four performed surgery cases with dog patients. Results of the replacement surgery in dogs indicate that individualized additively manufactured metallic implants significantly increase chances for successful recovery process, and AM techniques present a viable alternative to amputation in a large number of veterinary cases. The same time overcoming challenges of implant individualization in veterinary practice significantly contributes to the knowledge directly relevant to the modern medical practice. An experience from veterinary cases where organ-preserving surgery with 3D-printed patient-specific implants is performed provides a unique opportunity for future development of better human implants.

Multicentric and multifocal breast cancer diagnostics (review and portfolio)

Breast cancer in (42-48) % of cases is a multicentric or multifocal process. Multicentricity of the tumor is the presence of several tumor foci located in different quadrants (segments) of the breast; multifocality is the presence of several tumor foci in one square or segment. Multifocal and multicentric cancers evidently are biologically different diseases. The importance of identifying all the foci is that with a multicentric lesion, more radical types of surgical treatment are applied. With cancer monocentricity, organ-preserving surgery is predominantly chosen, and with multicentricity – radical mastectomy. Multifocality not detected at the preoperative stage and, especially, multicentricity is the cause of relapses in more than 40 % of cases. The purpose of the review is to consider the information content and effectiveness of radiation diagnostic technologies in the aspect of identification of multicentric and multifocal breast cancer. X-ray mammography, full-format digital X-ray mammography, magnetic resonance imaging, multispiral computed tomography, infrared thermography of transmission optical tomography, sonography, digital tomosynthesis, mammoscintigraphy, electric impedance mammography are considered. Key words: multifocal and multicentric cancer, mammography, magnetic resonance mammography, multispiral computer tomography, mammoscintigraphy, sonography, electric impedance mammography.

Modern ultrasound diagnostics, management tactics and pregnant delivery with central placenta previa and its simultaneous germination into the postoperating scar

Postoperative observation of diagnostics, management tactics and pregnant delivery with central placenta previa and its simultaneous germination into the postoperating scar are presented. The patient has a history of 4 abortions, radical surgery for the brain left frontal lobe meningioma, 3 deliveries by caesarean section. Echographic and magnetic resonance imaging investigations were performed. The patient was delivered in full-term by the operation “cesarean section” in a planned order with an organ-preserving surgery.

Development and practical implementation of organ preservation surgery in case of placenta accreta in patients with a scar on the uterus

Comparative analysis of methods for preventing/stopping intraoperative hemorrhage during surgical delivery of patients with placenta accreta (temporary balloon-assisted occlusion of common iliac arteries, internal iliac artery ligation; uterine artery embolization - UAE) has shown that internal iliac artery ligation is not effective. UAE and especially balloon-assisted occlusion of common iliac arteries have demonstrated a significantly greater effect due to the temporary 'devascularization' of the uterine corpus. It has been proved that an innovative surgical technique - a lower segment Caesarean section (LSCS) significantly reduces intraoperative blood loss. The main purpose of an alternative uterus cut - anterior placenta previa preserving and bleeding absence before the child removal - has been achieved within all observations. LSCS has caused a significantly smaller (by 1.6 times) amount of intraoperative blood loss than the corporal one. Another innovative surgical technique is metroplasty. It entails removing placenta accreta areas from the uterus with subsequent restoration of the organ integrity. The authors have proved the necessity of autologous advance blood donation and hemodilution strategy, which was first implemented in Moscow Center for Family Planning and Reproduction, and after 2006 was used in all obstetric institutions in Moscow. This allowed reducing the number of blood donations up to 85% and additionally decreased transfusiological risks which is economically valuable as well. Improvement of diagnostic methods, operating techniques, hemostasis, blood volume redistribution and creating an algorithm on its basis has proved the possibility of implementing an organ-, life, health- and fertility preserving approach in cases of placenta accreta in patients with a scar on the uterus after cesarean section. The introduction of the enhanced principles of patient management with placenta accreta has significantly reduced the number of hysterectomies in Moscow (from 48 in 2007 to 8 in 2016), and during the last 2 years no patient with this complication has had a hysterectomy. 12 out of 85 patients who had deliveries in accordance with the developed algorithm, have realized their subsequent fertility.

Pathophysiology of the cortico-sympathoadrenal system in the postoperative period of partial nephrectomy

Introduction. Organ-preserving kidney surgeries are widespread in urological practice. Any surgical intervention triggers a cascade of reactions in the body that are characteristic of stressful situations, which adversely affects blood flow volume in the parenchymal organs, worsens microcirculation, and reduces the trophic and reparative abilities of organs. The application of anti-ischemic protection is an essential part of patient rehabilitation to maintain renal function. Objective. To investigate the nephroprotective properties of α-tocopherol acetate (a-TA) and its effect on α-tocopherol acetate (a-TA) parameters of the cortico-sympathoadrenal system following organ-preserving kidney surgery. Material and methods. An experimental study was performed on 70 white laboratory rats, 10 of which were not subjected to surgical treatment. Sixty rats underwent lower pole left kidney superimposition with Z-joints. Postoperatively, 30 rats were intramuscularly injected with a 10% oil solution of 0.2 mL a-TA twice a day for 5 days. The cortico-sympathoadrenal system parameters were determined on the 7th, 14th, and 28th days. Results. Postoperative administration of a-TA resulted in early normalization of the cortico-sympathoadrenal system. Conclusion. The studied indices regarding the tissue of the operated kidney are responsible for regulating vascular tone, severity of the inflammatory response, microcirculation, and reparative processes. The use of a-TA accelerates recovery from organ-preserving surgery and biochemical abnormalities. (For citation: Shormanov IS, Los MS. Pathophysiology of the cortico-sympathoadrenal system in the postoperative period of partial nephrectomy. Urologicheskie vedomosti. 2018;8(2):11-17. doi: 10.17816/uroved8211-17).

Pathological anatomy of reparative processes in the resected kidney treated with α-tocopherol acetate in experiment

Violation of the integrity of the kidney parenchyma during organ-preserving surgery is always accompanied by functional impairment in that part of the organ. This is due to mechanical damage to the nephron and the development of aseptic necrosis in the area of the resection, followed by development of an ischemic zone that expands during the repair process due to disrupted parenchymal cell metabolism and pressure from regenerating connective tissue.
 Objective. To investigate the effect of α-tocopherol acetate on repair processes in the kidney parenchyma after an organ-preserving operation in a rat model.
 Materials and methods. An experimental study was performed on 60 white laboratory rats that underwent resection of the lower pole of the left kidney. Postoperatively, a study group (n = 30) underwent intramuscular injections of a 10% α-tocopherol acetate oil solution, 0.2 ml 2 times a day for 5 days. A control group (n = 30) were left untreated.
 Results. Compared with the control group, animals in the study group had a narrower zone of total necrosis and less pronounced inflammation and vascular stasis on days 7, 14, and 28 after the operation.
 Conclusion. Use of the natural antioxidant α-tocopherol acetate in the postoperative period of organ-preserving kidney surgery may accelerate reparative processes in the damaged parenchyma.

Long-term prognostic analysis on complete/near-complete clinical remission for mid-low rectal cancer after neoadjuvant chemoradiotherapy

To investigate the long-term outcome of organ preservation with local excision or "watch and wait" strategy for mid-low rectal cancer patients evaluated as clinical complete remission (cCR) or near-cCR following neoadjuvant chemoradiotherapy (NCRT). Clinical data of 62 mid-low rectal cancer patients evaluated as cCR/near-cCR after NCRT undergoing organ preservation surgery with local excision or receiving "watch and wait" strategy at Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute from March 2011 to August 2017 were retrospectively analyzed. According to the approximate 1:2 pairing, 123 patients who underwent radical resection with complete pathological remission(ypCR) after neoadjuvant chemotherapy during the same period were selected for prognosis comparison. The primary endpoint of the study was 3-year non-regrowth disease-free survival (NR-DFS) and tumor specific survival (CSS). Survival analysis was performed using the Kaplan-Meier curve (Log-rank method). The secondary endpoint of the study was 3-year organ preservation and sphincter preservation. The retrospective study included 38 male and 24 female patients. The median age was 60 (31-79) years and the median distance from tumor to anal verge was 4(1-8) cm. The ratio of cCR and near-cCR was 79.0%(49/62) and 21.0%(13/62) respectively. Local regrowth rate was 24.2%(15/62). Of 15 with tumor regrowth, 9 patients received salvage radical rectal resection and no local recurrence was found during follow-up; 4 patients received salvage local excision among whom one patient had a local recurrence occurred patient; 2 patients refused further surgery. The overall metastasis rate was 8.1%(5/62), including resectable metastasis(4.8%,3/62) and unresectable metastasis (3.2%,2/62). The valid 3-year organ preservation rate and sphincter preservation rate were 85.5%(53/62) and 95.2%(59/62) respectively. The median follow-up was 36.2(8.6-89.0) months. The 3-year NR-DFS of patients with cCR and near-cCR was 88.6% and 83.1% respectively, which was not significantly different to that of patients with ypCR (94.7%, P=0.217). The 3-year CSS of patients with cCR and near-cCR was both 100%, which was not significantly different to that of patients with ypCR(93.4%, P=0.186). Mid-low rectal cancer patients with cCR or near-cCR after NCRT undergoing organ preservation with local excision or receiving "watch and wait" strategy have good long-term prognosis with low rates of local tumor regrowth and distant metastasis, which is similar to those with ypCR after radical surgery. This treatment mode may be used as an option for organ preservation in mid-low rectal cancer patients with good tumor remission after NCRT.

Органосохраняющая хирургия рака почки

Цель. Представить собственный опыт в свете общепризнанных тенденций органосохраняющей хирургии рака почки.
 Материалы и методы. С 2008 по декабрь 2017 г. выполнено 127 резекций почки, из них 32 - лапароскопически, в 111 наблюдениях - по поводу рака почки.
 Результаты. При открытой резекции почки в 74% наблюдений применяли тепловую ишемию продолжительностью от 10 до 27 мин, в среднем 14 мин. Во время лапароскопической резекции почки к тепловой ишемии прибегали в 82% наблюдений, ее продолжительность составляла от 9 до 39 мин, в среднем 26 мин. Средняя продолжительность операции при лапароскопической резекции почки составляла в среднем (170 ± 40) мин, при открытом доступе - (104 ± 40) мин. После обоих типов операций гистологически подтвержден негативный край резекции. За период наблюдения рецидив почечно-клеточного рака (ПКР) выявлен у 3 (2,4%) больных после открытой резекции почки на стадии T3a (гистологически - опухолевые эмболы в сегментарных сосудах). Всем этим пациентам успешно выполнена лапароскопическая нефрэктомия. Безрецидивная выживаемость составила 97,6%.
 Выводы. Выполнение лапароскопической резекции почки безопасно у пациентов с опухолями в стадии рТ1 и не сопряжено с большим количеством периоперационных осложнений в сравнении с открытой резекцией почки, однако при этом достоверно увеличивается продолжительность тепловой ишемии почки. Для тщательно отобранных пациентов среди оперативных доступов предпочтение следует отдавать тем способам, которые могут быть выполнены без тепловой ишемии почки.

Biomarkers in diagnostics of acute kidney injury after the organ-preserving surgery of localized renal cancer

Objective: to assess perspectives using biomarkers for early detection of developing acute kidney injury (AKI) among patients during partial nephrectomy under the warm ischemia of the kidney. Materials and methods: data of 100 patients was assessed with a localized renal cancer Т1N0М0 aged 56,5±8,7 years. All the patients underwent partial nephrectomy under warm ischemia of the kidney. The concentration of the following “early markers of AKI” was tested in blood of the patients using the ELISA technique and standard test-systems: cystatin С (BioVendor, Czech Republic), NGAL (BCMDiagnostics, USA), L-FABP (Hycult Biotechnology, Netherlands). The duration of warm ischemia was also fixed and the rate of diuresis was valued either. The test was carried out 24 hours prior to and 16 hours after the surgical interference. All the patients were diagnosed and classified by the presence or absence of AKI during the early postoperative period according to the generally accepted classification KDIGO. The obtained results were processed with the help of Microsoft Excel software, the statistical reliability of the results was defined on the basis of the use of Wilcoxon non-parametric test. Simultaneously the expert analysis of the clinical data and results of the laboratory research was carried out. Results: the method of the early diagnostics of AKI among patients who underwent partial nephrectomy under the warm ischemia of the kidney was developed. The method is based on the successive identification of the concentration of the early biochemical markers of AKI, the duration of warm ischemia and the rate of diuresis. Conclusions: the use of the developed method allows diagnosing the development of AKI among patients undergoing partial nephretomy under the warm ischemia already in 16 hours after the surgical interference (before the rise in the creatinine level).

The Diagnosis and Treatment of Penile Cancer.

The incidence of penile cancer in Europe lies in the range of 0.9 to 2.1 cases per 100 000 persons per year. Carcinogenesis is associated with human papilloma virus (HPV) infection and with chronic inflammation. This review is based on publications (2010-2017) retrieved by a selective search in PubMed and EMBASE and on the guidelines of the European Association of Urology, the European Society of Medical Oncology, the National Comprehensive Cancer Network, and the National Institute for Health and Care Excellence (NICE). 95% of cases of penile cancer are accounted for by squamous cell carcinoma, whose numerous subtypes have different clinical courses. Chronic preputial inflammation due to phimosis or lichen sclerosus is often associated with penile cancer. Circumcision lowers the risk of penile cancer (hazard ratio: 0.33). Maximally organ-preserving surgery with safety margins of no more than a few millimeters is the current therapeutic standard, because a local recurrence, if it arises, can still be treated locally with curative intent. Local radiotherapy can be performed in early stages. Lymphogenic metastasis must be treated with radical lymphadenectomy and adjuvant chemotherapy. Patients with clinically unremarkable inguinal lymph nodes nonetheless need invasive lymph node staging because of the high rate of lymphogenic micrometastasis. Penile cancer is curable in all early stages with the appropriate treatment, but its prognosis depends crucially on the proper management of the regional (i.e., inguinal) lymph nodes. In many countries, the treatment of this rare disease entity has been centralized.

Clinical prognostic factors of bilateral synchronous renal cancer

The aim of the study is to assess the positive and negative prognostic factors of survival in patients with bilateral synchronous renal cancer (BRC). Materials and methods. The study was conducted on the basis of N.N.Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation. Cohort of patients with the synchronous BRC consisted of 160 patients between 1996 and 2014. All patients after finishing treatment were observed on an ambulatory basis during the period from 11 months to 12 years (median follow-up 81.05±46.7 months). We studied factors affecting 5-year survival rate, both positive and negative. Statistical analysis of the obtained results carried out using generally accepted statistical methods such as SPSS 23.0 - block of programs for Windows. Results. In case of synchronous BRC in 2/3 (65%) of patients the first kidney was operated on using organ-preserving surgery, in 1/4 of patients (n=21, 26.2%) both kidneys were operated on using organ-preserving surgery. In case of synchronous renal cancer the best results of survival, but without statistical significance (p=0.112) had patients with bilateral renal cancer who operated on using organ-preserving surgery. The 10-year overall survival in this group of patients was 90.5% in comparison with 62.5% - when nephrectomy was performed on the first stage and 76.4% in patients who had nephrectomy performed because of the renal cancer in the second kidney. Conclusions. The main factors affecting the 5-year survival rate of patients with synchronous BRC were: smoking, primary tumor size, age and type of surgery.

Practical aspects of treatment of kidney cancer in a modern hospital: the evolution of surgical approaches

Objective: analysis of results of the outcomes of surgical treatment for renal tumors in the Saint Petersburg City Hospital No. 40 over the last 5 years and determination the trends.Materials and methods. The study included 293 patients that underwent 296 surgeries for renal tumors. The majority of patients (87.84 %) were diagnosed with localized cancer, whereas locally advanced and metastatic forms were detected in 4.39 and 7.77 % of cases respectively. We performed radical nephrectomy (RNE) or nephron sparing (NS) via open or minimally invasive route (videoendoscopic or robot-assisted surgery using the da Vinci Surgical System).Results. Organ-preserving surgeries were performed in 52.36 % of patients, RNE – in 47.64 % of patients; minimally invasive and open surgeries were conducted in 95.95 and 4.05 % respectively. In individuals with stage cT1a cancer, NS and RNE were performed in 87 and 13 % of cases respectively; in patients with stage cT1b cancer, NS and RNE were performed in 50.82 and 49.18 % of cases respectively. The majority (90.2 %) of patients with renal tumors >7 cm underwent minimally invasive surgeries, primarily RNE. The incidence of severe postoperative complications after NS and RNE was comparable: 5.75–8.06 and 1.67–15.38 % respectively (р = 0.64).Conclusion. Minimally invasive NS is the method of choice for stage сT1 tumors; however, in some cases, we should also consider it for tumors >7 cm. Videoendoscopic surgery is the most preferable option for these patients, whereas robot-assisted techniques should be used for organpreserving surgeries and RNE in difficult cases.

Surgical treatment of patients with compressive complications of chronic pancreatitis

Background. Treatment of patients with chronic pancreatitis complications remains one of the complex problems in modern gastroenterology. Surgical treatment of these patients is not always effective, the risk of postoperative complications is significant. Surgical treatment of such patients has special features, since the use of traditional resective organ preservation techniques has certain limitations. Material and methods. The experience of surgical treatment of 185 patients with complicated chronic pancreatitis has been analyzed for the last 7 years. The clinical efficacy of surgical treatment of 31 patients with compressive complications of chronic pancreatitis was studies. Results. The main types of interventions performed in compression forms of chronic pancreatitis were drainage operations (in 12 patients) and pancreatic resections (in 8 patients), as well as surgeries with the formation of various cystodigestive anastomoses (5 patients). When radical interventions are impossible (6 episodes), the formation of bypass gastroenteroanastomosis, biliodigestive anastomosis or bile ducts external drainage were performed. The indications to the operations, their efficacy and complications were considered. Conclusions. Standard pancreatic organ preservation surgeries in most cases can eliminate the phenomena of subcompensated forms of biliary and portal hypertension, as well as duodenal obstruction. The obtained results proved the reasonability of pancreatic duct drainages in all types of resection that ensures the aggressive compounds removal from the place of anastomosis during its healing and reduces hydrostatic pressure in the pancreatic duct system.

Organ preservation vs primary surgery in the management of T3 laryngeal and hypopharyngeal cancers.

The main objective is to compare the oncologic outcomes of patients with T3 laryngeal cancers who underwent total laryngectomy or organ preservation protocol (OPP) as the initial plan of management. This is a retrospective study on 120 patients treated for T3 laryngeal and hypopharyngeal cancers. Patients with functional larynx underwent OPP and dysfunctional larynx underwent upfront laryngectomy. Median follow-up of the patients was 4.6years. There was a significant difference in 3year disease-free survival (DFS) between upfront laryngectomy and OPP (73.2 vs. 55.7%; P = 0.028) group but not in 3year overall survival (73.2 vs. 68.7%, P = 0.8). The rate laryngeal preservation was 65% in CCRT and 44% in only radiotherapy group. At 3years, the laryngectomy-free survival was 57.2% and the laryngo-esophageal dysfunction-free survival (LEDS) was 53.0%. T3 laryngeal cancers treated with upfront laryngectomy have an improved DFS when compared to those treated with non-surgical modalities. Primary surgery should be offered as an option for selected patients especially when CCRT is not feasible.

Organ-preserving and extensive pancreatic surgery for VON HIPPEL-LINDAU disease. Six cases of 42 patients under surveillance

Organ-preserving and extensive pancreatic surgery for VON HIPPEL-LINDAU disease. Six cases of 42 patients under surveillance

EARLY BREAST CANCER: THE IMPORTANCE OF THE BIOLOGICAL TUMOR SUBTYPE FOR CHOOSING SURGICAL TREATMENT TACTICS (А LITERATURE REVIEW)

Purpose: to determine the dependence of the development of local relapse depending on the chosen tactics of surgical treatment with different biological subtypes of breast cancer. Materials and methods: molecular taxonomy of breast cancer may improve the prognosis of regional regional recurrence (MPR) and has a great potential for improving decisionmaking regarding local treatment for breast cancer. The review of the world literature, reflecting prospective and retrospective studies on the biological characteristics of breast cancer, is reviewed. The studies reflect such parameters as the degree of malignancy, the age of the patients, the biological subtype of the tumor, and the treatment performed. The development of local and regional regional relapse was assessed depending on the choice of surgical treatment tactics: radical mastectomy and organ-preserving treatment + radiotherapy. The search was limited to 2001, when biological subtypes of breast cancer were identified. Prospective and retrospective studies were evaluated in patients with early operable breast cancer. Conclusions: young age, tumor malignancy, tumor node size, presence of lymphovascular invasion or lymph node involvement and unfavorable tumor subtypes such as Her2 /neu and triple-negative tumors can be considered as the main predictors of relapse in breast cancer. Tumors having a triple-negative nature have the most aggressive course, this concerns both local, regional relapse, and distant metastasis. Advances in modern neoadjuvant therapy have reduced the overall number of local relapses for all subgroups. Radiation therapy also helps to reduce the risk of local and regional recurrence. At present, there is no single-valued data on the choice of surgical treatment tactics for various biological subtypes, however effective systemic therapy as well as radiotherapy reduces the frequency of local recurrences after performing organ-preserving surgeries in unfavorable tumor subtypes and according to the results of studies, the total and disease-free survival is comparable, as and during mastectomy.

SENTINEL LYMPH NODE BIOPSY: HISTORY AND CURRENT CONCEPTS

The present review is devoted to the concept of sentinel lymph node biopsy, which is an increasingly recognized method that was included into the guidelines for surgical treatment of various tumors developed by the European Organisation for Research and Treatment of Cancer (EORTC). Since the implementation of organ preservation surgeries, lymph node biopsy is considered the second most significant achievement in surgical treatment of breast cancer, because it reduces the frequency of complications (which often occur after axillary-subclavian lymphadenectomy), duration of hospital stay and treatment expenditures .

Organ preservation surgery for patients with T4a laryngeal cancer.

Surgical preservation of laryngeal function is very challenging in patients with advanced SCCL, especially those of stage T4a. The purpose of this study was to assess the feasibility of organ preservation surgery for patients with T4a squamous cell carcinoma of the larynx (SCCL). We enrolled 32 patients with T4a SCCL and performed organ preservation surgery on them. Surgical details and perioperative morbidity were described, functional and oncologic outcomes were also evaluated. All patients underwent supracricoid subtotal laryngectomy with unilateral or bilateral neck dissection, restoring laryngeal function via direct anastomosis of the cricoid cartilage and tongue base. The patients recovered well and exhibited relatively acceptable survival duration, with a 5-year overall survival rate of 62.5%. Most patients commenced oral intake within 2 weeks, and aspiration was commonly observed. Subjective functional outcomes indicated a relatively acceptable swallowing function and voice quality. Our retrospective analysis of 32 patients with T4a SCCL showed that successful organ preservation surgery is safe and reliable, and associated with a relatively acceptable disease-free survival, normal swallowing function, and acceptable voice quality. More patients with T4a SCCL who wish to preserve the larynx should be considered for organ preservation surgery.

Positive surgical margins in nephron-sparing surgery; the great unknown

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences.

EXPERIENCE OF RECONSTRUCTION OF THE BREAST WITH THE USE OF THORACODORSAL FLAP

Purpose: To analyze the results of treatment and the quality of medical care for breast cancer patients with breast reconstruction using thoracodorsal flap (TDF). Material and methods: The study was conducted on the basis of the N.N. Petrov National Medical Research Center of Oncology at the Department of Breast Tumors for the period 2016-2017. When using the reconstruction of the breast with the help of TDF the feature was the complete intersection of the muscle in the anterior-axillary line before closing the defect of the breast tissue but with the preservation of the thoracodorsal vascular sheaf. Surgical treatment was provided to 67 patients with breast cancer including after neoadjuvant therapy. Results: One-time reconstruction was performed in 16 (23.8%) patients under the organ-preserving surgery, mastectomy in two (2.9%) patients and mastectomy with implant placement in 27 (40.2%) patients. Delayed reconstruction of the breast: TDF in combination with the implant - 20 (29.8%), the use of TDF without an implant - 2 (2.9%) patients. Complications were observed in 6 (8.9%) patients. Conclusion: Reconstruction of the breast with TDF is the method of choice and priority for patients who underwent radiation therapy with a lack of integumentary tissues to cover the implant. TDF is a «good» plastic material and could be used in patients with severe defect of breast shape after organ-preserving surgery and mastectomy. TDF is characterized by a low incidence of complications. The use of TDF does not worsen the rehabilitation of patients and does not shift the timing of adjuvant treatment.