الفهرس 
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Abstract
Breast cancer (BC) is a prevalent malignancy among women, including around 25% of all malignancies globally. It ranks as one of the leading causes of mortality in women, contributing to an estimated 627,000 deaths in 2018.
The death rates associated with breast cancer have decelerated in industrialized nations. The prevalence of this phenomenon has witnessed an upward trend in low- and middle-income countries, mostly attributed to the process of westernization in lifestyle choices, the aging population, population growth, delayed diagnoses at late stages, and limited access to contemporary medical interventions. Furthermore, the lack of knowledge, inadequate infrastructure, and absence of comprehensive countrywide screening initiatives have also contributed to this increase.
The primary goal of treatment for breast cancer is the surgical removal of the tumor, which can be achieved by either mastectomy or breast-conserving surgery, often known as lumpectomy. The surgical procedure known as mastectomy has historically been the prevailing treatment option within the medical industry. However, the advent of breast-conserving surgery (BCS) has instigated a notable transition in clinical practice. Breast-conserving surgery (BCS) emerged as a strategy to save the breast while ensuring survival rates remain unaffected.
Currently, the assessment of breast cancer therapy is mainly based on the rates of successful remission and the impact on patients’ overall well-being. A superior aesthetic outcome typically yields a more favorable psychological consequence.
Achieving optimal cosmesis is a significant objective in the context of breast conservation. Breast deformity is a probable outcome in cases where the amount of breast tissue removed during conventional wide local excision exceeds 20-30%. The occurrence of deformity can be observed even with a lesser volume excision, particularly in cases where the tumor is situated in the medial or caudal region of the breast. Reconstruction subsequent to imperfections arising from breast conservative surgery (BCS) might provide considerable challenges, necessitating the consideration of contralateral symmetry surgery as a potential sole solution.
With advancements in techniques, the utilization of lipomodelling has expanded in various applications, including reconstruction after breast cancer surgery, treatment of secondary defects following breast cancer reconstruction, management of tissue damages and deformities resulting from radiotherapy, correction of congenital and acquired breast deformities, and more recently, cosmetic augmentation.
Adipose tissue serves as an optimal filler because to its desirable characteristics, including its soft consistency, non-allogeneic nature, abundant availability, ease of collection, and uncomplicated transplanting process with minimum associated morbidity. Delayed lipomodelling has emerged as a viable and efficacious approach for addressing the long-term effects of breast cancer surgery. In certain circumstances, it may serve as a viable alternative approach for breast reconstruction, exhibiting a greater degree of patient acceptability and compliance.
Two decades of research have shown that lipomodelling is a safe reconstructive technique for patients with primary invasive breast cancer, and that it does not increase the risk of oncogenesis or the risk of recurrence in these patients. Recurrence rates were similar in individuals with local and regional breast cancer who underwent mastectomy and reconstruction with or without fat transfer. There was no correlation between autologous fat graft and the recurrence of breast cancer in the aforementioned research.
The technique of BCS (breast-conserving surgery) combined with immediate lipomodelling is a treatment that can be acquired with relative ease, allowing breast surgeons to proficiently do it. This additional step in the surgical process often extends the whole operation duration by roughly 20 minutes. Lipofilling is often conducted as a remarkable treatment, effectively mitigating breast deformities resulting after breast-conserving surgery (BCS). Consequently, it is anticipated that lipomodelling would offer a more economically efficient approach compared to addressing subsequent problems necessitating 2-4 separate instances of lipomodelling. Additionally, it possesses the capacity to facilitate increased representation of women as candidates for BCS.
Although this technique appears to represent a considerable advance in the therapeutic armamentarium for moderate sequelae of conservative treatment, we consider it as only part of a multidisciplinary approach. The radiologist who carries out preoperative investigation must be in agreement with the principle of the procedure, as must the oncologist following the patient for her cancer. The opinion of all those involved must be respected. Such an approach and sharing of responsibility allow all those involved to work together to limit the potential medicolegal complexities in the event of further progression of cancer.
The aim of this study was to evaluate efficacy, complications, patient satisfaction and esthetic outcomes of immediate Lipomodelling used for correction of deformities resulting from breast conserving surgery for breast cancer patients. And to evaluate the lipomodelling and the incidence of local recurrence in its experimental level.
As a pre-clinical study, the experimental laboratory results were obtained prior to the start of the human research.
This study was carried out on 50 female patients admitted to the surgical department of Medical Research Institute suffering from malignant breast lesions and operated upon breast conservative surgery (BCS) throughout a year. Immediate Lipomodelling is done at the same setting of the (BCS) to correct the resultant tissue defect &/or deformities. The follow up period was 24 months.
Full laboratory and radiological investigations were performed in all patients.
Preoperative markings of both donor and recipient areas were done in standing position. The technique used was Coleman’s technique consisting of:
1. Harvesting by a blunt-tipped liposuction cannula (2mm) with slight negative pressure of 50cc Luer Lock syringe to allow fat harvesting.
2. Processing by centrifuge of harvested fat under aseptic technique at 3000 rpm for 3-4 min. The fat is separated into 3 layers: top oily layer, middle layer of purified fat and bottom layer of blood residues.
3. Lipoinjection of the cellular component (middle layer) transferred to a 1 or 3 cc Luer- Lock syringe and prepared for injection by blunttipped small caliber infiltration cannula (1-2 mm).
The findings can be summarized into:
• The mean age of the patients was 43.8±9.73 years, ranged from 29-61.
• Half of the patients has no medical history, 24.0% had diabetes mellitus, asthma 6(12%), HTN 5(10%) and cardiac 2(4%).
• The mean weight resected was 93.7± 21.71 gm,
• The mean volume injected was 105.04 ±27.26 gm.
• The decrease in AFG by 28± 9% assessed by Ct breast volumetry scan.
• The pathology of the primary tumor was: IDC type was higher with 36 cases (72%), ILC type in 11 case (22%) and mixed in 3(6%).
• The stage was: 10 % of the cases (5 case) were: stage I, 50% (25 cases) stage IIA, and 40% (20 cases) stage IIB.
• The mean duration of operation was 65.9 ± 8.54 minutes; ranged from 50 minutes to 78 minutes.
• The donor complications were: ecchymosis in 10 cases (20%),
• The recipient complications were: macrocalcifications in 10 cases (20%). oil cyst in 4 cases (8%), ecchymosis in 3 cases (6%), seroma in 6 cases (12 %), and local recurrence in 1 case (2%).
• Local recurrence, with the same histologic subtype of the primary tumor (ILC), occurred in 1 case (2%), in another quadrant (UIQ).
• Regarding surgeon assessment the most cases were excellent and good 38 cases (76%) regarding surgeon assessment. Degree of satisfaction was 5 and 4 in 39 cases (78%). Regarding esthetic results by BCCT core program, excellent and good was found in 28 (56%).
• Regarding patient satisfaction degree of satisfaction was 4 in 23(46%) cases and 5 in 16(32%) cases.
• Regarding esthetic results by BCCT core program, good was higher with 23(46%) followed by fair with 18(36%).
Our results showed a statistically significant relation between surgeon assessment and patients’ satisfaction (P < 0.05), also, there was statistically significant relation between esthetic results by BCCT core program and patients’ satisfaction (P < 0.05). There was a statistically significant relation between site of the tumor and Esthetic results by BCCT core program (P > 0.05). On the other hand, it was found that there was a statistically significant relation between BCCT assessment and age (P > 0.05), also there was no statistically significant relation between BCCT assessment and Weight resected (P > 0.05).
The results showed that there was no statistically significant relation between BCCT assessment and Volume injected (P > 0.05), also it was found a significant relation between patients’ satisfaction and site of mass, weight of mass resected and volume of injected.