The article is devoted to the actual topic of breast reconstruction with autologous tissues. The article discusses the key stages in the development of breast reconstructive surgery using free flaps using microsurgical techniques. A flap of the anterior abdominal wall, among other techniques, is the method of choice for breast reconstruction today, also because it allows you to achieve the most "natural" result. The authors compares different variants of autologous flaps, describes the advantages of the DIEP flap in comparison with the TRAM flap. Also, special attention is paid to the choice of breast reconstruction method depending on age, constitutional characteristics and the presence of risk factors such as smoking, diabetes mellitus and excess BMI. Analyzing the advantages of breast reconstruction with autograft flaps, the author concludes that there is a higher quality of life and improved outcomes in these patients than in patients who underwent implant-based reconstruction. Based on the literature review, it was found that breast reconstruction with the help of perforating flaps is still an area of innovation and constant progress: research in this area to date is mainly aimed at reducing the morbidity of the donor area and methods for isolating recipient vessels, shortening the rehabilitation period and developing reproducible reconstruction method.

Breast reconstruction after complex oncological treatment is an urgent issue due to the high incidence of breast cancer. Aim. To analyze the effect of postoperative radiotherapy on the incidence of fat necrosis in single-stage autologous breast reconstruction with a DIEP flap and to evaluate the number of complications in groups with and without postoperative radiotherapy, as well as to determine the risk factors for complications. Materials and methods. The medical records of 34 breast cancer patients who underwent one-stage breast reconstruction using a DIEP flap after skin-sparing/subcutaneous mastectomy with and without subsequent radiation therapy were retrospectively studied. The frequency of complications in groups with and without postoperative radiation therapy was assessed. Results. Complications developed in 22 (64.7%) patients out of 34. Mild complications developed in 6 (17.6%) patients (divergence of the edges of the postoperative wound of the anterior abdominal wall). Complications of moderate severity developed in 12 (35.3%) patients. Severe complications developed in 4 (11.8%) patients. Out of 22 patients, 6 (17.4%) patients developed areas of fat necrosis after remote radiation therapy in the delayed period, 4 (11.8%) patients, without ESWL, also developed fat necrosis of a part of the flap (areas up to 5 cm). Excision of the area of fat necrosis of the flap was performed in 2 (5.9%) cases under local anesthesia, the rest of the areas of fat necrosis were not excised. The percentage of complications was higher in the group of patients with obesity (20.6%), which indicates that obesity is a risk factor for the development of intraoperative and postoperative complications in patients with simultaneous breast reconstruction with a DIEP flap. Conclusion. During radiotherapy after breast reconstruction with a DIEP flap, the incidence of fat necrosis of the flap was higher. Obesity is a risk of intraoperative and postoperative complications in patients with simultaneous increased breast reconstruction with a DIEP flap, since the incidence of complications was in the group of patients with obesity.

Reconstructive surgeries have long been considered as an essential part of rehabilitation of breast cancer patients. The majority of patients tend to choose one-stage reconstruction, because this type of surgery ensures rapid emotional and physical recovery. Due to the lack of subcutaneous fat in a substantial proportion of cases, which leads to postoperative complications, the most common surgical tactics now is simultaneous reconstruction after subcutaneous mastectomy with subpectoral implant location and strengthening of the lower breast slope using different materials. So far, there has been no gold standard material for secure covering of the lower pole of the implant. Autologous acellular dura mater grafts are a promising material for breast reconstruction. Studies evaluating biointegration, compatibility, inertness, reactivity, and cost effectiveness of autologous acellular dura mater grafts have determined feasibility of using these grafts in reconstructive surgeries.

Background. Simultaneous breast reconstruction after subcutaneous or skin-sparing mastectomy using silicone implants is associated with a high risk of postoperative complications. Therefore, the issue of additional shell cover for breast implants is highly relevant. Synthetic and biological implants are believed to be the most effective.Aim. To assess the efficacy and safety of autologous dura mater grafts in reconstructive surgeries for breast cancer patients.Materials and methods. This study included 164 patients who had undergone subcutaneous or skin-sparing mastectomy with simultaneous breast reconstruction using implants and additional shell cover with either autologous dura mater grafts (experimental group, n = 83) or synthetic mesh implants (control group, n = 81) between 2017 and 2022. The mean patients’ age was 41.4 ± 7.2 years (41.2 ± 7.1 years in the experimental group and 41.6 ± 7.2 years in the control group). The mean follow-up time was 38.0 ± 21.4 months (min: 12 months; max: 80 months).Results. The 3-year relapse-free survival rate was 100 %. The 3-year progression-free survival was 97.4 % (95 % confidence interval 92.6–100.0 %). We observed no significant differences in the time to disease progression between the experimental and control group (p = 0.573). The assessment of aesthetic outcomes using a special surgical questionnaire showed excellent cosmetic and psycho-emotional results. Patients in both groups demonstrated comparable cosmetic results (p 0.05); however, psychoemotional satisfaction with surgery results was higher in the experimental group (p0.05). Postoperative complications (primarily capsule contracture) were registered in 18 patients from the experimental group (21.7 %) and 31 patients from the control group (38.3 %) (p0.05). We also calculated the incidence rate ratio (IRR) and found that the difference was due to different follow-up time. Clinically significant capsule contracture was observed in 9 patients from the experimental group (10.8 %). The incidence of capsule contracture was higher among patients who had radiation therapy than in those who had no radiation therapy (15.8 % and 0.0 %, respectively; p0.05).Conclusion. Subcutaneous or skin-sparing mastectomy with simultaneous breast reconstruction using silicone implants and autologous dura mater grafts is a safe and effective surgical method for breast cancer patients. The analysis of the international Breast-Q questionnaire results and surgical questionnaire results demonstrated that all patients had a high quality of life after simultaneous breast reconstruction using an autologous dura mater graft.

ЦЕЛЬ ИССЛЕДОВАНИЯ Определить факторы неблагоприятного прогноза и бессобытийную выживаемость у больных первично-операбельным раком молочной железы (РМЖ) после одномоментной реконструкции. МАТЕРИАЛ И МЕТОДЫ В работе проанализированы данные 203 больных РМЖ, которым была выполнена кожесохранная/подкожная мастэктомия (КМЭ/ПМЭ) с одномоментной реконструкцией силиконовым эндопротезом в рамках комбинированного или комплексного лечения в период с января 2008 г. по март 2018 г. Средний возраст больных на момент операции составил 45,08±0,65 года (диапазон 18—75 лет). Медиана наблюдения 51 мес (95% ДИ от 49 до 53 мес), средняя длительность наблюдения 60,3±1,9 мес. ПМЭ с одномоментной реконструкцией силиконовым эндопротезом была выполнена у 71,4% больных. РЕЗУЛЬТАТЫ Кумулятивная безрецидивная выживаемость в течение 3 и 5 лет составила 100%, 10 лет — 92,6% (95% ДИ: 81,9—100%). Среднее время до прогрессирования 30,9 мес. Выживаемость без отдаленного метастазирования в течение 3 лет была 97% (95% ДИ: 94,7—99,4%), 10 лет — 91,6% (95% ДИ: 86,7—96,6%). В общей группе больных 10-летняя опухолеспецифическая выживаемость составила 99,3% Наличие лимфоваскулярной инвазии (p=0,048) и метастатического поражения регионарных лимфатических узлов (p=0,008) связано с ухудшением бессобытийной выживаемости. ЗАКЛЮЧЕНИЕ Выполнение КМЭ/ПМЭ с одномоментной реконструкцией силиконовым эндопротезом является безопасным хирургическим методом у больных РМЖ. Риск развития локальных рецидивов и прогрессирования остается высоким в течение 5 ближайших лет после лечения и стабильным в течение следующих 10 лет.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучение влияния полного патоморфологического ответа опухоли (pCR) после неоадъювантной полихимиотерапии (НАПХТ) у больных раком молочной железы (РМЖ) на 3-, 5-летнюю безрецидивную и общую выживаемость. МАТЕРИАЛ И МЕТОДЫ С 2013 по 2020 г. проанализирована медицинская документация 200 больных РМЖ II—III стадии (исключена IIIB стадия), которым на втором этапе комплексного лечения выполнены органосохраняющие операции и радикальные мастэктомии после НАПХТ в отделении ОРПХ молочной железы и кожи МНИОИ им. П.А. Герцена. Распределение по стадиям РМЖ было следующим: I стадия диагностирована у 5 больных (2,5%), II стадия — у 113 (56,5%), III стадия — у 82 (41%) (исключена IIIB стадия). РЕЗУЛЬТАТЫ Полный патоморфологический ответ (pCR) был достигнут у 37 (18,5%) больных, частичный (pPR) — у 163 (81,5%). Полный патоморфологический ответ наиболее часто был достигнут при инвазивном неспецифическом РМЖ (90,5%). Из 37 больных в 37,5% случаев pCR достигнут при тройном негативном типе, в 30% при Her2/neu-позитивном, в 17,5% при люминальном B, Her2/neu-позитивном, в 15% при люминальном B, Her2/neu-негативном типах. Полный патоморфологический ответ достигнут при низкодифференцированном РМЖ (G3) в 57,5% случаев, при умеренно-дифференцированном (G2) в 42,5%. 5-летняя безрецидивная и общая выживаемость составила 100%. У 1 больной отмечено прогрессирование заболевания в виде метастазирования в легкие спустя 22 месяцев после хирургического лечения. ЗАКЛЮЧЕНИЕ На основании проведенного исследования установлена корреляционная зависимость между степенью патоморфологического ответа опухоли у больных РМЖ после НАПХТ и показателями 3-, 5-летней безрецидивной и общей выживаемостью. Прогностическая ценность полного патоморфологического ответа (pCR) находится в прямой зависимости от ИГХ-типа рака молочной железы, который чаще выявляют при агрессивных морфологических вариантах: her2/neu-позитивном типе у 47,5%, тройном негативном — у 37,5% больных.