ABSTRACT
(1) Objective: Breast cancer is the most common cancer in women, and the incidence of the disease continues to increase. The issue of immediate breast reconstruction (IBR) in women with BRCA mutations and breast cancer is highly topical. This study is based on the long-term experience of our workplace with the diagnosis and treatment of breast cancer in women. We use the possibilities of oncoplastic surgery, including IBR. Our effort involves learning about women's awareness of IBR with a mastectomy at the same time. (2) Methods: The method of quantitative research of women's awareness using a structured anonymous questionnaire was chosen. Out of the total number of 84 respondents who already underwent IBR, 36.9% were due to BRCA mutations, and 63.1% were due to breast cancer. (3) Results: All of the respondents learned about the possibility of IBR before treatment or during treatment planning. The information was first obtained mainly from an oncologist. Women obtained the most information regarding IBR from a plastic surgeon. Before the mastectomy, all of the respondents already knew what IBR meant, as well as about the payment of IBR by the health insurance company. All of the respondents would choose the IBR option again. A total of 94.0% of women cited preservation of body integrity as a reason for undergoing IBR, and 88.1% of women knew about the possibility of performing IBR with their own tissues. (4) Conclusions: There are few specialized centers with a team of experts in reconstructive breast surgery in the Czech Republic, especially those that perform IBR. Research has shown that all of the patients were well informed about IBR, but the vast majority only learned about IBR before the surgical procedure was planned. All of the women wished to maintain body integrity. Our study results in the recommendations for patients and for healthcare management.
ABSTRACT
BACKGROUND: Human embryonic stem cells (hESCs) have the unique ability to differentiate into any cell type in the human body and to proliferate indefinitely. Cell therapies involving hESC have shown very promising results for the treatment of certain diseases and confirmed the safety of hESC-derived cells for humans. They are used in cell therapy, mainly in targeted therapy of diseases that are currently incurable. OBJECTIVES: The aim of this study was the derivation of clinical-grade hESCs usable in drug development, non-native medicine and cell therapy. MATERIAL AND METHODS: Embryos were thawed, cultivated to the blastocyst stage if necessary, and assisted hatching was subsequently performed. Embryoblasts were mechanically isolated using narrow needles. Each line was kept as a separate batch. The derived hESCs were cultured under hypoxic culture conditions (5% O2, 5% CO2, 37°C) in a NutriStem® hPSC XF Medium with a daily medium change. RESULTS: From January 2018 to July 2020, 138 selected clients were asked for consent to donate embryos, of whom 52 did not respond, 19 terminated the storage of their embryos and 29 extended the storage. Only 38 clients (27.5%) agreed to donate embryos for the derivation of hESCs. At the same time, personal communication with clients took place and another 17 embryo donors were recruited. A total of 160 embryos from 55 donors aged 26-42 years were collected. The embryos were frozen at the blastocyst (33.1%) or morula (46.3%) stage. After the preparation of 64 embryos, embryoblasts were isolated and cultured. Finally, 7 hESC lines were obtained, 4 research-grade and 3 clinical-grade, the first in the Czech Republic. CONCLUSIONS: We established a current good manufacturing practice (cGMP)-defined xeno-free and feeder-free system for the derivation, culture and banking of clinical-grade hESC lines that are suitable for preclinical and clinical trials. The quality control testing with criteria concerning sterility, safety and characterization according to cGMP ensured the clinical-grade quality of hESC lines.
Subject(s)
Embryonic Stem Cells , Quality of Life , Humans , Czech Republic , Cell Line , Embryo, MammalianABSTRACT
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.
