Simultaneous breast reconstruction with the application of preventive lymphovenular anostomosis in a patient with breast cancer

Breast cancer (BC) occupies a leading position among all oncological diseases. More than 2.3 million new cases are registered annually, and the death rate exceeds 670 thousand. In the Republic of Kazakhstan, the incidence is steadily increasing (in 2024, the primary incidence was 204.8 per 100,000 population), while 94.3% of cases are detected at stages I – II, and 82% of cases are women of active working age (up to 65 years), which emphasizes the socio-economic importance of maintaining the quality of life.

Radical mastectomy remains the standard of surgical treatment, ensuring oncological radicalism. However, the loss of the breast (the organ that defines female identity) leads to psychoemotional disorders and social stigmatization. Simultaneous implant reconstruction allows combining radicalism and aesthetics, improving the psychological state of patients and reducing disability. The key success factor is the choice of a fixing material to strengthen the lower pole of the implant. This is what determines the frequency and severity of complications (seroma, infection, necrosis of the skin flap, capsular contracture, implant loss), reaching 2035%. Traditional axillary lymphodissection (TAL) in the surgical treatment of breast cancer is associated with a high risk of lymphedema (20-40%), which significantly affects the quality of life.

The article describes a clinical case of a 34-year-old patient with luminal B, HER2/neu-negative subtype of BC, who received neoadjuvant chemotherapy. During surgical treatment, a radical mastectomy with simultaneous reconstruction with an implant and mesh was performed, as well as preventive lymphatic reconstruction during TAL. The postoperative period was uneventful; the signs of lymphedema were observed dynamically (6 months) and were not revealed. The case demonstrates the integration of modern approaches: the patient underwent surgery (subcutaneous radical mastectomy with simultaneous reconstruction of the implant, fixation of the lower pole of the implant with a polypropylene mesh, biopsy of the signal lymph node and intraoperative staging (N-status) using ICG lymphography), then, according to the indications, an extended lymph dissection of 1-3 orders was performed, simultaneous application of lymphvenular anastomosis for the prevention of lymphedema.

The described comprehensive approach in the treatment of patients with breast cancer is important for the Republic of Kazakhstan, where there is an increase in the number of young patients with breast cancer and access to reconstructive and microsurgical technologies is limited.

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