Clinical and morphological evaluation of a study of resection margins in breast cancer after subcutaneous/skin-sparing mastectomy with reconstruction

Objective. To improve the results of surgical treatment in patients with breast cancer (BC), by reducing the incidence of a local recurrence with a positive resection margin (R1), as evidenced by elective histological examination after subcutaneous or skin-sparing mastectomies with simultaneous reconstruction for BC. Materials and methods. The material for the investigation was tissue samples obtained during the examination of 34 patients diagnosed with BC, in whom a positive margin (R1) was detected during an elective histological examination. The paper presents the clinical features and morphological characteristics of the tumor. There are two treatment tactics for positive R1 edges: radiation therapy or repeated surgery. Results. A total of 16 repeated operations for R1 were performed in 15 of the 34 patients due to primary multiple synchronous BC in one patient), combined treatment involving radiotherapy was used in 29 of the 34 patients, including patients after resurgery. The follow-up lasting 6 to 84 months revealed three recurrences following 28, 16, and 84 months, respectively. The histological characteristics of recurrent tumors were invasive carcinoma without the signs of specificity in 3 cases, G2 in 2 cases, G3 in 1 case; there was luminal type A in 2 cases and luminal type B HER2-positive in 1 case. The recurrent tumor of BC was multicentric in 1 case. While treating the recurrent tumor, the skin and subcutaneous tumor with a tumor node were excised in 1 case; an implant with a capsule and the breast skin were removed, by replacing the implant, in 2 cases. In the analyzed group, a recurrence was diagnosed in 8.8% of cases; the three-year relapse-free survival was observed in 91.2%; the overall survival rate was 100%. Conclusion. Based on the conducted investigation and assessment of long-term results, we consider it expedient to perform resurgery for positive two or more margins and radiotherapy for one positive margin after subcutaneous /skin-sparing mastectomy. Resurgery is not indicated. © 2023, Media Sphera Publishing Group. All rights reserved.