Role of Oncoplastic Breast Surgery In Breast Cancer Treatement
Role of Oncoplastic Breast Surgery In Breast Cancer Treatement
Role of Oncoplastic Breast Surgery In Breast Cancer Treatement
Breast cancer is the most common cancer in women throughout the world (FerlayJ.,2010) .

 The overarching principle guiding surgical management of women with breast cancer remains the
 oncological safety. The mainstay of satisfactory local control continues to be adequate
 clearance of the primary tumour and involved axillary lymph nodes. Improvements in
 understanding of tumour biology have enabled the risk of loco-regional recurrence and distant
 events to be further reduced by adjuvant, or neo-adjuvant, radiotherapy and systemic
 treatments. In keeping with this, breast conserving therapy has become well established as
 the treatment of choice for most women with early breast cancer . However, approximately
 one-third of women still undergo mastectomy, either due to patient preference or in cases
 where breast conservation is not oncologically or aesthetically compatible with the size or
 distribution of disease. (Reefy et al; 2010)

 The primary aim of BCS is preservation of the breast while adhering to oncologic principles,
 with the secondary objective to provide breast aesthetics. In recent years, with advances in
 early detection and adjuvant therapy life expectancy has prolonged in breast cancer prolonged
 and quality of life issues have gained importance (Veiga DF.,2010)

 Skin sparing mastectomy involves the en-bloc removal of all glandular tissue including the
 nipple-areola complex and in some cases adjacent biopsy scars and skin overlying superficial
 tumours. In contrast to conventional mastectomy, there is maximal preservation of the
 remaining breast skin envelope and infra-mammary fold that facilitate immediate breast
 reconstruction with autologous tissue and/or prosthetic implants by utilising the native skin
 envelope to optimise the contour, texture, colour and scarring of the reconstructed breast.
 (Cunnick and Mokbel; 2004).

 Due to the positive results obtained in the surgical treatment of breast cancer, the
 prevalence of this technique is increasing throughout the world and our country. There was an
 approximately 2.3-fold increase in OBS publications over the last five years (Losken A et
 al.,2014)

 Surgical planning and timing of reconstruction should include breast volume, tumor location,
 the extent of glandular tissue resected, enabling each patient to receive an individual
 "custom-made" reconstruction. With immediate oncoplastic approach, the surgical process is
 smooth since oncological and reconstructive surgery can be associated in one operative
 setting. Additionally, because there is no scar and fibrosis tissue, breast reshaping is
 easier, and the aesthetic is improved (Munhoz AM et al .,2011) When considering a patient for
 an oncoplastic breast conserving procedure, the following points must be considered:

 1. volume of tissue to be excised;

 2. tumour location;

 3. breast size and glandular density;

 4. patient related risk factors, particularly smoking, obesity, diabetes, previous surgery;

 5. adjuvant therapies. Excision volume is the single, most predictive factor for breast
 deformity (Clough KB et al .,2010).

 Recently, several studies have contributed to the evidence base supporting the oncological
 adequacy of skin sparing mastectomy in selected early-stage breast cancer , excluding
 inflammatory breast cancer and tumours with extensive involvement of the skin. In this study
 the oncological safety, post-operative morbidity and patients' satisfaction with skin sparing
 mastectomy and immediate breast reconstruction will be evaluated in a prospective cohort of
 women with early-stage breast cancer. (Cunnick and Mokbel; 2004) Skin sparing mastectomy and
 immediate breast reconstruction is particularly attractive for women with ductal Carcinoma
 In-Situ in view of the fact that post-mastectomy radiotherapy is not given to the
 reconstructed breast and the risk of loco-regional recurrence is very low. (Spiegel and
 Butler; 2003)

 Most women who will undergo skin sparing mastectomy and immediate breast reconstruction for
 early-stage breast cancer will not require post-mastectomy radiotherapy. However,
 post-mastectomy radiotherapy has been shown to reduce loco-regional recurrence and improve
 survival for patients with three or more involved regional lymph nodes or tumors >5 cm.
 (Recht and Edge; 2003) Mastectomy can also be indicated in several non-invasive conditions.
 Ductal Carcinoma In-Situ may necessitate mastectomy when the lesions are extensive,
 multi-centric or recurrent, however, patients request to be managed in this way. Mastectomy
 for ductal Carcinoma In-Situ is associated with cure rates in excess of 98%. (Mokbel; 2003)
Inclusion Criteria:

 -  The study will include 30 women with early-stage breast cancer treated at general
 surgery department, Assuit University Hospitals

 -  For all patients an informed consent for their inclusion in the study including the
 use of images will be obtained.

 -  Selection criteria include women with a pre-operative diagnosis (clinical examination,
 imaging and needle biopsy) of Tis, T1 and T2 tumours without extensive skin
 involvement.

 Exclusion Criteria:

 -  • contraindaction for general anesthesia

 -  Positive margin requiring mastectomy

 -  Insufficient remaining breast volume

 -  Diffuse microcalcifications

 -  Multicentric tumor?

 -  Inflammatory breast cancer

 -  Previous radiotherapy

 -  Concomitant disease ( Diabetes, smoking )