[Primary plastic reconstructive surgery as a component of therapy for breast cancer]. / Pervichnye rekonstruktivno-plasticheskie operatsii pri rake molochnoi zhelezy.

We have carried out 281 primary plastic reconstructive operations (thoracodorsal flap--171; rectoabdominal flap--104) as a component of therapy for breast cancer in 1998-2004. Such indications as young age and the patient's desire to preserve the breast were considered. Radical intervention was followed by breast reconstruction. Individualized treatment made it possible to combine radicality of intervention with formation of a breast well matching the intact one.

[Biopsy of non-palpable tumors of the breast]. / Biopsiia nepal'piruemykh obrazovanii molochnoi zhelezy.

14 biopsies were performed in patients with non-palpable tumors of the breast with stereotaxic automated system (ABBI) and disposable "pistol-needle" ("Auto-Suture") whose needle-harpoon penetrates into pathologic focus under local anesthesia (four fold digital stereotaxic control guarantees the precision of biopsy). Non-palpable breast cancer in the tissue areas of 4, 7 and 11 mm in horizontal section was diagnosed in 3 patients. Biopsy was performed outpatiently, there were no complications. The procedure is like a diagnostic sectoral resection of the breast.

[Parasternal lymph node excision in breast cancer]. / Parasternal'naia limfadenéktomiia pri rake molochnoi zhelezy.

Comparative analysis of the results of videothoracoscopic parasternal lymphadenectomy and standard mastectomy by Urban--Holdin is presented. In November 1995 to December 1999 205 videothoracoscopic parasternal lymphadenectomies were performed (96--on the left, 104--on the right). Central and medial location of breast cancer was indication for this operation. Age of the patients ranged from 23 to 73 years. Surgery was performed under intravenous anesthesia in the conditions of artificial lung ventilation with separate lung intubation. Mastectomy was performed as the first stage. Further, thoracoports were introduced into pleural cavity in the 5th intercostal space along medioclavicular and mediaxillar lines and in the 4th intercostal space along anterior axillar line. Parietal pleurotemy was performed parallely to internal thoracic vessels, parasternal fat and lymph nodes were removed en-block. Parasternal lymph nodes were involved in 40 (19.5%) patients. The spirometry, cardiomonitoring which were used pre-, intra-, postoperatively demonstrated that parasternal thoracoscopic lymphadenectomy is less traumatic and effective as diagnostic method than mastectomy by Urban--Holdin. Parasternal thoracoscopic lymphadenectomy can be recommended as a method of choice in medial and central breast cancer.