Results of Treatment of Patients with Stage I‒Ii Breast Cancer after Subcutaneous/Skin-Preserving Mastectomies with Reconstruction with/without Radiation Therapy
Authors: Rasskazova Е.А. ,   P.A. Hertsen Moscow Oncology Research Institute, Moscow, Russia, Zikiryakhodzhaev A.D. ,   P.A. Hertsen Moscow Oncology Research Institute, Moscow, Russia,   I.M. Sechenov First Moscow State Medical University, Moscow, Russia,   People’s Friendship University of Russia, Moscow, Russia
Published: August 2024

Purpos: To study the oncological results and features of complications in patients with breast cancer in stages I‒II after subcutaneous/skin-preserving mastectomies with reconstruction with/without radiation therapy. Material and methods: From 2013 to 2022, 984 breast cancer patients underwent 1020 subcutaneous/skin-preserving mastectomies with simultaneous one- or two-stage reconstruction at the Herzen Moscow Medical Research Institute. Subcutaneous mastectomy with reconstruction was performed in 617 (60.5 %), skin-preserving mastectomy in 403 (39.5 %) cases. Reconstruction with the patient’s own tissues was performed in 5.7 %, expanders/implants in 94.3 % of patients. Results: The recurrence rate of breast cancer was 41 (4.2±0.6 %), the frequency of distant metastases was diagnosed in 53 (5.4±0.7 %) in the studied group of patients. Complications were diagnosed in 241 (24.5 %) patients. Recurrence in the group with radiation therapy was 2.6±0.6 (OR 0.98, CI 1.52‒3.48, 95 %), without radiation therapy 5.9 % (OR 2.13, CI 0.92‒5.18, 95 %) regardless of the stage of breast cancer (criterion T > 2, p ˂ 0,05). Capsular contracture (CC) of the III‒IV degree was diagnosed in 9.4 % of the analyzed group of patients. Capsular contracture of the III‒IV degree worsens the aesthetic result of breast reconstruction, as well as reduces the quality of life of patients. With simultaneous two–stage reconstruction, the risk of developing CC was 4.2 % (after LT 4.7 %, without LT 3.6 %), with one-stage reconstruction, the risk of developing CC 11.2 % (after LT 15.8 %, without LT 4 %). In the study group of patients, the effect of LT on the risk of CC was 12.6 %, without LT 3.7 % (p < 0.05), the difference is statistically significant. In our study, the recurrence of breast cancer at the edge of R1 was 6.8±2.5 %, at R0 – 3±0.6 % (p > 0.05). When analyzing the age and risk of recurrence, we did not identify an age dependence, before 40 years the probability of recurrence was 4.3±1 %, after 40 years – 3.3±0.7 % (criterion T = 0.44, p > 0.05). A statistically significant difference in our study was revealed, except for radiation therapy, during NAPHT, thus, in the group with NAPHT, the recurrence was 2.4± 0.8 %, without NAPHT – 4.6±0.7 % (criterion T = 2.16, p ˂ 0.05). When performing a simultaneous two-stage reconstruction of a patient with the inclusion of radiation therapy (LT), the risk of skin protrusion was 18 %, without radiation therapy – 8.3 %. Capsular contracture (CC) of the III‒IV degree was diagnosed in 9.4 % of the analyzed group of patients. Capsular contracture of the III‒IV degree worsens the aesthetic result of breast reconstruction, as well as reduces the quality of life of patients. With simultaneous two–stage reconstruction, the risk of developing CC was 4.2 % (after LT 4.7 %, without LT 3.6 %), with one-stage reconstruction, the risk of developing CC 11.2 % (after LT 15.8 %, without LT 4 %). In the study group of patients, the effect of LT on the risk of CC was 12.6 %, without LT 3.7 % (p < 0.05), the difference is statistically significant.