ADM-assisted prepectoral breast reconstruction is not associated with high complication rate as before: a Meta-analysis

Inferior Breast Pole Dermal Flap: A 7-year Experience

Background

The use of an inferior breast pole dermal flap for implant support in breast reconstruction is a reconstructive option with particularly favorable results in patients with macromastia and/or ptosis. The purpose of this study was to analyze the outcomes of Hispanic patients and compare them with those in the existing literature.

Methods

This observational study was conducted using a single surgeon's database. The study included female patients with macromastia and/or ptosis who underwent skin-sparing breast reconstruction using an inferior dermal flap for implant support. Variables obtained included patient demographics, history of chemotherapy or radiotherapy, degree of ptosis, brassiere size, size of initial tissue expander, final implant size, number of expansions, and complications.

Results

A total of 202 women met the inclusion criteria; 136 underwent bilateral reconstruction and 66 underwent unilateral reconstruction. All patients underwent immediate reconstruction, 180 (89.1%) underwent 2-stage reconstruction, and 22 (10.9%) underwent 1-stage reconstruction. No significant trend was observed among those who went directly to implant and those who had tissue expander placement. The majority of patients had ptosis grade III (47.8%). Between 2017 and 2023, there were a total of 22 complications (10.9%), with the most common being infection (3.5%). Forty-two patients received radiotherapy, of which only 5 developed complications.

Conclusions

Breast reconstruction with an inferior breast pole dermal flap is a safe and feasible option, with minimal complications in Hispanic patients with ptosis and macromastia.

Postoperative complications of ADM use in previously irradiated patients during stage I of implant-based breast reconstruction: A national database propensity score-matched analysis

INTRODUCTION

Acellular dermal matrix (ADM) is widely used in implant-based reconstruction to prevent capsular contracture, but its safety in irradiated patients is underexplored. We aimed to evaluate postoperative complications associated with ADM use in stage I of implant-based breast reconstruction in patients with premastectomy radiation.

METHODS

Using the Merative MarketScan Research Databases, 2012-2020, previously irradiated patients undergoing outpatient stage I implant breast reconstruction (prepectoral and submuscular) were stratified by ADM use and propensity score-matched. Postoperative complications and additional surgical interventions within 90 days were analyzed using multivariate logistic regression.

RESULTS

Among 1234 matched patients (617 ADM and 617 non-ADM), ADM use was first recorded in 2012, and its frequency showed a positive correlation over the study (r = 0.214, p <.001). Patients with ADM experienced higher rates of wound (8.5% vs. 7.8%) and tissue necrosis (5.5% vs. 4.0%) than non-ADM patients, but these differences were not statistically significant. Additionally, no significant differences were observed between ADM and non-ADM groups in the rates of seroma formation, hematoma, fat necrosis, or postoperative infections. ADM use was associated with significantly lower odds of requiring image-guided fluid drainage for hematomas or seromas (OR 0.11, 95% CI 0.01-0.89, p =.039).

CONCLUSION

No significant difference in complication rates was found between previously irradiated breast cancer patients with and without ADM on a large scale, even with ADM usage increasing over time. Its adoption should balance cost, surgeon preferences, and esthetic outcomes, with further research needed on its role in various reconstruction planes and cost impacts.

Use of 801 Acellular Dermal Matrices (ADMs) in Direct-to-Implant Breast Reconstruction: A Clinical Observation of Complication Profiles Over a 7-Year Period

BACKGROUND

The emergence of acellular dermal matrices (ADMs) revolutionized prepectoral breast reconstruction, allowing partial or complete implant coverage. ADM had been described to possess several important benefits; nevertheless, the literature described an increased postoperative complication rate.

OBJECTIVES

The aim of this study was to delineate H.Y.K.'s experience with ADM in direct-to-implant (DTI) breast reconstruction, and to describe complication rate and patient satisfaction.

METHODS

This was a retrospective patient cohort that underwent primary or revisional breast reconstruction (DTI) utilizing DermaCell, from Jan 2017 to Jan 2024.

RESULTS

A total of 230 consecutive patients, 410 breasts, and 801 DermaCell sheets were evaluated. All were DTI breast reconstructions. Complication rate was described per breast. A total of 92 cases of complication occurred (22.4%). Rippling was seen in 18 breasts (4.39%), skin ischemia in 21 breasts (5.12%), hematoma in 5 (1.21%), and seroma in 9 (2.19%). Seventeen breasts experienced capsular contraction. In the nonirradiated group, capsular contracture (CC), Baker grade 3 to 4, was seen in 4 breasts (1.11%), with 9 (18%) in the irradiated group. The postoperative follow-up period was 18 months (range: 6-84 months). BREAST-Q satisfaction with the breast increased by a mean of 10.45. Satisfaction with the implant was 6.61 out of 8.

CONCLUSIONS

This cohort study represents the most comprehensive and up-to-date experience with DermaCell for DTI breast reconstructive surgery. The favorable complication profile suggests that DermaCell ADM offers a safe and reliable option, making it an important tool in the armamentarium of reconstructive plastic surgeon. DermaCell is an important component in prepectoral breast reconstruction, contributing to better results, an improved complication profile, and patient satisfaction.

LEVEL OF EVIDENCE: 4 (THERAPEUTIC)

Redefining infection management in implant-based breast reconstruction: Insights and innovations from an 11-year retrospective analysis

BACKGROUND

Infections associated with implant-based breast reconstructive surgery are challenging for both patients and surgeons, often implying high recurrence rate, long treatments (both medical and surgical management), multiple invasive procedures, and delay of the end-result and, in some cases, even reconstruction failure. Early diagnosis is crucial but not always easy to achieve. Various treatment options are available and have been described in literature, with no clear winning strategy. Recent improvements in microbiological and therapeutic tools have led the authors to question what would be considered the best plan for reconstruction salvage approach.

METHODS

All patients who underwent implant-based breast reconstruction between 2012 and 2023 were enrolled. Clinical records regarding infections and treatment were retrospectively analyzed.

RESULTS

Among a total of 506 patients, 26 (5.14%) developed implant-associated infections. Discussing the results, we realized that previous protocol was old-fashioned and required improvements. Through a multidisciplinary approach, a new prevention and treatment algorithm was derived. First, microbiological screening through nasal and rectal swab allows for proper decontamination prior to intervention. However, the keystone improvement consists in the use of molecular biology analysis, thus minimizing diagnosis timing and allowing targeted antibiotic therapy shortly after the removal of the infected implant. In addition, a fundamental role is played using instillation negative pressure wound therapy as a temporary spacer to ensure the maintenance of the periprosthetic pocket.

CONCLUSIONS

By following these precise steps in case of implant-associated infection, treatment can be optimized to reduce both therapy and hospitalization time, allowing the patient to achieve a reconstruction in a relatively short period.

LEVEL OF EVIDENCE

IV.

Complications and patient-reported outcomes after radiotherapy in breast cancer patients undergoing implant-based breast reconstruction: a retrospective study from a large Chinese breast disease center

BACKGROUND

Postmastectomy radiation therapy (PMRT) can influence the outcome of implant-based breast reconstruction (IBBR). This study aims to investigate the complications and patient-reported outcomes (PROs) following PMRT between direct-to-implant (DTI) and tissue expander-to-implant (TEI) reconstruction.

METHODS

The retrospective study included breast cancer patients undergoing IBBR and PMRT. Patients were divided into a permanent implant group (PI-PMRT) and a tissue expander group (TE-PMRT). Complications, reconstruction failure, and reoperation were compared between the two groups. PROs were assessed using the BREAST-Q scale.

RESULTS

A total of 203 patients were included: 99 in the PI-PMRT group and 104 in the TE-PMRT group. The incidence of severe capsular contracture was significantly higher in the PI-PMRT group compared to the TE-PMRT group (37.4% vs. 24.0%, p = 0.039). The PI-PMRT group had a significantly lower rate of reconstruction failure (9.1% vs. 19.2%, p = 0.039) and reoperation (13.1% vs. 24.0%, p = 0.046). Multivariate analysis revealed that the absence of mesh (OR = 2.177, p = 0.040) and DTI reconstruction (OR = 1.922, p = 0.046) were independent predictors of severe capsular contracture; the absence of mesh (OR = 4.699, p = 0.015) and TEI reconstruction (OR = 2.429, p = 0.043) were independent predictors of reconstruction failure. BREAST-Q scores indicated greater breast satisfaction in the PI-PMRT group (p = 0.031).

CONCLUSIONS

Although DTI reconstruction resulted in a higher risk of severe capsular contracture, the higher risk of reconstruction failure and reoperation in patients undergoing TEI reconstruction was even more concerning. Furthermore, patients were more likely to report greater breast satisfaction with DTI reconstruction. Therefore, DTI reconstruction may be a more appropriate option for patients anticipating PMRT.

Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons

Large-scale defects of body in the reconstructive surgical practice, and the helplessness of their repair with autologous tissues, have been an important factor in the development of artificial biological products for the temporary, definitive, or staged repair of these defects. A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices (ADMs). In recent years, not only the type of tissue from which ADMs are produced, product range, diversity and areas of use have increased, but their use in reconstructive fields, especially in post oncologic breast surgery, has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future. It is essential that reconstructive surgeons become familiar with some of the ADM's as well as the advantages and limitations to their use. This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the armamentarium of reconstructive surgeons. Brief considerations of possible future directions for ADMs are also conducted in the end.

A Pericardium Bovine Matrix Pocket in DTI Prepectoral Breast Reconstruction

Breast reconstructive surgery has evolved significantly over the years. One of the recent advancements is the use of prepectoral implants in combination with synthetic and biological material as a natural and effective coverage. To date, there is little published data on breast reconstruction using acellular bovine pericardium matrix and most concern submuscular breast reconstruction. This study aimed to describe the multicentric-multisurgeon experience in performing direct to implant (DTI) prepectoral breast reconstructions using acellular bovine pericardium matrix (ABPM) pocket. A retrospective multicentric data collection of the all the immediate prepectoral breast reconstructions using acellular bovine pericardium was carried out by the authors. Surgical data including type of mastectomy, axillary surgery, type and size of implant, size of ABPM, duration of surgery were collected for each patient. Postoperative data including adjuvant treatments, complications, necessity to perform other interventions, patient's satisfaction were collected. Cosmetic results were also evaluated by 7 different observers at minimum 1 year follow-up. A total of 65 breast reconstruction were included in the study. Mean follow up was 21.3 months. Average surgical time was 1,42 hours. Minor complications occurred in 4 breasts; major complications occurred in 2 breasts. After 6 months follow-up, 7 patients underwent fat grafting to correct any rippling and /or wrinkling. Breast aesthetic and patients reported outcomes were satisfactory. Not significant capsular contracture was noted at the follow up control. To date, this is the largest study about prepectoral breast reconstruction with ABPM. On the basis of our results, prepectoral breast reconstruction ABPM assisted is a reliable, safe and suitable option providing good patient satisfaction outcomes.

Prepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in "Thin Patients"

BACKGROUND

Prepectoral direct-to-implant reconstruction with acellular dermal matrix (ADM) represents a safe, fast, and successful option in breast reconstruction in a selected cohort of patients. Nowadays, this procedure is considered challenging in thin. Meanwhile, his cohort has not been accurately analyzed yet.

METHODS

A single institution retrospective cohort study was performed between January 2019 and March 2023 in all women who underwent mastectomy. Biometrical and clinical data were recorded. Also, surgical technique, operating room (OR) time, mastectomy weights, implant choice, and acellular dermal matrix (ADM) types were properly noted. Postoperative complications represented the main topic: these were classified into early and late ones based on onset time. At least 12-month follow-up was required. A comparison between thin and ideal body mass index (BMI) populations was performed.

RESULTS

Early complications did not seem to differ between the 2 groups with 37.8% and 38.9% of women having at least 1 early complication in thin and ideal-weight women, respectively (P = .919). In univariable regression analysis, compared with women with a BMI of 22.1 to 25.0, women with a BMI ≤ 22.0 were associated with an increased risk of late complications of 2.84 (1.13-7.14). Specifically, thin women appeared to have a 3-fold increased risk (OR = 2.97, 95% CI 1.08-8.18) of ripples/wrinkles compared with women with ideal weight.

CONCLUSIONS

Prepectoral reconstruction with ADM in thin patients may be considered as safe as in standard BMI patients. Rippling may be more frequent, but, whenever needed, easy to correct with a few sessions of lipo-grafts.

LEVEL OF EVIDENCE

III.

Do we need acellular dermal matrix in prepectoral breast reconstruction? A systematic review and meta-analysis

Acellular dermal matrices (ADMs) are commonly used in prepectoral breast reconstruction. However, ADM is associated with high cost and potentially infection and seroma. Comparative studies on prepectoral reconstruction with and without ADM are limited to small, single-institution series. The purpose of this study was to perform a meta-analysis of prepectoral reconstruction with and without ADM. A systematic literature review was performed to identify studies comparing prepectoral reconstruction with and without ADM using PubMed, EMBASE, and Cochrane databases. Pooled rates of patient demographics and outcomes were analyzed. Meta-analytic effect size estimates were calculated for reconstructive complications in studies comparing reconstruction with and without ADM. In total, 515 reconstructions from four studies were included. Most cases were nipple-sparing mastectomies and utilized tissue-expander reconstructions. Meta-analysis demonstrated no significant difference in the rate of complications between cohorts with and without ADM. Short-term complications included reconstructive failure (1.2% in ADM cohort and 2.8% in no-ADM), seroma (1.2% and 8.3%, respectively), hematoma (1.2% and 2.1%), infection (4.7% and 4.2%), and mastectomy flap ischemia and/or necrosis (2.4% and 5.2%). Long-term complications included rippling (3.3% in ADM and 5.1% in no-ADM cohorts) and capsular contracture (6.8% and 3.4%, respectively). This meta-analysis demonstrated no difference in the rate of complications between cases with and without ADM. However, the outcomes data from no-ADM reconstruction mostly reflect robust mastectomy flaps. Surgeon discretion as informed by specific clinical scenarios should guide decisions regarding the use of ADM in prepectoral breast reconstruction.

ADM-Assisted Direct-to-Implant Prepectoral Breast Reconstruction in Postmastectomy Radiation Therapy Setting: Long-Term Results

BACKGROUND

Postmastectomy radiotherapy (PMRT) on immediate breast reconstruction historically involved a marked increase in complication rate (up to 50%). Prepectoral breast reconstruction (PPBR) has shown promising early postoperative results. This study aims to evaluate PPBR long-term results in PMRT setting.

MATERIALS AND METHODS

This is a retrospective monocentric analysis of 485 PPBR (439 patients) undergoing Acellular-Dermal-Matrix assisted direct-to-implant reconstruction (46 bilateral procedures) between January 2015 and December 2020 (mean FU:35.6 months). Group 1 comprised 401 PPBR not submitted to PMRT, and 84 reconstructions receiving PMRT in Group 2. Patients' characteristics, postoperative complication and revisional surgery rate were examined. PMRT characteristics and subcutaneous tissue thickness, measured in Group 2 by CT scan, were also evaluated.

RESULTS

Long-term complication rate was 11.2% in Group 1 vs. 21.4% in Group 2 (P-value = .019). Capsular contracture represented the only complication associated to a statistically significant difference between the 2 groups (P-value < .001). In Group 2, only 4.8% implant loss and 8.3% severe capsular contracture rate was found. In patients who underwent PMRT, 38.9% of complications settled with no consequences, and only 4.8% of patients needed revisional surgery in the long-term FU. According to multivariate analysis, drug intake and PMRT were significantly associated with postoperative complications. In Group 2, a thinner subcutaneous tissue was linked to a higher complication risk.

CONCLUSION

In our series, patients treated with PPBR who underwent PMRT, presented a low complication rate and minimal need for revisional surgery in the long-term follow-up, suggesting that this technique is feasible and safe also in PMRT context.

Optimizing Acellular Dermal Matrix Integration in Heterologous Breast Reconstructive Surgery: Surgical Tips and Post-Operative Management

Background and Objective: Prepectoral implant placement in breast reconstruction is currently a must-have in the portfolios of breast surgeons. The introduction of new tools and conservative mastectomies is a game changer in this field. The prepectoral plane usually goes hand-in-hand with the ADM wrapping of the implant. It is a cell-free dermal matrix comprising a structurally integrated basement membrane complex and an extracellular matrix. The literature reports that ADMs may be useful, but proper patient selection, surgical placement, and post-operative management are essential to unlock the potential of this tool, as these factors contribute to the proper integration of the matrix with surrounding tissues. Materials and Methods: A total of 245 prepectoral breast reconstructions with prostheses or expanders and ADMs were performed in our institution between 2016 and 2022. A retrospective study was carried out to record patient characteristics, risk factors, surgical procedures, reconstructive processes, and complications. Based on our experience, we developed a meticulous reconstruction protocol in order to optimize surgical practice and lower complication rates. The DTI and two-stage reconstruction were compared. Results: Seroma formation was the most frequent early complication (less than 90 days after surgery) that we observed; however, the majority were drained in outpatient settings and healed rapidly. Secondary healing of wounds, which required a few more weeks of dressing, represented the second most frequent early complication (10.61%). Rippling was the most common late complication, particularly in DTI patients. After comparing the DTI and two-stage reconstruction, no statistically significant increase in complications was found. Conclusions: The weakness of prepectoral breast reconstruction is poor matrix integration, which leads to seroma and other complications. ADM acts like a graft; it requires firm and healthy tissues to set in. In order to do so, there are three key steps to follow: (1) adequate patient selection; (2) preservative and gentle handling of intra-operative technique; and (3) meticulous post-operative management.

Significance of liquid-liquid phase separation (LLPS)-related genes in breast cancer: a multi-omics analysis

Currently, the role of liquid-liquid phase separation (LLPS) in cancer has been preliminarily explained. However, the significance of LLPS in breast cancer is unclear. In this study, single cell sequencing datasets GSE188600 and GSE198745 for breast cancer were downloaded from the GEO database. Transcriptome sequencing data for breast cancer were downloaded from UCSC database. We divided breast cancer cells into high-LLPS group and low-LLPS group by down dimension clustering analysis of single-cell sequencing data set, and obtained differentially expressed genes between the two groups. Subsequently, weighted co-expression network analysis (WGCNA) was performed on transcriptome sequencing data, and the module genes most associated with LLPS were obtained. COX regression and Lasso regression were performed and the prognostic model was constructed. Subsequently, survival analysis, principal component analysis, clinical correlation analysis, and nomogram construction were used to evaluate the significance of the prognostic model. Finally, cell experiments were used to verify the function of the model's key gene, PGAM1. We constructed a LLPS-related prognosis model consisting of nine genes: POLR3GL, PLAT, NDRG1, HMGB3, HSPH1, PSMD7, PDCD2, NONO and PGAM1. By calculating LLPS-related risk scores, breast cancer patients could be divided into high-risk and low-risk groups, with the high-risk group having a significantly worse prognosis. Cell experiments showed that the activity, proliferation, invasion and healing ability of breast cancer cell lines were significantly decreased after knockdown of the key gene PGAM1 in the model. Our study provides a new idea for prognostic stratification of breast cancer and provides a novel marker: PGAM1.

Advances in Prepectoral Breast Reconstruction

Breast reconstruction can be divided into prepectoral breast reconstruction (PPBR) and subpectoral breast reconstruction (SPBR) according to the implant plane. The original prepectoral breast reconstruction was abandoned for a long time due to the frequent and severe complications. Now, advances in materials technology and improved methods of mastectomy have made safe prepectoral breast reconstruction possible. Moreover, a number of studies have gradually demonstrated the advantages of prepectoral breast reconstruction. As prepectoral breast reconstruction becomes more and more attractive, it is time to review the current advances in prepectoral breast reconstruction.

Subpectoral versus prepectoral two-stage breast reconstruction: A propensity score-matched analysis of 30-day morbidity and long-term outcomes

BACKGROUND

Approximately 80% of patients undergoing total mastectomy in the US opt for implant-based breast reconstruction (IBBR). A two-stage reconstruction with tissue expander (TE) remains the most common technique. Since the implementation of ADMs, a prepectoral approach has gained popularity and is becoming the standard of care. Herein, we compared the surgical and postoperative outcomes of prepectoral versus subpectoral two-stage IBBR.

METHODS

A retrospective chart review was performed between January 2011 and December 2020. We included female patients undergoing immediate two-stage IBBR. The primary outcomes of this study were to compare the 30-day morbidity and the overall rate of complications during the first and second stages of reconstruction, and to compare the time to initiate postmastectomy radiotherapy (PMRT). Propensity score matching was implemented.

RESULTS

After matching, 154 reconstructions were analyzed, 77 in each group. The two matched groups exhibited comparable (p > 0.05) characteristics for all analyzed demographic and intraoperative independent variables. Reconstructions in the prepectoral group had a shortened median time for drain removal (13-days vs. 15-days, p = 0.001). The intraoperative expansion volumes were higher in the prepectoral group (300 ml versus 200 ml, p = 0.025). The 30-day morbidity and first- and second-stage complication rates were not significantly different between groups. The time to start postmastectomy radiation therapy (PMRT) was not significantly different between groups (134-days versus 126.5-days, p = 0.58).

CONCLUSION

Prepectoral and subpectoral TE placement had comparable complication rates during the first and second stages of IBBR. Timing for TE-to-Implant exchange and initiation of PMRT were comparable between the two approaches.

Clinical significance for diagnosis and prognosis of POP1 and its potential role in breast cancer: a comprehensive analysis based on multiple databases

Background: Breast cancer (BC) is one of the most common cancers in women. The discovery of available biomarkers is crucial for early diagnosis and improving prognosis. The effect of POP1 in BC remains unrevealed. Our study aims to explore the expression of POP1 in BC and demonstrate its clinical significance and potential molecular mechanisms.

Methods: The Cancer Genome Atlas (TCGA) BC cohort transcriptome data and corresponding clinical information were downloaded. GSE42568 cohort, GSE162228 cohort, GSE7904 cohort, and GSE161533 cohort in the Gene Expression Omnibus (GEO) database were used as verification groups. R software and several web tools were used for statistical analysis. Moreover, the proliferation, transwell, wound healing experiments, and flow cytometry were used for in vitro investigation.

Results: Compared with normal breast tissue, POP1 expression was up-regulated in BC tissue with a higher mutation rate. POP1 had good diagnostic value for BC and could be utilized as a new marker. POP1 was significantly correlated with multiple pathways in BC and played an important role in the immune infiltration of BC. High-POP1 expression patients were more prone to be responded to immunotherapy and had a significantly higher percentage of immunotherapy response rate. Moreover, POP1 promoted proliferation and migration and inhibited apoptosis in BC cells.

Conclusions: POP1 expression was up-regulated in BC and was associated with a poor prognosis. Patients with high-POP1 expression were more likely to be responded to immunotherapy. Our study can provide a potential marker POP1 for BC, which is beneficial in the diagnosis and treatment of BC.

A Single-Center Retrospective Analysis of Local and Distant Relapse of Breast Cancer Following Immediate Breast Reconstruction According to Molecular Subtypes

Purpose

Concerns have been raised about the oncologic safety of immediate breast reconstruction (IBR) following mastectomy for breast cancer. This study aimed to evaluate locoregional recurrence (LRR) and distant metastasis (DM) of breast cancer according to its molecular subtype in patients who underwent mastectomy alone or IBR after mastectomy.

Methods

In this retrospective cohort study, consecutive breast cancer patients treated by the single senior surgeon (XZ) between February 2010 and December 2014 were eligible. In total, 389 consecutive patients were included; 295 patients underwent mastectomy alone and 94 patients underwent mastectomy with IBR. Data were retrospectively collected and analyzed for LRR and DM stratified by molecular subtypes.

Results

With a median follow-up of 73 and 87.5 months, 1.69% of patients in the mastectomy alone group developed LRR compared to 0% in the reconstruction group (p = 0.342) and the total incidence of DMs was 11.52% in patients who received mastectomy alone and 7.44% in patients who received postmastectomy IBR (p = 0.262), respectively. The cumulative incidence of LRR was 2.1% vs. 0% for luminal A, 0% vs. 0% for luminal B, 0% vs. 0% for human epidermal growth factor receptor 2 (HER2)-enriched, and 4.5% vs. 0% for triple-negative in the mastectomy alone group compared to the postmastectomy IBR group. The cumulative incidence of DM was 15.5% vs. 5.7% for luminal A, 10% vs. 8.7% for luminal B, 17.3% vs. 0% for HER2-enriched, and 6.8% vs. 7.1% for triple-negative in the mastectomy alone group compared to the postmastectomy IBR group. On multivariable Cox regression analysis, lymph node metastasis was associated with an increased risk of DM in the mastectomy alone group (p = 0.03) and neoadjuvant chemotherapy was associated with an increased risk of DM in the postmastectomy IBR group (p = 0.021).

Conclusion

This study suggests that IBR does not have a negative impact on the LRR and DM of breast cancer according to molecular subtypes.

Integrated Analysis of Genomic and Transcriptomic Profiles Identified the Role of GTP Binding Protein-4 (GTPBP4) in Breast Cancer

Purpose: To explore the significance of GTP-binding protein 4 (GTPBP4) in breast cancer.

Methods: Firstly, GTPBP4 expression analysis was performed in TIMER and UALCAN databases. Subsequently, the TCGA cohort and multiple Gene Expression Omnibus Cohorts were used as validation for GTPBP4 expression. Besides, we also evaluated the diagnostic value of GTPBP4 in TCGA Cohort and multiple GEO Cohorts. The predictive effect of GTPBP4 in breast cancer was then assessed using survival analysis. Then we look at the role of GTPBP4 in the immune milieu and create a Nomogram to help patients with breast cancer understand their prognosis. Finally, in vitro tests were carried out to look at GTPBP4 expression and function in breast cancer cell lines.

Results: GTPBP4 is an independent breast cancer prognostic factor that is upregulated in the disease (p < 0.05). Enrichment analysis showed that GTPBP4 was associated with multiple functions and pathways. In addition, GTPBP4 is associated with a variety of immune cell types (p < 0.05). PCR assay showed that GTPBP4 expression was up-regulated in breast cancer cell lines. The activity, migration, and proliferation of breast cancer cells were considerably reduced after GTPBP4 knockdown in the CCK-8, Transwell, and Scratch assays.

Conclusions: Our research discovered a new breast cancer biomarker that can be used as a guide for breast cancer diagnosis and treatment.