V.E. Karasev1, A.Kh. Ismagilov2
1Clinical Oncology Dispensary, Omsk
2Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
Karasev V.E. — PhD (Medicine), Head of the Surgery Department for breast and soft tissue tumors
12, Lenin St., 644099 Omsk, Russian Federation, tel.: +7-913-618-35-66, e-mail: kobra919@yandex.ru, ORCID ID: 0000-0002-6134-8719
Abstract. Mastectomy is an effective treatment for breast cancer, but it is accompanied by physical suffering and psychological trauma associated with organ loss. Reconstruction is the only way to restore the breast after a radical mastectomy.
Objective — to evaluate the oncological safety of oncoplastic surgeries and their impact on the psycho-emotional state of women who underwent mastectomy.
Material and methods. An open single-center prospective randomized study was conducted with the participation of 577 women suffering from breast cancer from stage I to III A and 40 healthy women aged 18 to 40 years after aesthetic mammoplasty. The patients were divided into groups depending on the type of tumor, as well as into subgroups depending on the type of surgical treatment. We polled the patients to assess the anxiety and depression levels. The level of cortisol in the blood serum and the content of vanillylmindal acid in the urine were also determined.
Results. In the preoperative period, patients with breast cancer had clinically significant anxiety and depression, most pronounced in subgroup A, as well as in patients with stage III breast cancer. In the postoperative period, in subgroups B and C, the level of cortisol in the blood and vanillylmindal acid in the urine normalized against the background of a decrease in depression and anxiety. In subgroup A, clinically pronounced anxiety and depression persisted against the background of a sharp decrease in cortisol levels in the blood. During 5 years of follow-up, 34 patients (5.9% of all operated patients) developed local relapses in the area of the postoperative scar: in subgroup A — 8.4%, in subgroup B — 4%, in subgroup C — 4%. —Metastasis was detected in 81 patients (14%): in subgroup A — 16.3%, in subgroup B — 12.4%, in subgroup C — 12%. Reconstructive plastic surgery on the breast after radical mastectomy does not increase the frequency of the disease recurrence and the formation of metastases. On the contrary, by reducing the level of anxiety, depression, and stress in general, normalizing the level of cortisol and vanillylmindic acid in the urine, it helps to reduce the likelihood of recurrence and metastasis within five years after surgery.
Key words: mastectomy, stress, anxiety, depression, reconstructive surgery, rehabilitation.