الفهرس 
ANATOMY OF BREAST CANCEROnly 14 pages are availabe for public view
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Abstract
B
reast cancer is the commonest malignancy in women. It is the most common cause of cancer death among women worldwide. The female breast is a potent symbol of maternity and femininity. For many years after a mastectomy, many women experience psychological distress and feel that her everyday life has been disputed.
Treatment of the breast carcinoma largely depends upon the clinical stage of the disease at the time of presentation including not only the classical TNM staging but also often other tumor characteristics such as tumor grading. Added to that the development of diagnosis, imaging (Mammography, Ultrasonography and breast MRI), invasive diagnostic technique (Fine needle biopsy, core needle biopsy, Incisional biopsy and Excisional biopsy) and different protocols to learn the women self-examination.
The surgical treatment of patients with breast cancer involves either breast conserving surgery or mastectomy, both of which can result in considerable asymmetry of the breasts. Breast reconstruction offers restoration of breast symmetry to such women. Breast reconstruction has become an important aspect of breast cancer management. The patient needs to be aware that the reconstructed breasts will neither feel nor function like a normal breast but may help in restoring body image and self confidence.
OBS techniques include closure of the breast defect that resulted from tumor resection with glandular or dermoglandular flaps prepared within the breast and reshaping of breast OR filling of the breast defect with the patient’s own tissues from areas away from the breast. The last is used in patients with large tumor/breast volume ratio, those with deficient breast volume after resection, and those with significant breast defect
The patient’s choice will depend on the available options in the breast unit where she is being treated, which in turn will depend on the experience and attitude of the breast surgeon.
Latissimus Dorsi myocutaneous flap is an example of a breast volume filling technique. The LD myocutaneous flap allows for the reconstruction of a full range of breast volumes.
Advantages of LD flap in breast reconstruction LD flaps are viable options for patients who have undergone radiotherapy. LD flaps are good options for patients who are not candidates for abdominal flap-based reconstruction. LD flaps can be utilized for chest wall coverage or as salvage therapy after a previous breast reconstruction has failed.
On the other hand, Implant-based reconstructions offer patients the option of less invasive surgery with no need for an extra donor site, a shorter procedure, a shorter hospital stay and faster recovery period.
The main advantage of prosthetic reconstruction is simplicity. Additional advantages include the use of skin with similar qualities of texture and color compared with the contralateral breast, the elimination of donor site morbidity, the avoidance of new scars, less operative time and recovery, and leaving autologous tissue for a later date if necessary.
Implants also have the advantage that they can be changed if required to make the reconstructed breast moderately larger or smaller. With certain types of implants (permanent expanders), volume change can be done without surgery by injecting saline into a subcutaneous port, provided that the port has not yet been removed.
In our study we compared the two techniques in operative time, drain amount, post operative stay and cosmotic outcome.
A large breast (C and D) with large tumor size (2.5-4 cm) is better approached by skin sparring mastectomy with sub-pectoral implant, where in small breasts (A and B) with small tumor size (1–2 cm) is better approached by extended latissimus dorsi flap as in A retrospective cohort study done by Manie et al., 2017 included 64 patients who underwent immediate breast reconstruction with extended latissimus dorsi flap at the National Cancer Institute, Cairo University, between January 2014 and January 2016 showed that all patients with cup size A had aesthetically pleasing results. As the breast cup size increased, the favorable cosmetic outcomes were noted with lower BMI.
The Whole operative evaluation proved for skin sparring mastectomy with sub-pectoral implant to be very simple and safe procedure with relatively average operation time as mentioned in the study made by Massetti and Slgarello in 2012 in comparison for the extended latissimus dorsi flap, yet it has the least intra and post-operative blood loss and the least need for analgesia and the fastest recovery and discharge.
The skin sparring mastectomy with subpectoral implant had the highest mean cosmetic outcome score 4 which approaches the very good score. The wound being obscured around the NAC played an integral role in improving cosmetic outcome, patient satisfaction and acceptance in both early post-operative period and late follow up period. None of the cases have been given below good score.
Extended latissimus dorsi flap comes with mean cosmetic outcome 1.6 which falls between poor and fair. 2 0ut 0f 15 cases scored good with 13.3%. 5 out of 15 cases scored fair and the last 8 cases scored poor. None of cases scored ugly.
In contrast a retrospective analysis done by Qinghong et al., 2018 of 151 breast cancer patients underwent breast reconstruction after mastectomy between February 2009 to November 2015 with a median follow-up time of 44 months. Comparing cosmetic outcomes between the 2 groups found a better outcome (excellent or good) in flap vs immediate implant (62.7% vs 46.3%) and in this study it was (73.3% in extended latissimus dorsi flap with 0% in subpectoral implant). a better cosmetic outcome was found in the autologous flap reconstruction group, more natural shape and softness make it more advantageous than in immediate implant reconstruction.
The skin sparing mastectomy with sub-pectoral silicone implant technique has the best cosmetic outcome with average simplicity of the surgical procedure. While modified radical mastectomy with extended latissimus dorsi flap was the most complex technique with the least cosmetic outcome.