الفهرس 
Surgical Anatomy of the Breast
Blood Supply of the BreastOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the second most common cancer among
women and is the second leading cause of cancer deaths.
The management of patients with breast cancer has
evolved over the past couple of decades as a result of a better
understanding of the biologic behavior of breast cancer,
advances in adjuvant chemotherapy and hormonal therapy,
advances in radiographic detection of early-stage breast
cancer, and the implementation of breast conservation therapy
and sentinel lymph node biopsy.
Routine screening mammography and increased breast
cancer awareness are primarily responsible for the trend
towards earlier diagnosis. Although radical and modified
radical mastectomies have been the mainstay treatment for
early-stage breast cancer for decades, breast-conserving
therapy has recently become the preferred method of
treatment for appropriate patients with early-stage breast
cancer.
Breast reconstruction has become an integral aspect of
breast cancer management. The timing of breast
reconstruction after mastectomy involves many factors that
are important when choosing between immediate and delayed
reconstruction. Immediate reconstruction has positive psychological implications on patients by reducing the
physical mutilation in oppose to delayed reconstruction. In
addition, practice patterns have gradually trended towards
more immediate reconstructions for non-irradiated patients
owing to superior aesthetic outcomes, more facilitating
recoveries, and the ability to maintain an equivalent
oncologic outcome.
The primary goal of breast reconstruction is to create a
long lasting, naturally appearing breast after the treatment of
breast cancer. This goal should be achieved with the least
possible morbidity at the donor site.
Recent techniques in breast reconstruction are broadly
divided into autologous tissue reconstruction, non-autologous
reconstruction or a combination of both. Autologous tissue
breast reconstruction can generally be grouped into three main
categories: local tissue rearrangement with composite breast
flaps, reduction mammaplasty, and transfer of remote tissue
in the form of a vascularised regional or distant flap. Nonautologous or implant- based techniquesare a simple and
effective method of breast reconstruction, but they may not
be suitable for all patients, particularly those who need or
have had radiotherapy. Although autologous methods are
more surgically demanding, they yield better aesthetic results
than non-autologous methods.Nipple- areola complex reconstruction is an integral
component of breast reconstruction which transforms the
reconstructed breast mound into a more natural and pleasing
breast. It is typically performed three months after the mound
has been successfully reconstructed by the use of local flaps
with or without skin grafts or as a composite free nipple graft
from the contralateral breast. Areolar tattooing and secondary
procedures to improve nipple height can also be done at a later
date.
Symmetry is one of the most important aims in breast
reconstruction. This will further improve the overall outcome
and patient satisfaction. Two types of equality must be
considered: equality of volume and equality of shape. These
can be achieved by either a reduction or augmentation
mammaplasty procedure to the contralateral breast.
Complications of breast reconstruction are not amongst
patients’ expectations or in the surgeon’s interest. However,
like scarring, they can occur. Minor complications can delay
recovery or require further treatment and can be the cause of
severe frustration for the patient and her family. The
occurrence of complete failure, like total flap necrosis or the
need to remove a silicon implant due to infection is relatively
uncommon Various oncoplastic techniques for breast reconstruction
are available, and the decision of the technique used is based
on local tissue demands and the preferences of both the
surgeon and the patient to achieve the best possible results.