الفهرس 
ANATOMY OF THE BREAST
The horizontal septum and breast bipartitionOnly 14 pages are availabe for public view
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Abstract
Conservative breast therapy is a safe procedure in wellselected patients of early breast cancer. Deformities after CBT
occur in substantial portion of patients because of improper
scar orientation, lack of cavity closure after resection, and the
effect of postoperative radiotherapy. The balance between the
safe resection and keeping esthetically accepted results is
challenging.
Oncoplastic procedures combine the well-standardized
plastic surgery techniques to oncological tumor resection.
The aim of this study was to evaluate different techniques
of therapeutic mammoplasty for immediate reconstruction of
defects following resection of tumors. The technical aspects
were explored, feasibility of resection was judged and the
outcome in the terms of resection volume, margin involvement,
complications, esthetical results and patient‘s satisfaction, was
declared.
Thirty female patients with early breast cancer, submitted
to therapeutic mammoplasty for breast cancer in Ain Shams
University hospital and Alexandria main University hospital
between September 2013 and November 2015.
Patients who preferred mastectomy, with tumor mass
larger than 5 cm, metastatic disease, inflammatory breast carcinoma and multiple tumors were excluded. The choice of
procedure was made according to the size of the defect in
relation to the size of the breast and the position of tumor. Wide
local excision with a safety margin of at least one centimeter all
around the palpable edge of the tumor was included in resection.
The specimen weight was recorded. Surgical margins were
determined by histological examination of frozen sections of the
breast specimens in the operating room. A macroscopic tumor–
margin distance of less than 10 mm and a microscopic tumor–
margin distance of less than 2mm were considered compromising.
In both situations, the margin(s) in question was (were) re-excised.
The shape, appearance and positions of the NAC and
symmetry of the two breasts were evaluated. The aesthetic
evaluation of these categories was performed by an independent
observer. Acquired-informal questionnaire was used to grade the
patient‘s level of satisfaction with the aesthetic results.
All cases had eventually free margins. Definitive
pathology confirmed free margins in all cases. The weight
ranged from 65 to 565 grams with the average weight of 262.47
± 165.31grams.
Six different techniques were evaluated. Minor
complications occurred in sixteen patients (53.3%). Seroma
occurred in four patients, but eventually subsided after repeated
office aspirations. Hematoma formation occurred in one patient.Minor skin dehiscence occurred in three patients. Five patients
had wound infection; which resolved after two weeks of
antibiotic treatment. Radiotherapy edema, skin telangiectasia,
excoriations occurred in three cases. Fat necrosis complicated no
cases.
Follow up period ranged from 4 months to 24 months
(mean of 17 months). Local recurrence did not occur in any case.
Average result for shape was 3.5 out of four (87.5%)
indicating good result. Average result for NAC was 3.0 out of
four (75%) indicating good results. Average result for symmetry
was 2.93 out of four (73.3%) indicating fair results. Total overall
average score was 3.14 out of four (78.6%) indicating good
results. Nineteen patients graded their results as very satisfying,
ten patients were satisfied, and only one patient was
disappointed; but no patients regretted their decision. The
average score for patient satisfaction was 3.6 out of four.
We concluded that oncoplastic resection was feasible.
Larger margins could be obtained without serious deformity.
Cosmetic results were well accepted by patients and surgeons.
Learning curve rose while rate of complications felled. Longer
follow up is needed to assess oncological safety. Further
research should concentrate on each specific technique to assess
the technical considerations. We now have the idea that there is
no going back and a breast specialty is becoming a reality.