Autologous dura mater grafts in reconstructive surgeries for breast cancer patients

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.

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Monitoring Metastasis and Cachexia in a Patient with Breast Cancer: A Case Study

Clinical Medicine Insights Oncology ◽

10.4137/cmo.s40479 ◽

2016 ◽

Vol 10 ◽

pp. CMO.S40479 ◽

Cited By ~ 10

Author(s):

Nikita Consul ◽

Xiaotao Guo ◽

Courtney Coker ◽

Sara Lopez-Pintado ◽

Hanina Hibshoosh ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Subcutaneous Fat ◽

Surrogate Marker ◽

Metastatic Breast ◽

Tumor Burden ◽

Breast Cancer Patients ◽

The Third ◽

Metastatic Burden

Cachexia, a wasting syndrome associated with advanced cancer and metastasis, is rarely documented in breast cancer patients. However, the incidence of cachexia in breast cancer is now thought to be largely underestimated. In our case report of a breast cancer patient with bone metastasis monitored during the course of her treatment, we document the development of cachexia by image analysis in relation to her metastatic burden. Elucidation of the link between metastatic burden and cachexia could unveil a highly specific screening process for metastasis, by assessing true muscle mass loss. Our patient was a 49-year-old premenopausal woman, with metastatic invasive ductal breast carcinoma in the vertebral and iliac bones on presentation, which progressed with new metastases to her hips, thigh bones, and vertebrae. In the two-year period, that is between her diagnosis and death, she lost >10% of her baseline weight. During these two years, we retrospectively identified a decrease in paraspinal muscle (PM) at the third lumbar vertebra followed by a sharp decline in weight. The increased tumor burden over time in metastatic sites was accompanied by a decrease in abdominal muscle and visceral and subcutaneous fat and was followed by the patient's demise. The increasing tumor burden in the patient was correlated with the mass of other tissues to determine the tissue that could best serve as a surrogate marker to cachexia and tumor burden. We noted a strong negative correlation between PM area and metastatic tumor area at the third lumbar vertebral level, with PM loss correlating to increasing tumor burden. The monitoring of PM wasting may serve as a marker, and therefore a prognostic factor, for both cachexia and extent of metastatic disease, especially in breast cancer, where metastasis to bone is frequent. Based on our data and review of the literature in this case study, longitudinal monitoring of cachexia in the selected muscle groups can give clinicians early indications of the extent of cachexia in metastatic breast cancer patients.

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Sarcopenia to predict tolerance of adjuvant breast cancer chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.138 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 138-138

Author(s):

Michael S. Sabel ◽

Anna S.C. Conlon ◽

Kent A. Griffith ◽

Michael Englesbe ◽

Stewart Wang

Keyword(s):

Breast Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Patients ◽

Subcutaneous Fat ◽

Pulmonary Complications ◽

Muscle Size ◽

Ct Scans ◽

Breast Cancer Patients ◽

Mineral Density ◽

Increased Risk

138 Background: Despite improved survival with adjuvant chemotherapy among older women, it is less often recommended for fear they cannot complete therapy or will have excessive toxicity. Analytic morphometrics uses objective imaging measurements such as muscle size, bone mineral density (BMD) and body composition to improve risk stratification. We examined whether morphometrics might help predict toxicity of chemotherapy in breast cancer patients. Methods: Our prospective IRB-approved breast cancer database was queried for all patients who underwent adjuvant or neoadjuvant chemotherapy and had CT scans of the chest, abdomen and pelvis prior to chemo. Complications of chemotherapy were graded according to the NCI-CTC. CT scans were processed using semi-automated algorithms (MATLAB v13.0) to measure psoas area (PA) and density (PD), BMD and subcutaneous fat (SF), visceral fat (VF), and total body area (TBA. Outcome (DFS and OS) was assessed by K-M, and logistic regression models and ANOVA were used for toxicity events. Results: We identified 129 patients, ranging in age from 24 to 83 (median 52). 105 (81%) received AC/T while 19% received alternate regimens, all full weight based. T-stage, nodal status and HER2 expression were significantly associated with measures of obesity, except BMI, but not sarcopenia. After adjusting for stage and Her-2, BMI remained a significant predictor of DFS (OR 1.07 (95%CI 1.01, 1.13)) and OS (OR 1.06 (95% CI 1.00, 1.12)).After controlling for age, PD and VF were predictors of chemotherapy completion. The OR for completing chemotherapy decreased 0.95 (95% CI: 0.90, 1.01, p=0.08) for every increase of 1000 in VF and increased 1.08 (95% CI: 1.01, 1.15, p=0.03) for every unit increase in PD. Sarcopenia was associated with an increased risk of pulmonary complications (p=0.01) and anemia (p=0.06). Conclusions: Although age is a significant predictor of increased toxicity and inability to complete chemotherapy, sarcopenia is an objective, independent predictor of chemotherapy completion. Psoas density, easily obtainable from a pre-treatment CT scan, can help the clinician older breast cancer patients for adjuvant chemotherapy.

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Complications after simultaneous prepectoral breast reconstruction using polyurethane-coated implants in patients with breast cancer

Tumors of female reproductive system ◽

10.17650/1994-4098-2020-16-4-12-20 ◽

2021 ◽

Vol 16 (4) ◽

pp. 12-20

Author(s):

M. Yu. Vlasova ◽

A. D. Zikiryakhodzhaev ◽

I. V. Reshetov ◽

F. N. Usov ◽

E. K. Saribekyan ◽

...

Keyword(s):

Breast Cancer ◽

Breast Reconstruction ◽

Cancer Patients ◽

Capsular Contracture ◽

Functional Results ◽

Infectious Complications ◽

Breast Cancer Patients ◽

Oncology Research ◽

One Stage Reconstruction ◽

Reconstructive Plastic Surgery

Background. The development and improvement of reconstructive breast surgery provides medical, psychological and social rehabilitation of cancer patients, allowing them to achieve the best cosmetic and functional results. The trend towards the return of prepectoral reconstruction is associated not only with the improvement of mastectomy techniques, but also with implant coating and the emergence of highly cohesive silicone gel filling of implants. The use of polyurethane-coated endoprostheses in prepectoral reconstruction provides more reliable fixation to the surrounding tissues and allows reconstruction of the mammary glands without additional covering of the endoprosthesis.Objective: to improve the results of surgical treatment when performing a one-stage reconstruction by pre-rectal placement of polyurethanecoated implants in breast cancer. Materials and methods. In the period from April 2017 to September 2020 at the Department of Oncology and Reconstructive Plastic Surgery of the Breast and Skin of P.A. Herzen Moscow Oncology Research Institute performed 340 prepectoral breast reconstructions (direct-toimplant) using polyurethane-coated implants in breast cancer patients. A group of patients was analyzed (n = 208).Results. We noted the following complications: prolonged seroma (more than 30 days) in 39 (18.6 %) patients, red breast syndrome in 31 (14.8 %) patients, capsular contracture III–IV degree by J.L. Baker in 43 (20.57 %) patients, protrusion/extrusion of the endoprosthesis in 23 (11 %) patients, suture divergence in 8 (3.8 %) patients, necrosis in 8 (3.8 %) patients, infectious complications in 14 (6.7 %) patients, ripping in 10 (4.8 %) patients. Also, 2 (0.95 %) patients had a violation of the integrity of the endoprosthesis, and 2 (0.95 %) patients had rotation of the endoprosthesis. Conclusions. Prepectoral breast reconstruction can be used as an alternative to subpectoral reconstruction in primary operable forms of breast cancer with sufficient thickness of integumentary tissues.

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Local tissue interleukine profile in breast cancer

Russian Journal of Oncology ◽

10.18821/1028-9984-2015-21-1-60-65 ◽

2016 ◽

Vol 21 (1-2) ◽

pp. 60-65

Author(s):

Shamil Kh. Gantsev ◽

R. R Bakiyev

Keyword(s):

Breast Cancer ◽

Adipose Tissue ◽

Cancer Patients ◽

Subcutaneous Fat ◽

Anterior Chest Wall ◽

Fatty Tissue ◽

Breast Cancer Patients ◽

Intercellular Interactions ◽

Oncological Diseases

Breast cancer ranks first in the structure of oncological diseases in women in Russia and in the World. In recent years there have been numerous reports that the growth and progression of breast cancer and other tumors depend not only on their malignant potential, but also on stromal factors presented in the tumor microenvironment and intercellular interactions. The aim of our study was to evaluate intercellular interactions of the tissues surrounding the tumor, by means of determination of the locally interleukine profile. We have identified interleukine profiles of the axillary fatty tissue from the lesions and subcutaneous fat of the anterior chest wall, located at a maximum distance from the tumors, in stage IIa-IIIb breast cancer patients. As a result we came to a conclusion: the method based on the measurement of IL-1, IL-2, IL-6, IL-10 and а-TNF levels in the tissues and in the blood allows to evaluate the immune processes occurring in the tissues surrounding the tumor; adipose tissue of various areas of breast cancer patients differs significantly according to the level of interleukines, which indicates that different involvement of adipose tissue in various areas of the immune response; there is a dependence of the local immune status of armpit adipose tissue on the expression of ER, PgR, Her2/neu on the surface of breast cancer cells.

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