Breast cancer is one of the most frequently diagnosed malignancies in the Russian Federation (RF), accounting for 20.9% of the female population in Russia. The surgery remains the primary treatment for breast cancer. Development and improvement of various options for reconstructive plastic surgery provides medical, psychological and social rehabilitation in patients with breast cancer, allows to achieve the best aesthetic and functional results. The possibility of performing such operations contributes to improving the quality of life of patients. According to ASPS (American Society of Plastic Surgeons), 80% of breast cancer reconstructions in the world are performed using silicone implants. Currently, the return of prepectoral space for placement of endoprostheses during breast reconstruction is trending, which is associated not only with the improvement of mastectomy techniques, but also with the coating of implants and the appearance of silicone highly adhesive gel filling of implants. According to the world literature data, the use of polyurethane-coated endoprostheses for prepectoral/subcutaneous reconstruction reduces the risk of capsular contracture, provides a more reliable fixation to the surrounding tissues, and thus allows breast reconstruction without the need for additional cover of the endoprosthesis. The use of the prepectoral space is characterized by a simpler operation technique compared to the retromuscular placement of the implant, the absence of damage to the large pectoral muscle, minimization of pain, reduction of the bed-day in the hospital and a faster rehabilitation period. So, this type of breast reconstruction can be considered as an alternative to submuscular implant placement in primary operable forms of breast cancer with sufficient thickness of the integumentary tissues.

Для корреспонденции Рассказова Елена Александровна, к.м.н., научный сотрудник отделения онкологии и реконструктивно-пластической хирургии молочной железы и кожи Московского научно-исследовательского онкологического института им. П.А.Герцена-филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Министерства здравоохранения Российской Федерации Адрес: 125284, Российская Федерация, г. Москва, 2-й Боткинский проезд, д. 3

Вопросы реконструктивной и пластической хирургии № 2 (61) июнь'2017 of injury, blood loss, and surgery time, as well as assumes no defects of donor zones. The paper presents the review of publications and results obtained by the authors. Material and methods. Since 2013 till 2016, specialists of the P. Herzen Moscow Oncology Research Institute made 104 one-time breast cancer reconstructions with the use of mesh implants in 80 cases, acellular dermal matrix in 24 cases after radical skin-sparing or subcutaneous mastectomy. Average age of patients was 47.2 years. Stage 0 breast cancer was diagnosed in 2% of cases, I-30%, IIA-33%, IIB-16%, IIIA-15%, IIIB-2%, IIIC-2%. Titanium mesh implants were used in 12 patients, and polyester 3D mesh implants were applied in 68 cases. The size of silicone implants varied from 120 to 585 cm 3 depended on anatomic features of chest wall and breast constitution. Results. Cosmetic results were considered as excellent in 67.3% of cases, good in 19.2% of cases, satisfactory in 7.7% of cases, and poor in 5.8% of cases. The frequency of removal of silicone implant was 5.8% when titanium mesh implant was used and 0% for the polyester 3D mesh implant. Seroma was diagnosed in 1.9% of cases with the use of acellular dermal matrix and in 2.9% with the use of titanium mesh implant. Nipple-areola necrosis was observed in 1.9% of cases with the use of titanium mesh implant. Infection of implant site was observed in 2.9% of cases. Capsular contracture developed in 5.8% of cases after application of radiotherapy to the reconstructed breast. Conclusions. Biological and synthetic materials form a significant alternative to existing ways of breast reconstruction and, in many cases, adequate replacement of autologous muscular flaps at the proper selection of patients.

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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.