Chapters authored
Concurrent Administration of Trastuzumab and Anthracycline for Breast Cancer Treatment: An Unassailable Contraindication?
Anthracyclines have a severe adverse effect in cardiac function. Same here, trastuzumab has cardiotoxicity even in single use and also should lead to exacerbation of anthracycline-induced cardiotoxicity. Concurrent administration of anthracycline and trastuzumab is dangerous, but sequential administration is also dangerous. We should carefully design trastuzumab-containing regimens based on anthracycline dosing, regardless of whether it is concurrent or sequential. Contraindication of concurrent use of anthracyclines and trastuzumab has distracted us from its potential efficacy as well as from the inherent danger of anthracyclines together with trastuzumab. Avoidance of concurrent dosing is insufficient. As anthracyclines and trastuzumab are essential agents for HER2-positive breast cancer, and so, we must continue to address this issue from both safety and efficacy aspects.
Part of the book: Cardiotoxicity
Direct-to-Implant Breast Reconstruction Method: Muscle Anchoring Technique Using Absorbable Strings and Its Safety
In prosthesis-based breast reconstruction, surgeons select the sub-muscle layer for implant placement, but the pectoralis major muscle is not sufficient to cover the implant. The pectoralis major muscle does not reach the inframammary sulcus line, so the muscle pockets for implant inevitably have defects. From 2016 to 2019, we performed direct-to-implant (DTI) breast reconstruction for 123 patients, during which the implant was placed partially under the muscle plane and the inferior-lateral portion was placed directly underneath the skin flap. We divided the pectoralis major muscle and serratus anterior muscle in their origin partially and arranged their shape and position. To maintain their intended placement, we used the absorbable mesh sling. From 2020, we had arranged this method and performed DTI in 35 patients using absorbable strings simply as a substitute for mesh. The DTI reconstruction using mesh or using absorbable strings could show the acceptable safety and feasibility. Both techniques were associated with a low risk of surgical complications, reoperation (with mesh 4.1%, and without mesh 0%), and removal of implant (with mesh 2.4%, and without mesh 0%).
Part of the book: Breast Reconstruction