Breast cancer is a common disease affecting millions of women, often at a relatively young age. Every tenth woman in the Uzbekistan develop breast cancer during her lifetime; 2.5 million women survive annually after treatment, and a significant increase in the number of such patients is expected in the coming decades.1 Reconstruction after a mastectomy enables women to alleviate the emotional and aesthetic defect of this severe illness. Successful breast surgery virtually eliminates a postmastectomy psychosocial defect - this is the main disabling factor. Oncoplastic surgery is increasingly performed in Uzbekish women;Uzbekish women usually have normal-big to moderate-sized breasts. To achieve better outcomes in reconstructed breasts, several factors determining the optimal surgical method should be considered. Methods: A total of 135 patients who underwent oncoplastic surgery from September 2015 to November 2019were retrospectively investigated. We used various methods, including glandular tissue reshaping, latissimus dorsi (LD) flap transposition, and reduction oncoplasty to restore the breast volume and symmetry. Results: The mean weight of the tumor specimen was 40.46 g and tumor specimen to breast volume ratio was 0.12 g/cc in the glandular tissue reshaping group (n=59), 101.47 g and 0.14 g/cc in the reduction oncoplasty group (n=17), and 82.54 g and 0.20 g/cc in the LD flap group (n=44). Glandular tissue reshaping was mostly performed in the upper outer quadrant and LD flap transposition in the lower inner quadrant. No major complications were noted. Most patients were satisfied with the aesthetic results. Conclusion: We had satisfactory outcomes of oncoplastic surgeries in Uzbekish patients. The results about specimen weight and tumor to breast ratio of Uzbekistan region patients will be a helpful reference to determine the method of oncoplastic surgery.
1. NIH consensus conference. Treatment of early-stage breast cancer.JAMA. 1991;265(3):391-395. 2. Al-Ghazal SK, Blamey RW. Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast. 1999;8(4):162-168. 3. Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471-481. 4. Serra-Renom JM, Serra-Mestre JM, Martinez L, D'Andrea F. Endoscopic reconstruction of partial mastectomy defects using latissimus dorsi muscle flap without causing scars on the back. Aesthetic Plast Surg. 2013;37(5):941-949. 5. Anderson BO, Masetti R, Silverstein MJ. Oncoplastic approaches to partial mastectomy: an overview of volume-displacement techniques. Lancet Oncol. 2005;6(3):145-157. 6. Losken A, Styblo TM, Carlson GW, Jones GE, Amerson BJ. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg. 2007;59(3):235-242. 7. Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26-34. 8. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-1241. 9. Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group.J ClinOncol. 1996;14(5):1558-1564. 10. Lichter AS, Lippman ME, Danforth DN, Jr., et al. Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. J ClinOncol. 1992;10(6):976-983. 11. Urban C, Lima R, Schunemann E, Spautz C, Rabinovich I, Anselmi K. Oncoplastic principles in breast conserving surgery. Breast. 2011;20Suppl 3:S92-95. 12. Yang JD, Kim MC, Lee JW, et al. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts. Arch Plast Surg.2012;39(5):489-496. 13. Clough KB, Kroll SS, Audretsch W. An approach to the repair of partial mastectomy defects. PlastReconstr Surg. 1999;104(2):409-420. 14. Rainsbury RM. Breast-sparing reconstruction with latissimus dorsiminiflaps. Eur J Surg Oncol. 2002;28(8):891-895.14 15. Munhoz AM, Montag E, Fels KW, et al. Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer. PlastReconstr Surg. 2005;116(3):741-752. 16. Losken A, Schaefer TG, Carlson GW, Jones GE, Styblo TM, Bostwick J, 3rd. Immediate endoscopic latissimus dorsi flap: risk or benefit in reconstructing partial mastectomy defects. Ann Plast Surg. 2004;53(1):1-5. 17. Losken A, Hamdi M. Partial breast reconstruction: current perspectives. PlastReconstr Surg. 2009;124(3):722-736. 18. Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505-1509. 19. Missana MC, Pomel C. Endoscopic latissimus dorsi flap harvesting. Am J Surg. 2007;194(2):164-169. 20. Yang CE, Roh TS, Yun IS, Kim YS, Lew DH. Immediate partial breast reconstruction with endoscopic latissimus dorsi muscle flap harvest. Arch Plast Surg. 2014;41(5):513-519. 21. Daltrey I, Thomson H, Hussien M, Krishna K, Rayter Z, Winters ZE. Randomized clinical trial of the effect of quilting latissimus dorsi flap donor site on seroma formation. Br J Surg. 2006;93(7):825-830. 22. Shin IS, Lee DW, Lew DH. Efficacy of quilting sutures and fibrin sealant together for prevention of seroma in extended latissimus dorsi flap donor sites. Arch Plast Surg. 2012;39(5):509-513. 23. Pogson CJ, Adwani A, Ebbs SR. Seroma following breast cancer surgery. Eur J SurgOncol. 2003;29(9):711-717. 24. Mills JM, Schultz DJ, Solin LJ. Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast. Int J RadiatOncolBiol Phys. 1997;39(3):637-641. 25. Taylor ME, Perez CA, Halverson KJ, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J RadiatOncolBiol Phys. 1995;31(4):753-764. 26. Lee JW, Kim MC, Park HY, Yang JD. Oncoplastic volume replacement techniques according to the excised volume and tumor location in small- to moderate-sized breasts. Gland Surg. 2014;3(1):14-21. 27. Tansini I. Sopra il mio nuovo processo di amputazione della mamella [in Italian]. Riforma Med. 1906;12:757. 28. Maxwell GP. Iginio Tansini and the origin of the latissimus dorsi musculocutaneous flap. Plast Reconstr Surg. 1980;65(5):686-692. 29 Spear SL, Clemens MW. Latissimus dorsi flap breast reconstruction. In: Neligan PC, Grotting JC, Ed. Plastic Surgery. 3rd ed. Philadelphia, PA: Saunders (Elsevier); 2012:370-392. 30. Schneider WJ, Hill HL Jr, Brown RG. Latissimus dorsi myocutaneous flap for breast reconstruction. Br J Plast Surg. 1977;30(4):277-281. 31. Bostwick J III, Vasconez LO, Jurkiewicz MJ. Breast reconstruction after a radical mastectomy. Plast Reconstr Surg. 1978;61(5):682-693. 32. Papp C, McCraw JB. Autogenous latissimus breast reconstruction. Clin Plast Surg. 1998;25(2):261-266. 33. Hokin JA, Silfverskiold KL. Breast reconstruction without an implant: results and complications using an extended latissimus dorsi flap. Plast Reconstr Surg. 1987;79(1):58-66. 34. McCraw JB, Papp C, Edwards A, McMellin A. The autogenous latissimus breast reconstruction. Clin Plast Surg. 1994;21(2):279-288. 35. Hartrampf CR, Scheflan M, Black P. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. 1982;69(2):216-224. 36. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994;32(1):32-38.11. Bartlett SP, May JW Jr, Yaremchuk MJ. The latissimus dorsi muscle: a fresh cadaver study of the primary neurovascular pedicle. Plast Reconstr Surg. 1981;67(5):631-636. 37. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation. Plast Reconstr Surg. 1981;67(2):177-187. 38. Chang DW, Youssef A, Cha S, Reece GP. Autologous breast reconstruction with the extended latissimus dorsi flap. Plast Reconstr Surg. 2002;110(3):751-759. 39. Elliott LF, Ghazi BH, Otterburn DM. The scarless latissimus dorsi flap for full muscle coverage in device-based immediate breast reconstruction: an autologous alternative to acellular dermal matrix. Plast Reconstr Surg. 2011;128(1):71-79. 40. Lee MA, Miteff KG. The scarless latissimus dorsi flap provides effective lower pole prosthetic coverage in breast reconstruction. Plast Reconstr Surg Global Open. 2014;2(5):e147. 41. de Runz A, Boccara D, Bekara F, Chaouat M, Mimoun M. Outcome of 122 delayed breast reconstruction following postmastectomy radiotherapy: the scarless latissimus dorsi flap with tissue expansion technique. Ann Chir Plast Esthet. 2017;62(1): 23-30. 42. Angrigiani C, Grilli D, Siebert J. Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg. 1995;96(7):1608-1614. 43. Schwabegger AH, Harpf C, Rainer C. Muscle-sparing latissimus dorsi myocutaneous flap with maintenance of muscle innervation, function, and aesthetic appearance of the donor site. Plast Reconstr Surg. 2003;111(4):1407-1411. 44. Saint-Cyr M, Nagarkar P, Schaverien M, Dauwe P, Wong C, Rohrich RJ. The pedicled descending branch muscle-sparing latissimus dorsi flap for breast reconstruction. Plast Reconstr Surg. 2009;123(1):13-24. 45. Cook J, Waughtel J, Brooks C, Hardin D, Hwee YK, Barnavon Y. The Muscle-sparing latissimus dorsi flap for breast reconstruction. Ann Plast Surg. 2017;78(5):S263-S268. 46. Hammond DC. Latissimus dorsi flap breast reconstruction. Clin Plast Surg. 2007;34(1):75-82. 47. Menke H, Erkens M, Olbrisch RR. Evolving concepts in breast reconstruction with latissimus dorsi flaps: results and follow-up of 121 consecutive patients. Ann Plast Surg. 2001;47(2):107-114. 48. Bailey SH, Oni G, Guevara R, Wong C, Saint-Cyr M. Latissimus dorsi donor-site morbidity: the combination of quilting and fibrin sealant reduce length of drain placement and seroma rate. Ann Plast Surg. 2012;68(6):555-558. 49. Hart AM, Duggal C, Pinell-White X, Losken A. A prospective randomized trial of the efficacy of fibrin glue, triamcinolone acetonide, and quilting sutures in seroma prevention after latissimus dorsi breast reconstruction. Plast Reconstr Surg. 2017; 139(4):854e-863e. 50. Obrego´n L, Ruiz-Castilla M, Binimelis MM, et al. Laparoscopic repair of non-complicated lumbar hernia secondary to a latissimus dorsi flap. J Plast Reconstr Surg. 2014;67(3):407-410. 51. Fraser SM, Fatayer H, Achuthan R. Lumbar herniation following extended autologous latissimus dorsi breast reconstruction. BMC Surg. 2013;13:16. 52. Smith S. functional morbidity following latissimus dorsi flap breast reconstruction. J Adv Pract Oncol. 2014;5(3):181-187. 53. Glassey N, Perks GB, McCulley SJ. A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction. Plast Reconstr Surg. 2008;122(5): 1334-1340. 54. Garusi C, Manconi A, Lanni G, et al. Shoulder function after breast reconstruction with the latissimus dorsi flap: a prospective cohort study—combining DASH score and objective evaluation. Breast. 2016;27:78-86. 55. Ignazio T, Andrej B, Fischer T. Evaluation of late results in breast reconstruction by latissimus dorsi flap and prosthesis implantation. Plast Reconstr Surg. 2006;117(5):1387-1394. 56. Perdikis G, Koonce S, Collis G, Eck D. Latissimus dorsi myocutaneous flap for breast reconstruction: bad rap or good flap Eplasty. 2011;11:e39. 57. Hardwicke JT, Prinsloo D. An analysis of 277 consecutive latissimus dorsi breast reconstructions: a focus on capsular contracture. Plast Reconstr Surg. 2011;128(1):63-70. 58. DeLong MR, Tandon VJ, Rudkin GH, Da Lio AL. Latissimus dorsi flap breast reconstruction—a Nationwide Inpatient Samples review. Ann Plast Surg. 2017;78(5 suppl 4):S185-S188. 59. Teisch LF, Gerth DJ, Tashiro J, Golpanian S, Thaller SR. Latis- simus dorsi flap versus pedicled transverse rectus abdominis myocutaneous breast reconstruction: outcomes. J Surg Res. 2015; 199(1):274-279. 60. Lindegren A, Halle M, Docherty Skogh AC. Postmastectomy breast reconstruction in the irradiated breast: a comparative study of DIEP and latissimus dorsi flap outcome. Plast Reconstr Surg. 2012;130(1):10-18. 61. Fischer JP, Nelson JA, Au A, Tuggle CT III, Serletti JM, Wu LC. Complications and morbidity following breast reconstruction—a review of 16,063 cases from the 2005-2010 NSQIP datasets. J Plast Surg Hand Surg. 2014;48(2):104-114. 62. Yezhelyev M, Duggal CS, Carlson GW, Losken A. Complications of latissimus dorsi flap breast reconstruction in overweight and obese patients. Ann Plast Surg. 2013;70(5):557-562.
Ataxanova, N.E.; Fayziyev, F.Sh.; Kurbankulov, U.M.; and Almuradova, D.M.
"SELECTION OF ONCOPLASTIC SURGERY IN UZBEKISTAN REGION BREAST CANCER PATIENTS,"
Central Asian Journal of Medicine: Vol. 2020
, Article 5.
Available at: https://uzjournals.edu.uz/tma/vol2020/iss4/5