Background. In recent years, the availability of reconstructive plastic surgery has reached a new level. when performing an oncological operation, the question arises about choosing further reconstruction tactics: through one-stage or through delayed reconstruction. In the vast majority of cases, tissue expanders/implants are used for simultaneous breast reconstruction, but it is still unclear which allograft allows achieving the best aesthetic results of the operation without increasing the incidence of postoperative complications. In this review, we assessed the impact of the type of implant on aesthetic satisfaction with the result of reconstruction and the incidence of postoperative complications in patients with breast cancer.Aim. To evaluate the impact of the type of implant during reconstruction on the risk of postoperative complications and quality of life in patients with breast cancer.Materials and methods. A search for relevant sources was carried out in PubMed, MedLine, Cochrane Library, EMBASE, Global Health, Cyber Leninka, SpringerLink, e-Library, publications from 2010 to 2022 were studied, with an analysis of the evidence-based experimental and clinical base on the most modern issues breast reconstruction. Results. Having analyzed articles published over the past 15 years, we can clearly conclude that performing reconstructive plastic surgery in patients with breast cancer using various types of implants improves the quality of life and improves the aesthetic result of reconstruction according to the BREAST-Q questionnaire, regardless of the type and type of implant used.Conclusion. The use of anatomical implants in breast reconstruction compared to round ones reduces the risk of rupture, rippling, and the frequency of symmetrizing operations, but increases the risk of infectious complications and repeated operations to replace/remove the implant. The use of textured implants reduces the incidence of capsular contracture relative to smooth ones. High satisfaction with the aesthetic outcome of reconstruction, as measured by the BREAST-Q questionnaire in patients with silicone implants, is not equivalent to an improvement in general health status (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30).

Key words: breast cancer; neoadjuvant drug therapy; organ-preserving operations; oncoplastic operations; resection margins.

Due to the success of neoadjuvant systemic therapy and modern approaches to the surgical treatment of breast cancer, the proportion of organ-preserving operations has increased significantly. Radiation therapy reduces the risk of local recurrence of breast cancer after breast preservation, but entails undesirable consequences of exposure to surrounding tissues. The popularity and low frequency of side effects of accelerated partial irradiation allows us to consider it in some cases as an alternative to traditional remote irradiation in breast cancer patients.

Performing immediate reconstructive plastic surgery, regardless of the type of reconstruction, reduces the level of anxiety in its various manifestations, anxiety disorders, depression, improves the quality of life and increases the level of aesthetic satisfaction of the patient with the results of surgical treatment.

One of the advantages of systemic cytotoxic therapy is the «transformation» of positive axillary nodes into negative nodes (cN+ → cN-); a similar concept is used in randomized clinical trials with «post-neoadjuvant» sentinel lymph node - pNsn. In studies of ACOSOG Z1071, SENTINA, SN FNAC, was evaluated the frequency of a false-negative result with a biopsy of the sentinel lymph node (BSLU) after neodjuvant chemotherapy. It was proved that there was no need for immunohistochemical examination of lymph nodes using the BSLU technique followed by adjuvant therapy, since the detected micrometastases did not worsen overall survival. As for patients with biopsy of signaling lymph nodes after neodjuvant chemotherapy, nowadays particular interest of prognostic in significance for micrometastases and individual tumor cells in the lymph nodes, as well as an estimate of the frequency of false-negative result.

Т. 18, №3 -НОВЫЕ ПОХОДЫ В ХИРУРГИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ Е.М.Бит-сава 1

The oncological breast surgeries with single-stage replacement of the lost volume by means of autogeneous tissue using distant flaps grafting (particularly by skin--muscular flaps of the latissimus dorsi) allow obtaining satisfactory and stable aesthetic results without the decrease of indices of relapse-free and general survival. The early results of the application of the skin-muscular flaps of the latissimus dorsi for single-stage breast reconstruction after radical breast resection are presented in this work in 3 patients with breast cancer. The technique allows performance of the extensive radical resection with single-stage grafting in patients with breast cancer and obtaining an objective clinical response against the background of neoadjuvant therapy with subsequent applying radiation therapy and systemic treatment.

An absence of breast is the irreversible cosmetic and physical defect, which reduces the self-assessment and psyco-emotional status of women. Nowadays the necessity of reconstruction after mastectomy will gain more popularity and plays a fundamental role in psychological and social rehabilitation of breast cancer patients. The article analyzes the experience of reconstructive plasty of 26 patients with I-III stages of breast cancer.