OBJECTIVE: Analysis of our approach to breast reconstruction after mastectomy in women with breast cancer and/or BRCA mutations. Oncoplastic surgery enables procedures that are sufficiently radical and with a very good cosmetic effect. With the development of genetic testing programs, the need for prophylactic procedures is also increasing. One-sided curative performance and at the same time prophylactic surgery on the other breast can be used. METHODS: We use the possibility of immediate breast reconstruction simultaneously with subcutaneous and skin-saving mastectomy. We solve the reconstruction either with an expander and in the second time by inserting a silicone implant, or directly by inserting the implant alone or in combination with the use of autologous tissue, depending on further oncological treatment (chemotherapy or radiotherapy). RESULTS: One-hundred and three reconstructive surgeries were performed on 58 women with breast cancer and/or BRCA mutations from April 2017 to May 2020. Of these, there were 52 immediate reconstructions for untreated tumors. A tissue expander was inserted in 27 women (46.6% of the group) with locally advanced tumors and the need for subsequent radiotherapy (18 immediate and 9 delayed reconstructions). Breast implants were used in 52 women (89.7% of the group) in a total of 80 implants. Breast reconstruction of own tissues was performed in 8 women, of which 5 operations had immediate reconstruction. Postoperative complications occurred in 11 women and 15 corrective procedures were performed (12.7% of operations). CONCLUSION: Breast reconstruction is a comprehensive set of techniques by which any patient can obtain a breast so that it does not depend on the epithelium. Patients with locally advanced disease who receive neoadjuvant chemotherapy and radiotherapy are at greater risk of complications. With the growing number of breast cancers, the demand for reconstructive procedures, especially immediate reconstructions, is increasing.

• Klíčová slova
• BRCA mutations, Mastectomy, breast cancer, breast implants, delayed reconstruction, expander, immediate breast reconstruction, mastectomy, tissue lobe,
• MeSH
• lidé MeSH
• mamoplastika * MeSH
• mastektomie MeSH
• mutace MeSH
• nádory prsu * genetika   chirurgie   MeSH
• pooperační komplikace MeSH
• prsní implantáty * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

In women at high risk of developing breast cancer, bilateral prophylactic mastectomy (BPM) 1 significantly reduces the risk; simultaneously, breast reconstruction preserves body integrity. Given the complex and personal nature of such surgical procedures, patient assessment of satisfaction and health-related quality of life (HRQoL) 2 is essential in evaluation of surgical outcomes. With this review, we aim to organize the current knowledge on patient-reported outcomes (PROs) 3 in bilateral prophylactic surgery. Literature search was conducted using the databases Google Scholar, PubMed, and Web of Science to address the following questions, which can help clinicians and women undergoing the procedures navigate their healthcare decision-making process: How does BPM with reconstruction influence cancer-related distress? How does the surgery impact patient satisfaction and HRQoL? How do preoperative PROs differ from postoperative outcomes? Does the type of BPM and the type of reconstruction impact patient satisfaction and HRQoL? Furthermore, we summarize available patient-reported outcome measures (PROMs) 4 that can be administered to women undergoing BPM with reconstruction. In addition, we discuss possible future directions for PRO research in prophylactic breast surgery.

• Klíčová slova
• Bilateral prophylactic mastectomy, Breast reconstruction, Health-related quality of life, Hereditary breast cancer, Patient-reported outcomes, Satisfaction,
• MeSH
• hodnocení výsledků péče pacientem MeSH
• kvalita života MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• mastektomie metody   MeSH
• nádory prsu * prevence a kontrola   chirurgie   MeSH
• profylaktická mastektomie * metody   MeSH
• spokojenost pacientů MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: The aim of this study was to assess the long-term impact and potential effectiveness of our specialized acellular dermal matrix (ADM) in a two-stage breast reconstruction process. OBJECTIVE: Opinions regarding the use of ADMs are currently divided. While their positive contribution to reconstructive breast surgery is evident, the results of studies vary depending on specific procedures, patient selection, and techniques employed. MATERIAL AND METHODS: In a retrospective study conducted between January 2015 and October 2023, it was examined a cohort of patients who underwent delayed two-stage breast reconstruction with the addition of ADM prepared by Central Tissue Bank (CTB) the Burn and Reconstructive Surgery Department University Hospital Ružinov. Our primary focus was on the occurrence of significant postoperative complications during both the initial and subsequent reconstruction periods, taking into account patients' medical history, comorbidities, and adjuvant therapy. RESULTS: We examined a total of 46 patients (49 breasts) who underwent two-stage breast reconstruction. The average age of the patients was 46 and the average BMI was 23.1. The average length of outpatient follow-up for female patients was 32 months. We observed a total of 4 cases of capsular contracture, ranging from grade I to grade III, with 2 cases requiring surgical revision through capsulotomy and implant exchange. Postoperative complications, such as infection and dehiscence leading to expander/implant loss, occurred in one case. The occurrence of seroma was noted in 3 cases. Complications were more frequently observed in the group of patients with post-radiation chest changes and comorbidities such as diabetes or hypertension, and in patients with a lower BMI than the group's average (23.1). In the group of patients who were smokers, we did not observe an increased rate of complications, with the exception of wound dehiscence in cases where there was no expander exposure. CONCLUSION: In experienced hands, ADM prepared by CTB and used in delayed two-stage breast reconstruction, can be beneficial as an adjunct to prosthetic breast reconstruction while also reducing costs.

• Klíčová slova
• acellular dermal matrix, breast expander, breast reconstruction, prosthetic breast reconstruction,
• MeSH
• acelulární dermis * MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mamoplastika * metody   škodlivé účinky   MeSH
• mastektomie metody   MeSH
• nádory prsu * chirurgie   MeSH
• pooperační komplikace epidemiologie   etiologie   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

The authors present a technique of bilateral breast reconstruction in case series of 5 patients, allowing simultaneous harvest of both latissimus dorsi myocutaneous flaps. Three patients underwent bilateral immediate reconstruction after prophylactic mastectomy. One patient underwent a delayed reconstruction, in 1 patient latissimus dorsi myocutaneous flap was used after prophylactic mastectomy and reconstruction with implants followed by bilateral necrosis of the skin flaps. The described technique enables safe breast reconstruction in one procedure. The average reconstruction time was about 4 hours, which represents bilateral latissimus dorsi procedure to the centre of the breast reconstructions range, between the reconstructions with double free tissue transfer and the breast implants.

• Klíčová slova
• bilateral breast reconstruction, latissimus dorsi myocutaneous flap, prophylactic mastectomy,
• MeSH
• lidé MeSH
• mamoplastika * metody   MeSH
• mastektomie MeSH
• nádory prsu * chirurgie   MeSH
• povrchové zádové svaly * MeSH
• prsní implantáty * MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Breast conserving surgery has been reserved for patients with favorable proportion between tumor dimensions and breast size. Introduction of local flaps from the lateral thoracic region has widened the indications for breast conserving surgery, by allowing surgeons to perform wider excisions, thus yet be able to ensure tumor-free surgical margins and a good aesthetic result. We have used lateral intercostal perforator flaps and flaps harvested on the lateral thoracic artery and lateral thoracic artery axial flap in patients with small breasts and an unfavorable tumor to breast size proportion. From May 2015 to October 2016, 19 patients with breast tumors have been treated with BCS and immediate volume replacement reconstruction by pedicle perforator flaps from the lateral thoracic region. In 15 patients lateral intercostal artery perforator flaps or lateral thoracic artery perforator flaps were used after quadrantectomy or wide local excision, in 3 patients as volume replacement after mastectomy and in 1 patient after mastectomy following previous augmentation mammoplasty. In all patients, good breast symmetry was achieved, with no major complications. Fibrosis of the flap and residual breast parenchyma, with volume reduction were noticed after postoperative radiotherapy in thin patients or flaps with little subcutaneous fat. Perforator flaps from the lateral thoracic region should become the gold standard for reconstructions after breast conserving surgery involving less than 20% of the breast volume or after mastectomy in patients with small breasts. The operating procedure is safe, quick and allows sparing of the latissimus dorsi muscle and thus minimal donor site morbidity, as well as an excellent aesthetic result.

• Klíčová slova
• LICAP, LTAP, breast reconstruction, perforator flaps,
• MeSH
• lidé MeSH
• mamoplastika metody   MeSH
• nádory prsu patologie   chirurgie   MeSH
• perforátorový lalok krevní zásobení   MeSH
• prsy patologie   chirurgie   MeSH
• segmentální mastektomie * MeSH
• tumor burden MeSH
• velikost orgánu MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Some patients undergoing breast reconstruction with acellular dermal matrices (ADMs) develop postoperative erythema overlying their ADM grafts named red breast syndrome (RBS). To the best of our knowledge this entity has never been related to the use of a synthetic mesh. We present a case of a 61-year-old patient who underwent bilateral nipple-sparing prophylactic mastectomy because of BRCA-1 gene mutation. The patient was reconstructed with a direct-to-implant approach, and the implants were covered with a polyglycolic acid mesh. Twenty days after the reconstruction, she presented with a blanching erythema of both reconstructed breasts without signs of infection on the area covered by the mesh. The patient denied symptoms like fever or tenderness and presented with no clinical signs of infection. Her laboratory tests were within normal range. We decided to watch and wait. The patient continued strict controls in the outpatient setting. Gradually, the erythema begun to disappear and it resolved spontaneously. RBS has only been described with the use of ADMs, but since in this case the mesh was made of polyglycolic acid, we suggest RBS should be considered either with the use of biological or synthetic meshes. The importance of its differential diagnosis resides in distinguishing it from an infection.

• Klíčová slova
• Breast cancer, Mastectomy, breast reconstruction, polyglactin mesh, polyglycolic acid mesh, red breast syndrome,
• MeSH
• chirurgické síťky * škodlivé účinky   MeSH
• erytém etiologie   MeSH
• implantace prsní náhrady MeSH
• lidé středního věku MeSH
• lidé MeSH
• mamoplastika * škodlivé účinky   MeSH
• mastektomie MeSH
• nádory prsu chirurgie   MeSH
• polyethylenglykoly MeSH
• prsní implantáty škodlivé účinky   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• polyethylenglykoly MeSH

In patients with large breasts undergoing a subcutaneous mastectomy with immediate implant-based reconstruction, is necessary to perform a mastopexy. The combination of these procedures increases the complication rate. To reduce it, it is necessary to cover the lower pole of the implant. Our study aimed to compare the use of an autologous dermal flap and an absorbable breast mesh. A total of 64 patients without previous breast surgery were divided into 2 groups, each with 32 patients. In the 1st group, the implant was covered with an autologous caudally based dermal flap, sutured to the great pectoral muscle. In the 2nd group, the implant was covered with a fully absorbable breast mesh, fixed caudally in the inframammary fold and cranially to the great pectoral muscle. The incidence of complications, the aesthetic effect, and patient satisfaction were evaluated in a one-year follow-up. In the 1st group, there were 2 cases of seroma, 2 partial nipple-areola complex necrosis, 4 cases of dehiscence in the T-suture, and the malposition of the implant in 2 patients. In the 2nd group, there were 2 cases of seroma, 2 cases of T-junction dehiscence, and 1 case of full nipple-areola complex necrosis, which resulted in implant loss. There was no significant difference in patient satisfaction between the study groups. The dermal flap is more suitable for breasts with pronounced ptosis. The use of the synthetic mesh is suitable for smaller breasts, where the possible dermal flap would be too small to cover the implant. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

• Klíčová slova
• Autologous dermal flap, Breast reconstruction, Fully absorbable breast mesh, Risk-reducing subcutaneous mastectomy, Silicone breast implants,
• MeSH
• chirurgické síťky MeSH
• lidé MeSH
• mamoplastika * škodlivé účinky   metody   MeSH
• mastektomie metody   MeSH
• nádory prsu * chirurgie   MeSH
• nekróza chirurgie   MeSH
• prsní bradavky chirurgie   MeSH
• retrospektivní studie MeSH
• serom chirurgie   MeSH
• subkutánní mastektomie * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Breast reconstruction is increasingly present in the treatment of breast cancer. It may be accomplished with implants or autologous tissues. This cross-sectional study evaluates patients satisfaction and quality of life in women after successful autologous or implant breast reconstruction. MATERIAL AND METHODS: 109 women who successfully underwent breast reconstruction between 2007 and 2016 were included. The patients completed the BREAST-Q questionnaire at follow-up visits. Additional data were collected retrospectively from the hospital charts regarding complications, smoking, chemotherapy, radiotherapy, unilateral or bilateral reconstruction, BMI and comorbidities. Mann-Whitney U Test was applied to evaluate differences between the autologous breast reconstruction group (n = 50) and the implant breast reconstruction group (n = 59). RESULTS: Women with a successful autologous reconstruction were significantly more satisfied with their reconstructed breasts than women with successful alloplastic breast reconstruction as measured by the BREAST-Q breasts module (p = 0. 00596), psycho-social well-being module (p=0.04) and sexual well-being module (p=0.00068). Furthermore, there is a higher degree of satisfaction in patients who have not undergone radiotherapy, with no complications and with a normal BMI for implant reconstruction group as well as in non-smokers, and bilateral reconstructions for flap reconstruction group. DISCUSSION: The findings of our study are in agreement with the data found in the literature, attributing greater satisfaction with physical, mental and social wellbeing, as well as with elements having repercussion on sexual wellbeing, to autologous breast reconstruction. CONCLUSIONS: Autologous breast reconstruction leads to higher patient satisfaction than implant breast reconstruction. This study may help patients and medical teams in their decision-making process regarding breast reconstruction. This pilot study opens several questions that need further investigations in a larger prospective studyKeywords: Breast reconstruction, breast-Q, satisfaction, implant, autologous tissue.

• MeSH
• autologní transplantace MeSH
• chirurgické laloky MeSH
• implantace prsní náhrady MeSH
• kvalita života MeSH
• lidé MeSH
• mamoplastika metody   MeSH
• mastektomie MeSH
• nádory prsu chirurgie   MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• prsní implantáty MeSH
• průřezové studie MeSH
• průzkumy zdravotní péče MeSH
• retrospektivní studie MeSH
• spokojenost pacientů * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: The treatment of breast cancer has developed a lot during the last decade, nevertheless it still remains a considerable social and economical problem all over the world. The choice of the surgical procedure depends on a patients protocol and the surgeons preferences. The aim of this study is to evaluate the stress on the scar after breast reconstruction. METHODS: Mathematical modeling of the sutured skin flap used for breast implant placement was divided into the following two steps. At first, material model of the selected silicone implant was identified. Afterwards, the mathematical model of the breast and implant was performed. RESULTS: Maximal geometrical deviation for anatomical and round implant is placed on the lower surface of the breast and upper surface of the breast, while in the area of lateral geometry and the area around the nipple the agreement reaches very high level. The maximal tension is located in two median stitches. The maximal force reaches 0.025 N. The Cauchy stress equivalent is located around the nipple and reaches the value of 380 kPa. CONCLUSION: From our results it can be seen, that the anatomical and round breast implants do not result in the same stress on the scar. The maximal value difference reaches 13.4% between stress values for these two breast implants and the round implant results in higher loaded scar compared to the anatomical implant.

• Klíčová slova
• Scar, breast, finite element method, silicone implant aesthetical surgery.,
• MeSH
• anatomické modely MeSH
• břicho MeSH
• chirurgické laloky * MeSH
• implantace prsní náhrady škodlivé účinky   metody   MeSH
• jizva etiologie   patologie   MeSH
• lidé MeSH
• mamoplastika škodlivé účinky   metody   MeSH
• nádory prsu chirurgie   MeSH
• prsní implantáty * MeSH
• statistické modely MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The aim of this study was to compare long-term clinical and patient-reported outcomes in terms of satisfaction and health-related quality of life (HRQoL) following postmastectomy breast reconstruction using BREAST-Q in patients undergoing implant-based reconstruction, abdominal-based autologous reconstruction, and combined reconstruction (with implant and LD flap or implant and TDAP flap). METHODS: A cross-sectional study was conducted. Patients had undergone delayed postmastectomy breast reconstruction and completed the BREAST-Q reconstruction module. The results were related to the clinical data obtained from the clinic's patient record system. A 5-year examination was included. Mean scores and standard deviations were calculated. Kruskal-Wallis test, Chi-square goodness of fit test and Chi-square test were used for the statistical analysis. RESULTS: Overall, 110 patients (n = 24 implant, n = 38 autologous, n = 48 combination) were included. Patients with autologous reconstruction reported greater postoperative satisfaction with breasts (p < 0.001), satisfaction with outcome (p < 0.001), psychosocial well-being (p = 0.001), and sexual well-being (p = 0.051). CONCLUSION: This study represents a comprehensive long-term examination of postmastectomy breast reconstruction. Autologous reconstruction patients had higher postoperative satisfaction and HRQoL than patients receiving other types of reconstruction despite having more intense oncological therapy and the highest mean number of follow-up surgical procedures. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

• Klíčová slova
• BREAST-Q, Breast reconstruction, Patient-reported outcomes,
• MeSH
• estetika MeSH
• hodnocení výsledků péče pacientem MeSH
• kvalita života MeSH
• lidé MeSH
• mamoplastika * škodlivé účinky   MeSH
• mastektomie MeSH
• nádory prsu * chirurgie   MeSH
• následné studie MeSH
• průřezové studie MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH