The comparison of effectivity in breast cancer prevention between skin sparing and subcutaneous mastectomy - 20 years of experience.

INTRODUCTION: Breast cancer is the leading cause of neoplasm mortality among women. Several prevention strategies have been implemented to early detect and prevent the cancer occurrence. The most effective protocol includes prevention mastectomy for the high-risk patients. In our study, we have compared the efficacy of subcutaneous mastectomy (SCM) and skin sparing mastectomy (SSM) in long-term follow up. METHODS: We have included 201 female patients who have been treated at our department over the course of 20 years between 2000 and 2019. All the patients were at high risk of developing breast cancer and therefore were indicated for the prophylactic mastectomy. The main indication was the presence of the mutation in the BRCA1 or BRCA2 cluster, however, even in the lack of such mutation, the family history was sufficient for the mastectomy indication. Patients underwent either SCM, SSM or areola sparing mastectomy (ASM), and were allocated to aforementioned groups, respectively. We have collected the data regarding the reconstruction method along with age, weight, height, body mass index (BMI) and presence of predisposing genetic mutations such as BRCA positivity. RESULTS: The patients who underwent SSM compared to those who underwent SCM were of higher age, with higher BMI and body mass. The patients in SSM group had statistically significantly higher BMI than in ASM. There was no difference in efficacy between patients who underwent SSM and SCM. The majority of patients (91.5%) were positive for BRCA1 or BRCA2 mutation. In our study, only four patients were tested negative for known breast cancer inducing mutation (three in SCM and one in SSM). The most common reconstruction method was an abdominal flap and breast implant. CONCLUSIONS: Prophylactic mastectomy is a reliable strategy for significantly reducing the number of breast cancer incidence in high-risk patients regardless of the selected method of mastectomy. These operations allow for the subsequent reconstruction with the whole spectrum of reconstructive options.

[Modification of the development of infant kidneys by homotransplantation to adult recipients. Hemodynamic and morphologic study on the minipig]. / Beeinflussung der Entwicklung von Säuglingsnieren durch Homotransplantation auf adulte Rezipienten. Hämodynamische und morphologische Studie am Minischwein.

To study the development or absence of a compensatory hypertrophy and early maturity of suckling kidneys after allotransplantation into adult recipients, MLC histocompatible piglet kidneys of the minipig were transplanted en bloc into the binephrectomized mother. As a result, the significant higher renal perfusion pressure in the circulation of the sow in comparison with the lower arterial pressure in the piglet organism caused a autoregulatoric increase in the blood flow of the infantile kidneys following the transplantation. After 1-2 weeks, the transplants showed an abnormal weight increase attributable to the prematurity associated with glomerular and tubular hypertrophy as well as to rejection-induced or unspecific inflammatory infiltrations. The functional effectiveness of the pediatric grafts were limited especially by the body weight of the recipients and by the rapidly occurring deficit of nephrons in consequence of infection and/or rejection. As a survival period of 45 days was reached in one case, the recipient shows approximately physiological creatinine concentrations in serum.

[Transplantation of the kidneys from newborn donors, using the Mini-Lewe minipig as a model]. / Transplantation von Spendernieren Neugeborener am Modell des Miniaturschweins Mini-Lewe.

The importance of kidneys from newborn donors in transplantation has not been clearly defined. The purpose of this study was to investigate the degree of morphological and functional adaptation of the newborn kidney in an adult recipient. 7 MLS-matched kidneys from Lewe minipig puppies (age: 3-4 weeks) had been transplanted en bloc to their mothers with immediately bilateral nephrectomy. Preliminary results suggested that arterial vasculature and blood supply are the limiting factors in adaptation of newborn donor kidneys in adult recipients.

[Possibilities and problems in the transplantation of kidneys from newborn donors using the minipig as a model]. / Möglichkeiten und Probleme der Transplantation von Spendernieren Neugeborener am Modell des Minischweins.

The importance of kidneys from newborn donors in transplantation has not been clearly defined. The purpose of this study was to investigate the degree of morphological and functional adaptation of the newborn kidney in an adult recipient. 7 MLS-matched kidneys from LEWE minipig puppies (age 3-4 weeks) had been transplanted en bloc to their mothers with immediately bilateral nephrectomy. Preliminary results suggested that arterial vasculature and blood supply are limiting factors in adaption of newborn donor kidneys in adult recipient.