Transoesophageal echocardiography in patients with ischemic stroke

• Natalya Yu. Germanovich
• Shchegolkova T.A.
• Mishchenko I.M.
• Narozhnykh V.S.
• Stepanova Yu.A.

Abstract

Breast cancer has for many years maintained its leading position in the structure of cancer among the female population in the world. Over the past few years, the approach to the treatment of breast cancer has changed, due to the tremendous development of drug and surgical treatments. Until a few decades ago, mastectomy was the only surgical treatment for breast cancer. The evolution of surgical treatment of breast cancer allows the reconstruction of the removed breast by performing reconstructive and plastic surgeries. There are various methods of reconstructive breast surgery, using both endoprostheses and autologous tissues, or a combination of both. These methods allow to get the optimal aesthetic result, taking into account all the principles of oncologic surgery, and thus minimize the number of disabling operations and significantly improve quality of life. The choice of variant for breast reconstruction depends on the stage of oncologic process, initial state of glands on both sides: the volume, presence and expression of asymmetry, form of a chest or its deformity, skin, subcutaneous fat.

Our own clinical experience of performing subcutaneous mastectomy with simultaneous implant reconstruction in the presence of pectus excavatum was presented.

Woman S., 44 years old, was admitted to A.V. Vishnevsky National Medical Research Center of Surgery with the diagnosis: T1N1M0 stage IIa breast cancer of the right breast. Luminal type B. HER2- negative. Status after 4 courses of neoadjuvant chemotherapy. According to patient’s anamnesis, the patient knows, that funnel-shaped chest deformity was corrected in 1989 by external traction, with the use of external correction device: thoracoplasty by G.A. Bairov, traction on I.A. Marshev’s splint. After the examination, the patient underwent subcutaneous radical mastectomy with one-stage reconstruction. Surgical tactics for the correction of breast asymmetry in breast cancer and chest defect were demostrated. An assessment of the aesthetic result in a patient with correction of breast asymmetry with a chest defect was given.

Keywords:breast cancer; funnel chest deformity; breast surgery; aesthetic mammoplasty

References

1.     Nevozhay V.I., Apanasevich V.I. Surgical treatment of breast cancer: history and current trends. Tikhookeanskiy meditsinskiy zhurnal [Pacific Medical Journal]. 2016; 4 (66): 11–3. DOI: https://doi.org/10.17238/PmJ1609-1175.2016.4.11-13  (in Russian)

2.     World Health Organization. The Global Cancer Observatory. December, 2020.

3.     Telichko S.V., Kovalenko N.V., Zhavoronkova V.V., Ivanov A.I., Sukhov V.A., Speransky D.L., et al. Modern methods of breast reconstruction. Own experience. Quarterly scientific and practical journal. Vestnik VolgGMU [Bulletin of VolgSMI]. 2020; 3 (75): 179–84. DOI: https://doi.org/10.19163/1994-9480-2020-3(75)-179-184  (in Russian)

4.     Toth B.A., Lappert P. Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning. Plast Reconstr Surg. 1991; 87: 1048–53.

5.     Rasskazova E.A., Pak D.D., Zikiryakhodzhaev A.D., Ablitsova N.V. Relapses after radical subcutaneous mastectomy. Onkologiya. Zhurnal imeni P.A. Gertsena [Oncology. Journal named after P.A. Gertsen]. 2014; 3 (2): 21–3. (in Russian)

6.     Blokhin S.N., Portnoy S.М., Laktionov K.P. Initial reconstruction of the mammary gland at cancer. In: Маterials of the 7th Russian Oncologic Congress. Moscow, 2003: 94–6. (in Russian)

7.     Baeva A.A. One-stage correction of asymmetry of the mammary glands: Diss. Moscow, 2016: 151 p. (in Russian)

8.     Tebbetts J.B. The greatest myths in breast augmentation. Plast Reconstr Surg. 2001; 107 (7): 1895–903. DOI: https://doi.org/10.1097/00006534-200106000-00042  

9.     Alyautdin S.R. Mammoplasty for chest defects: Diss. Moscow, 2015: 132 p. (in Russian)

10. Lednev A.N. Cryoablation of intercostal nerves in the prevention of pain after correction of pectus excavatum in adults: Diss. Moscow, 2022: 113 p. (in Russian)

11. Ibragimov Ya.Kh, Ibragimova M.Ya., Gizatulina L.Ya. Surgical treatment of chest deformity. Prakticheskaya meditsina [Practical Medicine]. 2013; 2 [1–2 (69)]: 56–8. (in Russian)

12. Saxena A.K. History of surgical repairs of chest wall deformities. In: A. Saxena (eds). Chest Wall Deformities. Berlin; Heidelberg: Springer, 2017: 740 p. DOI: https://doi.org/10.1007/978-3-662-53088-7_1  

13. Eggel C. Eine seltene Missbildung des Thorax. Virchows Arch Path Anat. 1870; 49: 230.

14. Meyer W.L. Zur chirurgischen Behandlung der angeborenen Trichterbrust. Berl Klin Wochenschr. 1911; 84: 1563–6.

15. Ravitch M.M. The operative treatment of pectus excavatum. Ann Surg. 1949; 129 (4): 429–44. DOI: https://doi.org/10.1097/00000658-194904000-00002

16. Nuss D., Kelly J.R., Croitoru D.P.A. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998; 33: 542–52.

17. Marshev I.A., Bairov G.A. Congenital deformities of the chest. Surgery of malformations in children. Leningrad: Meditsina, 1968: 116–35. (in Russian)

18. Slizovsky G.V., Kuzhelivsky I.I. Funnel chest: guidelines for physicians, interns and clinical residents. Guidelines for doctors, interns and clinical residents. Tomsk: SibGMU, 2015: 25 p. (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)