الفهرس 
Introduction
Core needle biopsyOnly 14 pages are availabe for public view
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Abstract
The evolution of breast surgery has been impressive during the past 50 years. The passage from aggressive and mutilating interventions, like radical mastectomy, to conservative treatments has been long, but constant, despite the controversies that appeared every time a new procedure came to light. Nowadays, the aesthetic satisfaction of breast cancer patients coupled with the oncological safety is the goal of the modern breast surgeon.A new surgical procedure emerged called “conservative mastectomy”. Although it may sound as a paradox, conservative mastectomy incorporates the advantage of the total glandular excision, offered by the traditional total mastectomy, with the satisfactory aesthetic result, offered by the conservation of the skin envelope and the nipple areola complex. The Use of expanders or fixed volume implants ensures a high quality reconstruction that leaves the patient with a new normal looking breast. At a first glance, conservative mastectomy may look similar to the already known subcutaneous mastectomy, which was first described by Freeman and is being used for risk reduction. However, there are two significant differences; the thickness of the skin f laps and the presence of the retroareolar tissue. Being a curative procedure, conservative mastectomy encompasses entirely all the breast parenchyma sparing only the skin with the nipple-areola complex (NAC). As a result, NAC ischemia and necrosis are some of the complications reported; nevertheless, their treatment is technically easy and without devastating consequences.The present study demonstrated that our conservative mastectomy with LD IBR was safe with no local recurrence, and was associated with a high level of patient satisfaction. It is necessary to have long term follow up for accurate identification of the incidence of local recurrence & properly other late complications. LD flap, without a prosthetic implant, could provide enough volume for breast reconstruction after conservative mastectomy, with low rates of morbidities especially in women with small sized breast.In spite of improvements, there is still an obstacle facing both breast surgeons and large-breasted women pursuing breast reconstruction, among them, Egyptian women. This involves gaining enough volume for a totally autologous breast reconstruction. The major limitation to wide spread use of the latissimus dorsi muscular flap in breast reconstruction is the insufficiency of bulk to recreate an adequate breast mound. Extra volume is created by including all the latissimus dorsi muscle and silicone implant.Conservative mastectomy is a step towards providing the best quality of life for women with breast cancer. Early procedures for breast conservation, followed by preservation of axillary nodes when not involved, and reduction of radiation fields have created conditions for better acceptance of this malignant disease. Low rates of local recurrence in most series, and 5-year survival rates of more than 95%, are reassuring for both patients and surgeons.Conclusion: The use of conservative mastectomy and immediate breast reconstruction is oncologically safe procedure that offers the promise of ideal aesthetic results without adding additional oncological risks. Technical expertise and proper patient selection are the essential components to the procedure. Conservative mastectomy and axillary dissection through a periareolar incision requires experience, good technique and patience. Meticulous care is taken to ensure viable skin flaps, nipple areola complex and a negligible volume of residual breast tissue.