Patients' satisfaction with immediate breast reconstruction with a latissimus dorsi musculocutaneous flap.

Immediate breast reconstruction with a latissimus dorsi musculocutaneous (LDM) flap is still not much reported, particularly in studies of patients' views. The aim of this study was to assess the level of patients' satisfaction with the technique. All patients (n = 257) who had had a mastectomy and immediate breast reconstruction with a LDM flap at a single hospital between January 1999 and December 2005 were identified, and 196 patients free of recurrence were included. The operations were done by the same surgical team in a standard manner. Clinical data, technical details, and outcome were collected prospectively. To assess the patients' degree of satisfaction with the aesthetic results in relation to clinical characteristics and treatment, a study-specific questionnaire and a visual analogue scale were sent to 196 patients; 178 forms were completed and returned. To analyse general satisfaction and aesthetic results we used the Mann-Whitney, Kruskal-Wallis, chi square, or Fisher's exact test, as appropriate. The median reconstruction follow-up period was 34 months. Patients who were 51 years or older at the time of reconstruction were less likely to opt for immediate breast reconstruction with LDM flap than younger patients. Patients who were divorced and those who had postoperative complications were less likely to be satisfied. One hundred and sixty-four patients (92%) were satisfied, and 161 (90%) said they would recommend the reconstruction. The median satisfaction score was 9 (range 1-10, mean 8.5). The technique provided satisfactory immediate breast reconstruction according to the patients' evaluation.

Silencing of LRRC49 and THAP10 genes by bidirectional promoter hypermethylation is a frequent event in breast cancer.

Previously we found that levels of LRRC49 (leucine rich repeat containing 49; FLJ20156) transcripts were elevated in ER-positive breast tumors compared with ER-negative breast tumors. The LRRC49 gene is located on chromosome 15q23 in close proximity to the THAP10 (THAP domain containing 10) gene. These two genes have a bidirectional organization being arranged head-to-head on opposite strands, possibly sharing the same promoter region. Analysis of the promoter region of this gene pair revealed the presence of potential estrogen response elements (EREs), suggesting the potential of this promoter to be under the control of estrogen. We used quantitative real-time PCR (qPCR) to evaluate the expression of LRRC49 and THAP10 in a series of 72 primary breast tumors, and found reduced LRRC49 and THAP10 expression in 61 and 46% of the primary breast tumors analyzed, respectively. In addition, the occurrence of LRRC49/THAP10 promoter hypermethylation was examined by methylation specific PCR (MSP) in a sub-group of the breast tumors. Hypermethylation was observed in 57.5% of the breast tumors analyzed, and the levels of mRNA expression of both genes were inversely correlated with promoter hypermethylation. We investigated the effects of 17beta-estradiol on LRRC49 and THAP10 expression in MCF-7 breast cancer cells and found both transcripts to be up-regulated 2- to 3-fold upon 17beta-estradiol treatment. Our results show that the transcripts of LRRC49/THAP10 bidirectional gene pair are co-regulated by estrogen and that hypermethylation of the bidirectional promoter region simultaneously silences both genes. Further studies will be necessary to elucidate the role of LRRC49/THAP10 down-regulation in breast cancer.