الفهرس 
Introduction
Topology of the Breast: An OverviewOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most frequent malignant tumor in women worldwide. The incidence and mortality rates among females vary among countries but are steadily increasing worldwide.[2,3]
In Egypt, breast cancer is estimated to be the most common cancer among females accounting for 37.7% of their total with 12,621 new cases in 2008. It is also the leading cause of cancer related mortality accounting for 29.1% of their total with 6546 deaths.[6,7,8]
Breasts comprising an important organ to females and its radical excision have a bad psychological impact on females.
This argument leads to emerging of conserving breast techniques in a trial to preserve breast contour with achieving ideal oncological safety.
Nowadays Breast conserving therapy represent the gold standard for management of low grade breast cancer with both oncological safety in a mean of the same survival rates as seen in patient treated with mastectomy and better cosmetic result when compared to mastectomy which satisfies the patient expectation and decreases the psychological impact.[10]
In this study we were aiming to emphasize the role of Breast conservative therapy followed by adjuvant therapy in management of cases of low grade tumors or cases of high grade breast tumors responding to proper neoadjuvant therapy to achieve proper oncological and cosmetic outcomes.
We also aim to assess role of IEFSA in decreasing reoperation and reexcision rates.
The study included 30 female patients with average age 35-65 years old presented with stage I, II and IIIa breast cancer whose were selected according to particular inclusion and exclusion criteria.
The commonest 1st presentation of cases in this study was breast lump (23 cases 76%) and the commonest site was upper outer quadrant (20 cases 66%).
All cases were underwent different techniques of breast conserving surgery, chosen of the ideal technique depends on site, size of the mass, mass/breast volume ratio, cup size and degree of breast ptosis.
All cases underwent post-operative adjuvant therapy in form of radiotherapy, chemotherapy and hormonal therapy depending on hormonal and molecular receptors, exception in cases presented with stage IIIa or those with mass ≥ 5 cm (5 cases 17%) these underwent a course of preoperative neoadjuvant therapy.
Application of intraoperative frozen section analysis believed to decrease rate of 2nd stage operation (3 cases 10%) and rate of reexcision (2 cases 6%) and these low rates are owing to its high sensitivity and specificity 71 %, 96% and high PPV and NPV 83%, 92% recorded in this study.
The surgical safety margins in this study were about one centimeter in average which is oncologically safe and technically applicable while more decrease in safety margins not affects oncological safety otherwise it increases cosmetic outcome as reported by recent guidelines.[204]
During one year follow up no cases reported to have local recurrence, however more duration of follow up is needed to detect any local recurrence.
Regarding cosmetic outcome in our study, according to four points scoring system 5 cases (17%) scored excellent with the treated breast identical to the other breast, 7 cases (23%) scored good, 13 cases (43%) were fair and 5 cases (17%) with poor cosmetic outcome.
We noticed that better cosmetic outcomes noticed in patients with large breast cup size, small masses in upper outer quadrant of the breast, ptotic breast and in patients with low breast-mass volume ratio.
Poor cosmetic outcomes noticed more in patients with larger masses, large breast tissue resection volume, masses located medially, lower and retroareolarand in patient underwent reexcision following primary surgery.
For large breast-mass volume ratio, oncoplastic techniques should take the upper hand to achieve better cosmetic results.
The psychological outcome was very impressive as most of our patient meets their aesthetic expectations.