Background: MMP-9 plays a significant role in invasion and migration of tumor cells and metastasis. A combination MMP-9 biomarker with HER2 and Ki-67 is expected to provide more specificity in prognosis for better breast cancer (BC) treatment options. Methods: A retrospective cohort of 34 patients with HER2 enriched breast cancer were studied from January 2016 until December 2020. Assessment MMP-9 by IHC using Monoclonal Mouse Anti-Human MMP-9 Antigen with semiquantitative immunoreactive scores methods was done. Results: The samples included patients aged 29 to 66 years. Patients’ educational level was mostly high school graduation (n=17; 50%). Distant metastases occurred in 10 (29.4%) patients, histopathological Grade II was found in 29 (85.7%) patients, positive LVI was found in 18 (52.9%) patients, and high proliferation rate (Ki67 > 20%) was found in 32 (94.1%) patients. All the patients underwent MRM with a history of chemotherapy in 29 (85.3%) patients, radiotherapy in 14 (41.2%) patients, and targeted therapy in only seven (20.6%) patients. Most of the patients had locally advanced stage III (n=21; 61.8%). The MMP-9 High expression was found in 20 (58.8%) patients and 14 (41.2%) patients had a low expression. A significant relationship was found between MMP-9 expression and DFS (p=0.023); while a significant relationship was found with OS (p=0.093). The mean DFS for High expression MMP-9 was 37.3 months and 45.3 months for low expression. The mean OS was 37.6 months for High-intensity MMP-9 and 42.7 months for Low-intensity. Conclusions: The MMP-9 expression (p=0.037), age group<40 years old (p=0.024), and the history of radiotherapy (p=0.035) were significantly related to he occurrence of distant metastases. The MMP-9 High expression had a 7.5 times greater risk of distant metastases. Impacts: The MMP-9 can be used as a prognostic factor for distant metastasis in HER2 Enriched BC.

Latar Belakang: Pembedahan kanker daerah kepala dan leher umumnya menimbulkan defek luas dan biasanya memerlukan flap. Meskipun free flap saat ini merupakan gold standard untuk rekonstruksi daerah kepala leher, pectoralis major myocutaneous flap (PMMC) masih digunakan. Kasus: Perempuan usia 47 tahun, dengan kanker tiroid papiler T4aN0M0 dengan ulserasi di kulit leher, menjalani tiroidektomi total dan defek operasi direkonstruksi dengan pectoralis major myocutaneous flap. Hasil rekonstruksi dapat diterima secara fungsional dan estetik. Tidak ada komplikasi hematom ataupun abses post operasi. Simpulan: Pectoralis major myocutaneous flap masih merupakan salah satu metode utama untuk rekonstruksi operasi kepala leher dan dapat diterima secara fungsional dan estetik jika free flap tidak dapat dilakukan. Background: Surgery for head and neck cancer generally leaves a wide defect that usually needed a flap. Although free flap is currently the gold standard for reconstruction of the head and neck, the pectoralis major myocutaneous flap is still popularly used. Case: A 47-year old female with thyroid carcinoma, underwent total thyroidectomy and the surgical defect was reconstructed with pectoralis major myocutaneous flap. The results were viable, functional, and aesthetically acceptable. No postoperative complications such as hematoma or abscess observed. Conclusion: Pectoralis major myocutaneous flap was still one of the main methods for head and neck reconstruction surgery.

<p><strong>Latar Belakang: </strong>Pembedahan kanker daerah kepala dan leher umumnya menimbulkan defek luas dan biasanya memerlukan <em>flap.</em> Meskipun <em>free flap</em> saat ini merupakan <em>gold standard </em>untuk rekonstruksi daerah kepala leher, <em>pectoralis major myocutaneous flap</em> (PMMC) masih digunakan. <strong>Kasus: </strong>Perempuan usia 47 tahun, dengan kanker tiroid papiler T4aN0M0 dengan ulserasi di kulit leher, menjalani tiroidektomi total dan defek operasi direkonstruksi dengan <em>pectoralis major myocutaneous flap</em>. Hasil rekonstruksi dapat diterima secara fungsional dan estetik. Tidak ada komplikasi hematom ataupun abses<em> post</em> operasi. <strong>Simpulan:</strong><strong> </strong><em>Pectoralis major myocutaneous flap </em>masih merupakan salah satu metode utama untuk rekonstruksi operasi kepala leher dan dapat diterima secara fungsional dan estetik jika <em>free flap</em> tidak dapat dilakukan.</p><p> </p><p><strong>Background:</strong> Surgery for head and neck cancer generally leaves a wide defect that usually needed a flap. Although free flap is currently the gold standard for reconstruction of the head and neck, the pectoralis major myocutaneous flap is still popularly used. <strong>Case</strong>: A 47-year old female with thyroid carcinoma, underwent total thyroidectomy and the surgical defect was reconstructed with pectoralis major myocutaneous flap. The results were viable, functional, and aesthetically acceptable. No postoperative complications such as hematoma or abscess observed. <strong>Conclusion</strong>: Pectoralis major myocutaneous flap was still one of the main methods for head and neck reconstruction surgery. </p>