الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breast conservation is a valuable component of breast cancer treatment. Recently, clinical experience with oncoplastic surgery has demonstrated the freedom to perform wider tumor excisions, potentially reducing margin involvement and allowing the excision of larger tumors without compromising cosmetic outcome. The treatment of breast cancer in large-breasted patients represents a great challenge to both surgeons and radiation oncologists. Among the main technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure. Usually, the application of TRM involves resection of the tumor and remodeling the breast using an aesthetic breast reduction technique.
The aim of this work was to assess therapeutic reduction mammaplasty as a surgical treatment option for breast cancer affecting females with cup D and more breast size.
This study included 43 large sized breasts female patients(2 of them were bilateral breast cancer) (cup D and more) with operable breast cancer who were admitted to the Surgical Oncology Unit, Alexandria Main University Hospital in the period from April 2015 to May 2018.
The mean age of our studied patients was 55years; the majority of them was multiparous and with family history of breast cancer. Nine patients were with encountered medical history. The commonest presentation of them was felling of a breast lump. All of them had large breast size (Cup D and more).Preoperative workup was done by mammosonography and metastatic workup to exclude distant matastasis. The mean size of the tumor was 3.8±2.13cm. The tumor location was distributed throughout all quadrants of the breast &was multifocal in 20% cases.
The reduction mammaplasty technique we used was the Wise pattern,. The technique used is based on tumor location. The chosen vascular pedicle is designed to maximize viability of the nipple areolar complex. Based upon the tumor location, the patients were divided according to whether tumor lies within the normal excision site of a recognized reduction mammaplasty method (32 cases) or outside of the expected excision sites, thus requiring a modified mammaplasty (13 cases).
The most frequently applied reduction techniques were superior pedicle and superior-medial pedicle reduction (31.1% for each), inferior pedicle reduction technique applied in 12cases (26.7%). Only 5 cases were candidates for amputation technique. The majority of patients refused to do contralateral reduction of the breast only 13 out of 43 patients were motivated to do simultaneous symmetrizing procedure. The mean operative time was 110 ±17.3 minutes for the surgery without symmetrizing procedure and was 163± 22.4 minutes when bilateral procedure was done. Blood loss was 360 ±79 ml for the surgery without symmetrizing procedure and was 660± 72 ml when symmetrizing procedure was done.