This study describes the experience of radical mastectomies with simultaneous breast reconstruction using TRAM flap in patients with inflammatory breast cancer. The study aimed to evaluate the effectiveness of primary breast reconstruction using the TRAM-flap procedure in patients with an inflammatory form of breast cancer. Our work is associated with some deviation from generally accepted standards: delayed breast reconstruction after radical mastectomy for inflammatory breast cancer. We describe the experience of radical mastectomies with the simultaneous reconstruction of the breast using a TRAM flap in patients with inflammatory breast cancer. This study included 12 patients diagnosed with breast cancer stages IIIB and IIIC. Almost all patients (eleven out of twelve patients) underwent radical mastectomy with one-stage reconstruction using a TRAM flap after chemotherapy. Two years later, one patient (8.3%) showed disease progression in the form of distant metastases in the bones of the spine. One patient (8.3%) had a regional relapse in the displaced flap near the postoperative scar. The rest of the patients (83.4%) showed no signs of continuing the disease. Patients with one-stage breast reconstruction improved socially, and their subjective well-being was better than those who underwent radical mastectomy without reconstruction. Experience in performing one-stage reconstructions in the surgical treatment of patients with inflammatory breast cancer is a reason for restrained optimism regarding the possibility and feasibility of these operations.

Introduction. Breast cancer (BC) is an important public health problem. These are BC patients in young age, hereditary (BRCA-associated) BC patients, inflammatory BC patients, synchronous cancer patients etc. In case of a large size of tumor or diffuse form of BC we often need to use extended surgery techniques in order to perform it radically and minimize a risk of recurrence. The aim of the study to evaluate the effectiveness of surgery approaches in inflammatory BC patients. Materials and research methods. Тhe first stage of our research was to evaluate extended surgical treatment using techniques by Handelhail and Beck on the risk of local recurrence. The study included 39 patients with breast cancer T4b-dN0-3M0 who in the period from 2014 to 2019 received complex treatment at National Cancer Institute of Ukraine. Besides neo- and adjuvant chemotherapy, an extended radical mastectomy using a technique by Handelhail and Beck was performed in 19 patients. In 20 patients a traditional (Madden) modified radical mastectomy was done. Results. When studying the data of a group of 20 patients we received a very high percentage of recurrence. Recurrences were classified as locoregional if they occurred in the ipsilateral breast or the axillary or supraclavicular lymph nodes, and as distant metastasis, if they occurred at any other site. Radical extended modified mastectomy consisted in the removal of the mammary gland and adjacent skin along the perimeter with subcutaneous tissue at a distance of 2-3 cm outward from the macroscopic edges of the gland, subclavian-axillary-subscapularis lymphadenectomy. The resulting defect was closed using a technique by Handelhail and Beck. The use of extended surgery made it possible to improve recurrence-free survival.

This study aimed to compare the results of free MS-TRAM and DIEP-flap based on the volume of the transplant and the unique characteristics of blood flow in the tissues. The study included 83 patients, 42 in the MS-TRAM-flap reconstruction group and 41 in the DIEP-flap breast reconstruction group. In the MS-TRAM-flap group, 35 patients received delayed reconstruction, and 7 received one-stage breast reconstruction, including one case of bilateral transplantation. In the DIEP-flap group, 5 patients received one-stage reconstruction, and 36 received delayed reconstruction. Complications associated with the flap tissue were observed in 7 (16.67%) in the MS-TRAM-flap group and 8 (19.51%) cases in the DIEP-flap group. The total level of fat necrosis in MS-TRAM-flap was 7.14% (p=0.033), and in DIEP-flap, it was 9.75% (p=0.039) (2 patients had a substantial amount of fat necrosis, while 2 patients had a modest amount of focal fat necrosis). The number and diameter of perforators (including veins), as well as the transplant volume, are the primary determinants of whether to use a DIEP- or MS-TRAM-flap. DIEP-flap is preferred if there are 1–2 large artery perforators (≥1 mm) and tissue volume of 700–800 grams, while MS-TRAM-flap is used when the tissue volume is significant (>2/3 of standard TRAM-flap).

Expression of pro-malignant factors (VEGF) and cytokines like inflammatory components support breast cancer development. We examined 46 patients with stage IIIB inflammatory breast cancer (IBC) and 24 with stage IIA-IIIB breast cancer (BC) without secondary edema. Hormone receptors, Her-2/neu, Ki-67 index, VEGF, and IL-6, were determined for all patients before and after neoadjuvant treatment. They associated the expression of VEGF for IBC patients with an unfavorable prognosis. VEGF level for IBC lymph node metastases was higher than in patients without such lesions (1.4 times), and there was a significant increase in VEGF levels in the G3 category of malignancy (1.54-fold increase). In IBC patients with positive HER2/neu status, VEGF levels were 1.51 times higher compared to those with negative HER2/neu status (r=0.36, p<0.05). IL-6 level during therapy in IBC patients remained high, which occurs in active tumor development. Comparative analysis of the VEGF/IL-6 ratio during treatment of patients with IBC was higher vs. IIIB stage breast cancer without edema (1.4 vs. 0.7), indicating the aggressiveness of the tumor process and confirmed by an objective response to treatment (regression<30%).