acpronАкадемия Практической ОнкологииAcademy for Practical Oncology3033-90733033-9421ООО "Издательский дом "МедИНК"10.63769/3033-9073-2026-1-2-27-38acpron-15Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHESСравнительный анализ клинических и функциональных результатов одноэтапной и двухэтапной реконструкции молочной железы после мастэктомии у пациенток с большим объемом молочных железComparative analysis of clinical and functional results of one-stage and two-stage breast reconstruction after mastectomy in patients with large mammary glandshttps://orcid.org/0000-0002-0741-0446КозловС. В.KozlovS. V.

Козлов Сергей Васильевич, д-р мед. наук, профессор

Самара

Sergey V. Kozlov, MD, Dr. Sci. (Medicine), Professor

Samara

KozlovSV@samaraonko.ruhttps://orcid.org/0000-0003-1765-6965КагановО. И.KaganovO. I.

Каганов Олег Игоревич, д-р мед. наук, профессор

Самара

Oleg I. Kaganov, MD, Dr. Sci. (Medicine), Professor

Samara

okaganov@yandex.ruhttps://orcid.org/0000-0002-4183-0647ТкачевМ. В.TkachevM. V.

Ткачев Максим Валерьевич, канд. мед. наук

Самара

Maksim V. Tkachev, MD, Cand. Sci. (Medicine)

Samara

m9277477577@mail.ruhttps://orcid.org/0009-0008-8083-2689БукинА. В.BukinA. V.

Букин Артем Владимирович, ординатор

Самара

Artem V. Bukin, resident

Samara

aarbukin@yandex.ruСамарский областной клинический онкологический диспансер; Самарский государственный медицинский университетРоссияSamara Regional Clinical Oncology Dispensary; Samara State Medical UniversityRussian FederationСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation202602092026122738Copyright © Козлов С.В., Каганов О.И., Ткачев М.В., Букин А.В., 20262026Козлов С.В., Каганов О.И., Ткачев М.В., Букин А.В.Kozlov S.V., Kaganov O.I., Tkachev M.V., Bukin A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.apo-j.ru/jour/article/view/15

Обоснование. Совершенствование и оптимизация подходов оперативной терапии карциномы молочной железы содействуют поддержанию высокого уровня жизни пациенток после восстановительных вмешательств, особенно при значительном размере молочной железы и выраженном опущении.

Цель исследования – сопоставить ближайшие, отдаленные исходы и уровень жизни пациенток при двухэтапном и одноэтапном восстановлении после кожесберегающей мастэктомии при размере молочной железы более 150 мл.Методы. Выполнена ретроспективная оценка исходов терапии 115 пациенток группы сопоставления с размером молочных желез более 150 мл. В 1-ю группу (n = 53) включены пациентки, которым в 2011–2015 гг. проведена мастэктомия с двухэтапным (эспандер / эндопротез) восстановлением; во 2-ю группу (n = 62) – пациентки, прооперированные в 2016–2020 гг. по предложенному способу («Способ реконструкции после подкожной маст эктомии с сохранением сосково-ареолярного комплекса при большом объеме молочной железы с птозом 3–4 степени»; патент на изобретение RU 2654583 от 21.05.2018). Фиксировались продолжительность вмешательства, объем кровопотери, послеоперационные осложнения (по классификации Clavien–Dindo). Безрецидивную и общую выживаемость оценивали по методу Каплана–Майера, уровень жизни – по опроснику Breast-Q до вмешательства и через 6 мес после терапии. Использовали параметрические и непараметрические методы при p <0,05.Результаты. Средняя продолжительность вмешательства составила 219,0 ± 12,97 мин в 1-й группе и 114,8 ± 7,77 мин во 2-й группе (p = 0,000); объем интраоперационной кровопотери – 222,7 ± 26,2 и 62,3 ± 3,73 мл соответственно (p = 0,000). Частота послеоперационных осложнений составила 33,96 и 16,13 % соответственно (p = 0,026), при этом протрузии эндопротеза в 1-й группе не выявлены (p = 0,000). Показатели 5-летней безрецидивной (73,32 % против 73,89 %; p = 0,787) и общей (88,39 % против 90,45 %; p = 0,578) выживаемости оказались сопоставимы. По всем шкалам Breast-Q уровень жизни в 1-й группе был статистически значимо выше.Заключение. Использование предложенной одноэтапной методики восстановления сопровождается статистически значимым снижением доли послеоперационных осложнений, повышением уровня жизни и экономической целесообразности при отсутствии расхождений отдаленных исходов терапии.

BACKGROUND: The advancement and refinement of surgical treatment approaches for breast carcinoma facilitate the preservation of a high quality of life in patients following reconstructive procedures, particularly in cases of substantial breast volume and pronounced ptosis.AIM: To compare the immediate and long-term outcomes and quality of life in patients undergoing two-stage versus one-stage reconstruction after skin-sparing mastectomy in breasts exceeding 150 mL in volume.METHODS: A retrospective analysis of treatment outcomes was conducted in 115 patients of comparison group 1 with a breast volume exceeding 150 mL. Supgroup 1 (n = 53) comprised patients who underwent mastectomy with two-stage (expander / implant) reconstruction in 2011–2015; group 2 (n = 62) comprised patients operated on in 2016–2020 using the newly developed “Method of reconstruction after subcutaneous mastectomy with preservation of the nipple-areolar complex in large breast volume with grade 3–4 ptosis” (patent RU 2654583 of 21.05.2018). Operative duration, blood loss, and postoperative complications (Clavien–Dindo classification) were documented. Disease-free and overall survival were evaluated using the Kaplan–Meier method; quality of life was measured using the Breast-Q questionnaire before surgery and 6 months after treatment. Parametric and non-parametric methods were employed at p <0.05.RESULTS: Mean operative duration was 219.0 ± 12.97 min in group 1 and 114.8 ± 7.77 min in group 2 (p = 0.000); intraoperative blood loss was 222.7 ± 26.2 and 62.3 ± 3.73 mL, respectively (p = 0.000). The postoperative complication rate was 33.96 % versus 16.13 % (p = 0.026), with no implant protrusions documented in group 2 (p = 0.000). Five-year disease-free (73.32 % versus 73.89 %; p = 0.787) and overall survival (88.39 % versus 90.45 %; p = 0.578) were comparable. All Breast-Q scales demonstrated statistically significantly higher quality of life in group 2.CONCLUSION: The implementation of the proposed one-stage reconstruction approach is associated with a statistically significant decrease in postoperative complications, enhanced quality of life, and cost-effectiveness, with no divergence in long-term treatment outcomes.

рак молочной железыоперативная терапиявосстановление молочной железысосково-ареолярный комплексуровень жизниBreast-Qbreast carcinomasurgical treatmentbreast reconstructionnipple-areolar complexquality of lifeBreast-QReferencesBurstein H.J., Curigliano G., Thürlimann B. et al. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines 2021. Ann Oncol 2021;32(10):1216–35. DOI: 10.1016/j.annonc.2021.06.023Burstein H.J., Curigliano G., Thürlimann B. et al. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines 2021. Ann Oncol 2021;32(10):1216–35. DOI: 10.1016/j.annonc.2021.06.023Cardoso F., Paluch-Shimon S., Senkus E. et al. 5th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 5). Ann Oncol 2020;31(12):1623–49. DOI: 10.1016/j.annonc.2020.09.010Cardoso F., Paluch-Shimon S., Senkus E. et al. 5th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 5). Ann Oncol 2020;31(12):1623–49. DOI: 10.1016/j.annonc.2020.09.010Agostinetto E., Gligorov J., Piccart M. Systemic therapy for earlystage breast cancer: learning from the past to build the future. Nat Rev Clin Oncol 2022;19(12):763–74. DOI: 10.1038/s41571-022-00687-1Agostinetto E., Gligorov J., Piccart M. Systemic therapy for earlystage breast cancer: learning from the past to build the future. Nat Rev Clin Oncol 2022;19(12):763–74. DOI: 10.1038/s41571-022-00687-1Moo T.A., Sanford R., Dang C., Morrow M. Overview of breast cancer therapy. PET Clin 2018;13(3):339–54. DOI: 10.1016/j.cpet.2018.02.006Moo T.A., Sanford R., Dang C., Morrow M. Overview of breast cancer therapy. PET Clin 2018;13(3):339–54. DOI: 10.1016/j.cpet.2018.02.006Cohen W.A., Mundy L.R., Ballard T.N.S. et al. The BREAST-Q in surgical research: a review of the literature 2009–2015. J Plast Reconstr Aesthet Surg2016;69(2):149–62. DOI: 10.1016/j.bjps.2015.11.013Cohen W.A., Mundy L.R., Ballard T.N.S. et al. The BREAST-Q in surgical research: a review of the literature 2009–2015. J Plast Reconstr Aesthet Surg2016;69(2):149–62. DOI: 10.1016/j.bjps.2015.11.013Arora N., Patel R., Sohi G. et al. A scoping review of the application of BREAST-Q in surgical research. JPRAS Open 2023;37:9–23. DOI: 10.1016/j.jpra.2023.04.005Arora N., Patel R., Sohi G. et al. A scoping review of the application of BREAST-Q in surgical research. JPRAS Open 2023;37:9–23. DOI: 10.1016/j.jpra.2023.04.005Salibian A.A., Frey J.D., Karp N.S. Strategies and considerations in selecting between subpectoral and prepectoral breast reconstruction. Gland Surg 2019;8(1):11–8. DOI: 10.21037/gs.2018.08.01Salibian A.A., Frey J.D., Karp N.S. Strategies and considerations in selecting between subpectoral and prepectoral breast reconstruction. Gland Surg 2019;8(1):11–8. DOI: 10.21037/gs.2018.08.01Tondu T., Thiessen F., Hubens G. et al. Delayed two-stage nipplesparing mastectomy and simultaneous expander-to-implant reconstruction of the large and ptotic breast. Gland Surg 2022;11(3):524–34. DOI: 10.21037/gs-21-734Tondu T., Thiessen F., Hubens G. et al. Delayed two-stage nipplesparing mastectomy and simultaneous expander-to-implant reconstruction of the large and ptotic breast. Gland Surg 2022;11(3):524–34. DOI: 10.21037/gs-21-734Antoniazzi E., De Grazia A., Dell’Antonia F. et al. Immediate prepectoral breast reconstruction in nipple-sparing mastectomy with Wise-pattern incision in large and ptotic breasts. J Plast Reconstr Aesthet Surg 2024;91:154–63. DOI: 10.1016/j.bjps.2024.01.042Antoniazzi E., De Grazia A., Dell’Antonia F. et al. Immediate prepectoral breast reconstruction in nipple-sparing mastectomy with Wise-pattern incision in large and ptotic breasts. J Plast Reconstr Aesthet Surg 2024;91:154–63. DOI: 10.1016/j.bjps.2024.01.042Ostapenko E., Nixdorf L., Devyatko Y. et al. Ptotic versus nonptotic breasts in nipple-sparing mastectomy and immediate prepectoral breast reconstruction. Plast Reconstr Surg Glob Open 2023;11(5):e5032. DOI: 10.1097/GOX.0000000000005032Ostapenko E., Nixdorf L., Devyatko Y. et al. Ptotic versus nonptotic breasts in nipple-sparing mastectomy and immediate prepectoral breast reconstruction. Plast Reconstr Surg Glob Open 2023;11(5):e5032. DOI: 10.1097/GOX.0000000000005032Bellini E., Pesce M., Santi P., Raposio E. Two-stage tissue-expander breast reconstruction: a focus on the surgical technique. BioMed Res Int 2017;2017:1791546. DOI: 10.1155/2017/1791546Bellini E., Pesce M., Santi P., Raposio E. Two-stage tissue-expander breast reconstruction: a focus on the surgical technique. BioMed Res Int 2017;2017:1791546. DOI: 10.1155/2017/1791546Nahabedian M.Y., Jacobson S.R. Two-stage prepectoral breast reconstruction. Gland Surg 2019;8(1):43–52. DOI: 10.21037/gs.2018.09.04Nahabedian M.Y., Jacobson S.R. Two-stage prepectoral breast reconstruction. Gland Surg 2019;8(1):43–52. DOI: 10.21037/gs.2018.09.04Волченко А.А., Пак Д.Д., Усов Ф.Н. Реконструктивно-пластические операции у больных раком молочной железы. Опухоли женской репродуктивной системы 2011;3:29–32.Volchenko A.A., Pak D.D., Usov F.N. Reconstructive plastic surgery in patients with breast cancer. Opukholi zhenskoy reproduktivnoy systemy = Tumors of female reproductive system 2011;3:29–32. (In Russ.).Weber W.P., Soysal S.D., El-Tamer M. et al. First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 2017;165(1):139–49. DOI: 10.1007/s10549-017-4314-5Weber W.P., Soysal S.D., El-Tamer M. et al. First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 2017;165(1):139–49. DOI: 10.1007/s10549-017-4314-5Reitsamer R., Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg 2015;68(2):162–7. DOI: 10.1016/j.bjps.2014.10.012Reitsamer R., Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: a new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg 2015;68(2):162–7. DOI: 10.1016/j.bjps.2014.10.012Franceschini G., Scardina L., Di Leone A. et al. A novel acellular dermal matrix fixation technique in prepectoral direct-to-implant breast reconstruction to reduce postoperative complications. Plast Reconstr Surg Glob Open 2024;12(6):e5874.Franceschini G., Scardina L., Di Leone A. et al. A novel acellular dermal matrix fixation technique in prepectoral direct-to-implant breast reconstruction to reduce postoperative complications. Plast Reconstr Surg Glob Open 2024;12(6):e5874.Yu C.S., Ma J., Yang L.G. et al. Application of pectoralis major fascia in retropectoral breast reconstruction. Gland Surg 2025;14(3):520–8. DOI: 10.21037/gs-24-463Yu C.S., Ma J., Yang L.G. et al. Application of pectoralis major fascia in retropectoral breast reconstruction. Gland Surg 2025;14(3):520–8. DOI: 10.21037/gs-24-463Giuliano A.E., Ballman K.V., McCall L. et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 2017;318(10):918–26. DOI: 10.1001/jama.2017.11470Giuliano A.E., Ballman K.V., McCall L. et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (Alliance) randomized clinical trial. JAMA 2017;318(10):918–26. DOI: 10.1001/jama.2017.11470De Boniface J., Frisell J., Andersson Y. et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized SENOMAC trial. BMC Cancer 2017;17:379. DOI: 10.1186/s12885-017-3361-yDe Boniface J., Frisell J., Andersson Y. et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized SENOMAC trial. BMC Cancer 2017;17:379. DOI: 10.1186/s12885-017-3361-yТимербулатов В.М., Тимербулатов Ш.В., Тимербулатов М.В. Классификация хирургических осложнений. Хирургия. Журнал им. Н.И. Пирогова 2018;(9):62–7. DOI: 10.17116/hirurgia201809162Timerbulatov V.M., Timerbulatov Sh.V., Timerbulatov M.V. Classification of surgical complications. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2018;(9):62–7. (In Russ.). DOI: 10.17116/hirurgia201809162Christiansen P., Mele M., Bodilsen A. et al. Breast-conserving surgery or mastectomy? Impact on survival. Ann Surg Open 2022;3(4):e205. DOI: 10.1097/AS9.0000000000000205Christiansen P., Mele M., Bodilsen A. et al. Breast-conserving surgery or mastectomy? Impact on survival. Ann Surg Open 2022;3(4):e205. DOI: 10.1097/AS9.0000000000000205Pusic A.L., Klassen A.F., Scott A.M. et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009;124(2):345–53. DOI: 10.1097/PRS.0b013e3181aee807Pusic A.L., Klassen A.F., Scott A.M. et al. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 2009;124(2):345–53. DOI: 10.1097/PRS.0b013e3181aee807Krishnan N.M., Fischer J.P., Basta M.N., Nahabedian M.Y. Is single-stage prosthetic reconstruction cost effective? A cost-utility analysis for the use of direct-to-implant breast reconstruction relative to expander-implant reconstruction in postmastectomy patients. Plast Reconstr Surg 2016;138(3):537–47. DOI: 10.1097/PRS.0000000000002428Krishnan N.M., Fischer J.P., Basta M.N., Nahabedian M.Y. Is single-stage prosthetic reconstruction cost effective? A cost-utility analysis for the use of direct-to-implant breast reconstruction relative to expander-implant reconstruction in postmastectomy patients. Plast Reconstr Surg 2016;138(3):537–47. DOI: 10.1097/PRS.0000000000002428Basta M.N., Gerety P.A., Serletti J.M. et al. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg 2015;136(6):1135–44. DOI: 10.1097/PRS.0000000000001749Basta M.N., Gerety P.A., Serletti J.M. et al. A systematic review and head-to-head meta-analysis of outcomes following direct-to-implant versus conventional two-stage implant reconstruction. Plast Reconstr Surg 2015;136(6):1135–44. DOI: 10.1097/PRS.0000000000001749Agrawal S.K., Imran M.M., Sethi S. et al. Sentinel lymph node biopsy vs. axillary lymph node dissection for early-stage breast cancer and sentinel lymph node metastasis: an updated systematic review and meta-analysis. Breast Cancer (Auckl) 2025;19:11782234251335409. DOI: 10.1177/11782234251335409Agrawal S.K., Imran M.M., Sethi S. et al. Sentinel lymph node biopsy vs. axillary lymph node dissection for early-stage breast cancer and sentinel lymph node metastasis: an updated systematic review and meta-analysis. Breast Cancer (Auckl) 2025;19:11782234251335409. DOI: 10.1177/11782234251335409McLaughlin S.A., DeSnyder S.M., Klimberg S. et al. Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema: Part 2: Preventive and Therapeutic Options. Ann Surg Oncol 2017;24(10):2827–35. DOI: 10.1245/s10434-017-5964-6McLaughlin S.A., DeSnyder S.M., Klimberg S. et al. Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema: Part 2: Preventive and Therapeutic Options. Ann Surg Oncol 2017;24(10):2827–35. DOI: 10.1245/s10434-017-5964-6Gurrado A., Pasculli A., Toma A. et al. Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction. Updates Surg 2023;75(1): 235–43. DOI: 10.1007/s13304-022-01416-0Gurrado A., Pasculli A., Toma A. et al. Mastectomy with one-stage or two-stage reconstruction in breast cancer: analysis of early outcomes and patient’s satisfaction. Updates Surg 2023;75(1): 235–43. DOI: 10.1007/s13304-022-01416-0Sinha I., Pusic A.L., Wilkins E.G. et al. Late surgical-site infection in immediate implant-based breast reconstruction. Plast Reconstr Surg 2017;139(1):20–8. DOI: 10.1097/PRS.0000000000002839Sinha I., Pusic A.L., Wilkins E.G. et al. Late surgical-site infection in immediate implant-based breast reconstruction. Plast Reconstr Surg 2017;139(1):20–8. DOI: 10.1097/PRS.0000000000002839Рак молочной железы. Клинические рекомендации Минздрава России, 2021.Breast cancer. Clinical guidelines of the Russian Ministry of Health, 2021. (In Russ.).Chen Q., Qu L., He Y. et al. Comparative effectiveness of nipplesparing mastectomy and breast-conserving surgery on long-term prognosis in breast cancer. Front Endocrinol (Lausanne) 2023;14:1222651. DOI: 10.3389/fendo.2023.1222651Chen Q., Qu L., He Y. et al. Comparative effectiveness of nipplesparing mastectomy and breast-conserving surgery on long-term prognosis in breast cancer. Front Endocrinol (Lausanne) 2023;14:1222651. DOI: 10.3389/fendo.2023.1222651Gradishar W.J., Anderso B.O., Abraham J. et al. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020;18(4):452–78. DOI: 10.6004/jnccn.2020.0016Gradishar W.J., Anderso B.O., Abraham J. et al. Breast Cancer, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020;18(4):452–78. DOI: 10.6004/jnccn.2020.0016Rampal R., Gormley M., McKeever D. et al. Three and twelvemonth analysis of the PROM-Q study: comparison of patientreported outcome measures using the BREAST-Q in pre- vs. sub-pectoral implant-based immediate breast reconstruction. Breast Cancer Res Treat 2024;207(3):585–95. DOI: 10.1007/s10549-024-07401-yRampal R., Gormley M., McKeever D. et al. Three and twelvemonth analysis of the PROM-Q study: comparison of patientreported outcome measures using the BREAST-Q in pre- vs. sub-pectoral implant-based immediate breast reconstruction. Breast Cancer Res Treat 2024;207(3):585–95. DOI: 10.1007/s10549-024-07401-yChinta S., Koh D.J., Sobti N. et al. Cost analysis of pre-pectoral implant-based breast reconstruction. Sci Rep 2022;12:17512. DOI: 10.1038/s41598-022-21675-6Chinta S., Koh D.J., Sobti N. et al. Cost analysis of pre-pectoral implant-based breast reconstruction. Sci Rep 2022;12:17512. DOI: 10.1038/s41598-022-21675-6Shiraishi M., Sowa Y., Tsuge I. et al. Long-term patient satisfaction and quality of life following breast reconstruction using the BREAST-Q. Front Oncol 2022;12:815498. DOI: 10.3389/fonc.2022.815498Shiraishi M., Sowa Y., Tsuge I. et al. Long-term patient satisfaction and quality of life following breast reconstruction using the BREAST-Q. Front Oncol 2022;12:815498. DOI: 10.3389/fonc.2022.815498

The authors declare that there are no conflicts of interest present.