Surgical Treatment Of Breast Cancer Research Articles

Influence of physiotherapy on the electrical excitability of the shoulder muscles in the early postoperative period after radical surgical treatment of breast cancer

BACKGROUND: Combined treatment of cancer patients includes a large number of aggressive therapies that lead to a complex of functional disorders. There are no publications on the influence of physical factors on the electrical excitability of the muscles of the shoulder girdle and upper limb from the side of surgery in the early period after surgical treatment of breast cancer.
 AIM: To determine the physical factor that will most significantly affect the electrical excitability of the muscles of the shoulder girdle and upper limb on the side of the operation after radical surgical treatment of breast cancer.
 MATERIAL AND METODS: A randomized, placebo-controlled study was conducted in 100 patients in the early postoperative period (24 days after surgery) for breast cancer. All patients underwent medical rehabilitation: individual physiotherapy exercises, balance therapy, sessions with a medical psychologist, physiotherapy treatment with a monofactor. The main group included 34 patients who included an extended method of fluctuorization in the course of medical rehabilitation and additionally underwent fluctuorization of the muscles of the forearm, group 2 (comparisons, n=33) the extended method of local magnetotherapy was included in the rehabilitation program and group 3 (comparisons, n=33) in addition to rehabilitation, general magnetic therapy procedures were performed. Patients underwent a study of the excitability of the neuromuscular system on the apparatus of stimulation and electrotherapy ASEtM-01/6 "Elesculap Med TeKo".
 RESULTS: It was found that fluctuating currents turned out to be more effective in the early stages, which pathogenetically contribute to the restoration of conduction along the peripheral nerves and the activation and contractility of the muscle fiber. A delayed effect of local and general magnetic therapy on improving the contractility of the muscles of the upper limb and the conductivity of the peripheral nerve fiber was noted.
 CONCLUSION: The inclusion of monophysical factors in the course of standard medical treatment, a course of physical therapy, exercises on a stabiloplatform and individual psychotherapy in the early stages (on days 24) after surgery contributed to the improvement in the functioning of the upper limb and the restoration of the electrical excitability of the muscles and nerves of the operated limb.

47 (PB-047) Poster - Analysis of factors with impact on duration of hospitalisation for patients operated for breast cancer during COVID 19 pandemic

Background: Short-stay hospitalization of the patient in units for breast cancer surgery is recognized as a measure of quality of organization and work, certainly without compromising the quality of treatment. The aims of this paper is to point out the factors that influenced the duration of hospitalization during the Covid 19 pandemic and to show the results in the surgical treatment of breast cancer during the Covid 19 pandemic achieved in an general hospital.

Correlation of Cytokine Content in the Lymph with the Morphological Parameters of the Mesenteric Lymph Nodes in Adjuvant Therapy of Experimental Breast Cancer with the Use of Fragmented Human DNA.

We studied the relationship between the level of cytokines in the lymph of the thoracic duct and the morphometric parameters of the mesenteric lymph nodes after surgical treatment of breast cancer, chemotherapy, and administration of fragmented (double-stranded, dsDNA) human DNA. In comparison with surgical treatment and with chemotherapy alone, administration of a human dsDNA has a stimulating effect on the T-cell link of the immune response. In the paracortical zone, the relationship between the chemokine MCP-1 and increased content of small lymphocytes in this zone was revealed. Interrelations of IL-2 cytokines with small lymphocytes and of IL-4 with medium lymphocytes were revealed in germinal centers. We also observed interrelations of IL-7 with small lymphocytes and IL-4 with macrophages in the medullary cords, chemokine MIP-1α with immature and mature plasma cells (the number of these cells is reduced), and of MCP-1 with immunoblasts (the number of which is also reduced) in the medullary sinuses.

38 (PB-038) Poster - Breast cancer axillary dissection a “lost procedure, sometimes still necessary…” how to prevent the lost of a surgical technique using cadaver body and Simlife

Background: Sentinel lymphonodal biopsy (SLB) is nowadays regarded has a standard procedure in breast cancer surgical treatment. Moreover some authors are investigating the option to omit SLB in tumor less than two cm. On the other hand axillary dissection has become a “rare” indication for breast cancer surgery, thus decreasing surgeon performance and the possibility of learning this procedure among young surgeons. To utilize cadaver body for learning is a valuable tool for surgery competence acquisition. Sim- life is a patented device helping cadaver body utilization for learning process. Material and methods: We analyze the ideal steps to learn axillary dissection, for young breast cancer surgeon throughout an individual experience of a trainee. The doctor attended the fourth year specialization school in Gynecology, with a dedicated time (8 months) at the breast cancer treatment at the University of Turin (Breast cancer Unit around 1000 cases per yr). The learning process developed throughout five steps for eight months duration: the first at the master of senology helping teacher in preparing anatomical lesson. The second as assistant in 20 surgical breast cancer procedures. The third as first operator in 20 breast cancer surgical procedures including SLB and starting with treating the axilla (axillary dissection) in a gradual manner. The fourth phase included a cadaver-lab course at University center of Poitier together with the senior tutor for two days, utilizing Sim- life patented device (revitalized cadaver system) and performing 4 complete axillary dissections (both sides per cadaver). In the fifth step the trainee performed two axillary dissections on patients under senior tutor assistance. The trainee had to fill a form developed to describe time of different surgical procedures, surgical difficulties and competences acquisition. Results: Both timing criteria and surgical items increases during the training period of 8 months with a decrease in time performing SLB of 50% (p = 0.005) and increase of more than 80% (p = 0.04) in competence acquisition in identifying anatomical structures during axillary dissection procedure in a statistically significant manner. Trainee self- confidence was also increased together with satisfaction even from a psychological point of view (data registered with a questionnaire). Conclusions: Programmed learning/tutoring process through pre-defined steps, in association with cadaver-lab, Sim-life device and hands-on practice improve surgical competences acquisition permitting practice also surgery that nowadays remains necessary, even though more rarely than in the past according to clinical indications, such as axillary dissection. No conflict of interest.

66 (PB-066) Poster - Healthcare providers’ perceptions of the surgical treatment for male breast cancer: Time to add surgical options other than mastectomy to the discussion

Background: The most common surgical treatment offered to male breast cancer (MBC) patients remains mastectomy. One possible explanation is healthcare providers’ perceptions of men’s experience and needs, and their limited knowledge of the surgery’s effect on men. This study explores healthcare providers’ perceptions of the surgical management of MBC, its effects on men, and the extent to which these are considered in medical decision-making.

Effect of manual lymphatic drainage on upper limb lymphedema after surgery for breast cancer

Evaluation of the effect of manual lymphatic drainage on lymphedema of the upper limb after previous axillary lymphadenectomy/sentinel node bio-psy during the maintenance phase of lymphedema after the breast cancer surgery. A total of 30 patients after surgical treatment of unilateral breast cancer underwent 10 manual lymphatic drainages within 8 consecutive weeks. All patients underwent upper limb circumference measurements before and after the study and completed two specialized EORTC questionnaires (QLQ-C30 and QLQ-BR23). The average time between surgery and admission into this study was 32.5 months. In the beginning of the study, lymphedema was present for an average of 19.8 months. At the end of a series of manual lymphatic drainages, the average volume decrease of the limb with lymphedema was 3% (1.5-5.6%). In contrary, the average loss of volume on the healthy (control) upper limb was only 0.4%. The average reduction of lymphedema volume after therapy achieved 57% (37-88%). After a series of manual lymphatic drainages, the results of the EORTC QLQ-C30 questionnaire showed a statistically significant improvement in physical and role functions, fatigue, nausea and vomiting, pain, dyspnea and constipation, while the results of the EORTC QLQ-BR23 questionnaire showed a statistically significant improvement in the arm and breast symptoms. There was no statistically significant deterioration in any of the monitored parameters. The results of the study showed a positive effect of manual lymphatic drainage on the maintenance phase of lymphedema in patients after breast cancer surgery. The questionnaires showed a significant improvement in hand and arm symptoms as well as an improvement of the other functions and symptoms affecting quality of life. Further studies should be performed on groups of patients with the maintenance phase of upper limb lymphedema to confirm or disprove our results.

Statewide Examination of Access to Cancer Surgery During the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic caused interruptions in the delivery of medical care across a wide range of conditions including cancer. Trends in surgical treatment for cancer during the pandemic have not been well described. We sought to characterize associations between the pandemic and access to surgical treatment for breast, colorectal, and lung cancer in Illinois. MethodsWe performed a retrospective cohort study evaluating inpatient admissions at Illinois hospitals providing surgical care for lung cancer (n = 1913 cases, n = 64 hospitals), breast cancer (n = 910 cases, n = 108 hospitals), and colorectal cancer (n = 5339 cases, n = 144 hospitals). Using discharge data from the Illinois Health and Hospital Association's Comparative Health Care and Hospital Data Reporting Services database, average monthly surgical case volumes were compared from 2019 to 2020. We also compared rates of cancer surgery for each cancer type, by patient characteristics, and hospital type across the three time periods using Pearson chi-squared and ANOVA testing as appropriate. Three discrete time periods were considered: prepandemic (7-12/2019), primary pandemic (4-6/2020), and pandemic recovery (7-12/2020). Hospital characteristics evaluated included hospital type (academic, community, safety net), COVID-19 burden, and baseline cancer surgery volume. ResultsThere were 2096 fewer operations performed for breast, colorectal, and lung cancer in 2020 than 2019 in Illinois, with the greatest reductions in cancer surgery volume occurring at the onset of the pandemic in April (colorectal, −48.3%; lung, −13.1%) and May (breast, −45.2%) of 2020. During the pandemic, breast (−14.6%) and colorectal (−13.8%) cancer surgery experienced reductions in volume whereas lung cancer operations were more common (+26.4%) compared to 2019. There were no significant differences noted in gender, race, ethnicity, or insurance status among patients receiving oncologic surgery during the primary pandemic or pandemic recovery periods. Academic hospitals, hospitals with larger numbers of COVID-19 admissions, and those with greater baseline cancer surgery volumes were associated with the greatest reduction in cancer surgery during the primary pandemic period (all cancer types, P < 0.01). During the recovery period, hospitals with greater baseline breast and lung cancer surgery volumes remained at reduced surgery volumes compared to their counterparts (P < 0.01). ConclusionsThe COVID-19 pandemic was associated with significant reductions in breast and colorectal cancer operations in Illinois, while lung cancer operations remained relatively consistent. Overall, there was a net reduction in cancer surgery that was not made up during the recovery period. Academic hospitals, those caring for more COVID-19 patients, and those with greater baseline surgery volumes were most vulnerable to reduced surgery rates during peaks of the pandemic and to delays in addressing the backlog of cases.

The Association between Breast Cancer Related Lymphedema and Area Deprivation Index.

Lymphedema affects up to 34% of patients after breast cancer treatment but remains underdiagnosed and undertreated. Here, we use area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, to determine how socioeconomic status may affect risk for and diagnosis of breast cancer-related lymphedema. Records of patients who underwent surgical treatment of breast cancer between 2017-2020 were examined. Patients' nine-digit ZIP codes were utilized to determine their deprivation level as a national ADI percentile, and those fitting into the most and least deprived quartiles were compared with evaluate lymphedema risk factors and incidence. A total of 1,333 breast cancer patients were included, 812 (61%) of whom resided within the most disadvantaged ADI quartile nationally, and 521 within the least disadvantaged quartile. The most deprived group had higher rates of diabetes, obesity, and regional breast cancer, and received more extensive surgeries (7.5% modified radical mastectomy vs 1.9%, p < 0.001) and chemotherapy compared with the least disadvantaged quartile. The most disadvantaged cohort were more often at extreme risk of lymphedema utilizing the Risk Assessment Tool Evaluating Lymphedema Risk (9.1% versus 2.5%, p < 0.001); however, the incidence of lymphedema diagnoses was not significantly higher (13% vs 12%, p > 0.9). Logistic regression showed that the most deprived ADI quartile had 44% lower odds of a lymphedema diagnosis in comparison to the least deprived quartile. Residing in more socioeconomically disadvantaged neighborhoods is associated with lower odds of a lymphedema diagnosis, despite higher rates of risk factors for lymphedema, suggesting significant underdiagnosis in this population.

Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer

BackgroundIn the surgical treatment of breast cancer, the goal of surgeons is to continually create and improve minimally invasive surgical techniques to increase patients’ quality of life. Currently, routine breast-conserving surgery is often performed using two obvious incisions. Here, we compare the clinical efficacy and aesthetic outcomes of a novel technique using one incision, called ‘single-port insufflation endoscopic breast-conserving surgery’ (SIE-BCS), vs. conventional breast-conserving surgery (C-BCS) in patients with early-stage breast cancer.MethodsA total of 180 patients with stage I or stage II breast cancer participated in this study, of whom 63 underwent SIE-BCS and 117 underwent C-BCS. Logistic regression analysis was conducted to assess the risk of local recurrence and metastasis. Aesthetic outcomes were evaluated using the BREAST-Q scale.ResultsThe mean operation time was significantly longer for SIE-BCS (194.9 ± 71.5 min) than for C-BCS (140.3 ± 56.9 min), but the mean incision length was significantly shorter for SIE-BCS than for C-BCS (3.4 ± 1.2 cm vs. 8.6 ± 2.3 cm). While both surgeries yielded similar BREAST-Q ratings for satisfaction with breasts and sexual well-being, SIE-BCS was associated with significantly better ratings for physical well-being (chest area) and psychological well-being. Additionally, SIE-BCS was associated with decreased rates of adverse effects of radiation. The preliminary analysis showed that SIE-BCS did not increase the risk of local recurrence or metastasis.ConclusionThe novel single-port insufflation endoscopic assisted BCS technique is feasible, safe, and improves patients’ postoperative comfort and psychological well-being, as compared to the conventional technique.

The State of Breast Cancer Reconstruction in Virginia: An Evidence-Based Framework for Identifying Locoregional Health Disparities.

Age, race, socioeconomic status, and proximity to plastic surgeons have been shown to impact receipt of reconstruction after mastectomy in several national studies. Given that targeted outreach efforts and programs to address these discrepancies would occur locoregionally, investigation of these reconstructive trends on a state level is warranted. Patients diagnosed with breast cancer in Virginia between 2000 and 2018 were identified in the Virginia Department of Health Cancer Registry. Patients who underwent mastectomy breast conservation surgery, and/or breast reconstruction at the time of oncologic surgery were identified. Patient demographics were analyzed, and logistic regression analyses were used to determine the likelihood of receipt of mastectomy, receipt of mastectomy versus breast conservation surgery, receipt of mastectomy with reconstruction versus mastectomy alone, and receipt of mastectomy with reconstruction versus breast conservation surgery with respect to the demographic variables. Geographically weighted regression analyses were also performed to determine impact of geographic location on receipt of mastectomy and reconstruction after mastectomy. A total of 78,682 patients in Virginia underwent surgical treatment for breast cancer between 2000 and 2018. Living outside a metropolitan area, increased age, lower socioeconomic status, non-White race, and lower number of plastic surgeons within 50 miles were associated with decreased rates of postmastectomy reconstruction. Rural setting, lower socioeconomic status, and lower plastic surgeon supply were also associated with decreased rates of breast conservation surgery. Reconstruction after mastectomy was lowest in the northwest, central, and southwest regions of Virginia. Within the state of Virginia, programs to improve access to breast reconstruction for patients residing in rural regions, as well as non-White patients, older patients, and those in lower socioeconomic groups should be implemented. Future studies would implement and study the efficacy of such outreach programs, which could then be applied and tailored to other states or regions to address sociodemographic disparities in access to breast reconstruction.

Estimation of Neural Tissue Mobility in Breast Cancer Survivors with Lymphedema.

Lymphedema in breast cancer survivors is a very common condition which progressively may lead to entrapment neuropathy. In lymphedema there is accumulation of fluid due to removal of lymph nodes which causes stretching of nerve fibres within the skin, compression on top of the nerve bundle leading to nerve entrapment. This will increase the neural mechanosensitivity and functional impairment of shoulder as a protective neural response to movement or traction. This study was carried out by assessing the total 72 breast cancer survivor women, with lymphedema. Out of 72, 28 of women underwent lumpectomy, 12 underwent quadrantectomy and 32 underwent unilateral mastectomy. These subjects were assessed for neural tissue mobility by taking pain assessment using visual analogue scale (VAS), range of motion (ROM) using goniometer, lymphedema measurement using an inch tape. The neural tissue mobility for median nerve, ulnar nerve and radial nerve was measured using limb tension test. The result obtained from this study showed that neural tissue mobility was significantly impaired in breast cancer survivors with lymphedema. The result of the upper limb tension tests showed 32 women with mild lymphedema had median nerve affected on the involved side 54.1%, about 21 women had moderate lymphedema with 75% of women had median and 25% ulnar nerve affected with median nerve affected in majority of women. Only 19 women with severe lymphedema had all the three nerves affected. This study of women who have undergone surgical intervention for breast cancer concludes that there was significant amount of neural tissue impairment noted to mechanical provocation test post operatively after 6 months of surgery. The study suggests that severity of lymphedema was directly related to the nerves affected due to neural tissue impairment.

The role of tumor phenotype in the surgical treatment of early-stage breast cancer

BackgroundWe investigated whether tumor phenotype influences surgical decision-making, and how that may impact overall survival (OS) for early-stage breast cancer. MethodsWomen aged 18–69 with cT0-2/cN0/cM0 breast cancer in the National Cancer Database (2010–2017) were included. A generalized logistic model was used to identify factors associated with surgery type. A Kaplan-Meier curve was used to visualize unadjusted OS, and the log-rank test was used to test for differences in OS between surgery types. ResultsOf 597,149 patients, 58% underwent lumpectomy with radiation (BCT), 25% unilateral mastectomy (UM), and 17% bilateral mastectomy (BM). After adjustment, HER2+ and triple-negative (TN) tumors were less likely to undergo UM than BCT, versus hormone receptor-positive tumors (OR = 0.881, 95% CI = 0.860–0.903; OR = 0.485, 95% CI = 0.470–0.501). UM and BM had worse 5-year OS versus BCT (UM: 0.926, vs BM: 0.952, vs BCT: 0.960). ConclusionsBCT is increasingly used to treat HER2+ and TN tumors. More extensive surgery is not associated with better survival outcomes, regardless of tumor phenotype.

Breast Tissue Restoration after the Partial Mastectomy Using Polycaprolactone Scaffold.

As breast conserving surgery increases in the surgical treatment of breast cancer, partial mastectomy is also increasing. Polycaprolactone (PCL) is a polymer that is used as an artifact in various parts of the human body based on the biocompatibility and mechanical properties of PCL. Here, we hypothesized that a PCL scaffold can be utilized for the restoration of breast tissue after a partial mastectomy. To demonstrate the hypothesis, a PCL scaffold was fabricated by 3D printing and three types of spherical PCL scaffold including PCL scaffold, PCL scaffold with collagen, and the PCL scaffold with breast tissue fragment were implanted in the rat breast defect model. After 6 months of implantation, the restoration of breast tissue was observed in the PCL scaffold and the expression of collagen in the PCL scaffold with collagen was seen. The expression of TNF-α was significantly increased in the PCL scaffold, but the expression of IL-6 showed no significant difference in all groups. Through this, it showed the possibility of using it as a method to conveniently repair tissue defects after partial mastectomy of the human body.

Evolution of surgical treatment for breast cancer

Breast cancer holds the leading position among womens cancer. Nowadays extensive experience has been acquired in surgical treatment of this disease. However, a significant proportion of young and middle-aged patients, the expansion of adjuvant therapy capabilities and the effectiveness of integrated treatment dictate a need to pay more attention to the aestheticity of surgical interventions. The review analyzes the results of the modern studies on the effectiveness and aestheticity of the most common types of surgical treatment of breast cancer; the evolutionary trends in oncosurgery are presented.

The experience of preoperative treatment with anthracyclines in patients with luminal-type B locally advanced breast cancer

Aim. To determine the effectiveness of preoperative treatment of luminal-type B locally advanced breast cancer in patients with the use of Doxorubicin + Cyclophosphamide chemotherapy regimen. Materials and methods. Thirty patients with luminal-type B locally advanced breast cancer who underwent chemotherapy with Doxorubicin 60 mg/m2 + Cyclophosphamide 600 mg/m2 regimen were examined at the medical center LLC “ONCOLIFE” from 2019 to 2020. Results of chemotherapy were assessed by CT scan examination and RECIST1.1 system with further surgical treatment of breast cancer. The results of pathomorphological response to treatment of tumor were assessed by the Miller–Payne system. Results. Before the surgery, clinical complete response to chemotherapy was achieved in 9 (30.0 %) patients, and complete pathomorphological response to the treatment of tumor was achieved in 7 (21.0 %) patients out of 30. Clinically, the minimal response to treatment (stabilization of the disease) was revealed in 4 (13.4 %) patients, minimal pathomorphological response – in 9 (32.4 %) patients. Conclusions. The method of selecting a chemotherapeutic regimen based on chemoresistance factor data could potentially improve the effectiveness of preoperative therapy and survival in the future that requires more detailed study.

Impact of Medicaid Expansion Under the Affordable Care Act on Receipt of Surgery for Breast Cancer.

Objective:To determine whether Medicaid expansion under the 2010 Affordable Care Act affected rates of breast cancer surgery.Background:Data regarding the impact of Medicaid expansion on access to surgical treatment of breast cancer are limited.Methods:Patients in the National Cancer Database diagnosed with non-metastatic breast cancer between January 1, 2010 and December 31, 2017 and residing in a state that expanded Medicaid in January 2014 or in a state that opted out of expansion were included. A quasi-experimental, difference-in-differences (DID) approach was used to assess rate of omission of surgical treatment.Results:Of 624,237 patients diagnosed with invasive breast cancer, 24,728 (4%) patients did not undergo surgical treatment. Overall, no significant differences in rates of omission of surgery over time were seen based on Medicaid expansion status. Significant findings were noted based on patient residential location. In rural areas, Medicaid expansion was associated with lower rates of omission of surgery (adjusted DID −2.47%, 95% confidence interval [CI] −4.01% to −0.94%; P = 0.002). In urban area, rates of omission of surgery increased over time for both groups, but the relative increase was lower in expansion states (adjusted DID −0.72%, 95% CI −1.25% to −0.20%; P = 0.007). In metro areas, changes in rates of surgery over time were comparable across expansion and non-expansion states (adjusted DID −0.08%, 95% CI −0.32% to 0.16%; P = 0.512).Conclusions:Medicaid expansion had no measurable effect on the receipt of surgery for breast cancer in the overall cohort. Medicaid expansion was associated with higher rates of surgery in rural areas, representing the minority of the population.

Reduction of Arm Lymphedema Using Manual Lymphatic Therapy (Godoy Method).

Background: The manual lymphatic drainage (MLD) technique used during the early stages following surgical treatment of breast cancer can help prevent the progression of clinical lymphedema.Objective: The objective of this study was to evaluate the effectiveness of manual lymphatic therapy (MLT) (Godoy method) in reducing the development of lymphedema immediately after breast cancer treatment.Method: A randomized, blind, crossover, clinical trial was conducted involving 66 women with breast cancer-related lymphedema (BCRL), who underwent one hour of manual physical therapy and one hour of the control procedure. To evaluate the volume before and after the application of the MLT technique, volumetry, a water displacement technique was used. For statistical analysis, the paired t-test with 5% alpha error by Stats Direct 3(StatsDirect Ltd, Wirral, UK) was used.Results: A significant reduction in the volume of the limb was found in all patients (p-value = 0.0001, paired t-test).Conclusion: MLT is effective in reducing lymphedema after breast cancer treatment.

General magnetic therapy and electrostatic field after radical surgical treatment of breast cancer at the 1st stage of medical rehabilitation

BACKGROUND: Various methods of physical therapy have been proposed for the rehabilitation of patients with breast cancer. However, a staged approach to prescribing physiotherapeutic factors in the early period after surgical treatment of breast cancer has not been developed enough.&#x0D; AIMS: to develop a staged approach to the appointment of physiotherapeutic factors at different times after surgical treatment of breast cancer.&#x0D; MATERIALS AND METHODS: Examination and treatment of 64 patients aged 30 to 70 years after surgical treatment for breast cancer were carried out. All patients underwent medical rehabilitation: individual exercise therapy, balanstherapy, sessions with a medical psychologist, course exposure to an alternating low-frequency electrostatic field and general magnetotherapy. The main group consisted of 33 patients who underwent a 2-stage course of medical rehabilitation: the 1st course on days 24 after the operation and the 2nd course after 11.5 months against the background of adjuvant radiation therapy. The control group 31 women, underwent physiotherapy placebo procedures.&#x0D; RESULTS: I was found that two-stage physical rehabilitation improves the quality of life, reduces swelling, increases the range of motion, decreases pain, decreases the number of postoperative complications, and shortens the duration of lymphorrhea.&#x0D; CONCLUSION: The inclusion of exposure to an alternating low-frequency electrostatic field and general magnetotherapy in the early stages (24 days) and 11.5 months after surgical treatment has broad functionality and allows you to obtain a pronounced functional and stable clinical result.

Prognostic Significance of Fibrotic Focus and Tumor Infiltrating Lymphocytes in Breast Cancer According to Molecular Subtypes

Purpose: This study aimed to analyze the association between fibrotic focus (FF) and tumor-infiltrating lymphocytes (TILs) and to determine the prognostic significance of FF and TILs in the breast according to its molecular subtypes.Methods: The study included patients who underwent surgical treatment for breast cancer, for whom tissue samples were available. FF within the tumor and TILs in breast cancer tissues were evaluated. Clinicopathological characteristics were reviewed from medical records.Results: FF and TILs were present in 31.3% and 81.7% of the patients, respectively. FF and TILs showed a positive correlation. FF were significantly associated with tumor size, lymphovascular invasion, regional lymph node metastasis, and tumor stage. TILs were significantly associated with menopausal status, histologic grade, tubule formation, nuclear grade, mitosis, human epidermal growth factor receptor 2 (HER2) overexpression, molecular subtype of breast cancer, and the number of cluster of differentiation 8+ T cells. In TIL-positive cases, FF were significantly associated with tumor size, regional lymph node metastasis, extranodal extension, lymphovascular invasion, tumor stage, recurrence-free survival, and overall survival (OS). Based on HER2 overexpression status, TILs were significantly associated with tumor size, tumor necrosis, histologic grade, estrogen receptor status, and epidermal growth factor receptor expression in HER2-negative breast cancer. Further, in HER2-negative breast cancer, OS and recurrence-free survival were significantly associated with FF. The OS of FF-positive patients was significantly shorter than that of FF-negative patients.Conclusion: Our study showed an association between FF and TIL levels in breast cancer, indicating that FF are associated with poor prognostic factors for breast cancer and poor OS, and that TILs are associated with HER2 overexpression. However, further studies are needed to elucidate the interactions between FF and TILs in breast cancer.

Reconstructive-plastic surgery within the framework in surgical treatment of breast cancer

Breast cancer is a leader in the structure of oncological pathology of the female reproductive system worldwide. The treatment of this disease is often associated with radical surgery, which inevitably affects the patients' subsequent quality of life. For this reason, it is necessary to practice client-centered approach in choosing the tactics of such patients' management. Surgical methods play a leading role in the treatment of breast cancer, while corrective plastic operations are currently of great importance. The article presents the clinical experience of performing oncoplastic operations for breast cancer. Cases of surgical treatment at various localizations of the oncological process, including performing one-stage reconstructions, have been demonstrated. The author proposes his own reconstruction technique for the superior medial localization of breast cancer. The experience of dealing with such a complication arising after radical mastectomy as lymphorrhea is shown.