الفهرس | Only 14 pages are availabe for public view |
Abstract Conservative breast therapy is a safe procedure in wellselected patients of early breast cancer. Deformities after CBT occur in substantial portion of patients because of improper scar orientation, lack of cavity closure after resection, and the effect of postoperative radiotherapy. The balance between the safe resection and keeping esthetically accepted results is challenging. Oncoplastic procedures combine the well-standardized plastic surgery techniques to oncological tumor resection. The aim of this study was to evaluate different techniques of therapeutic mammoplasty for immediate reconstruction of defects following resection of tumors. The technical aspects were explored, feasibility of resection was judged and the outcome in the terms of resection volume, margin involvement, complications, esthetical results and patient‘s satisfaction, was declared. Thirty female patients with early breast cancer, submitted to therapeutic mammoplasty for breast cancer in Ain Shams University hospital and Alexandria main University hospital between September 2013 and November 2015. Patients who preferred mastectomy, with tumor mass larger than 5 cm, metastatic disease, inflammatory breast carcinoma and multiple tumors were excluded. The choice of procedure was made according to the size of the defect in relation to the size of the breast and the position of tumor. Wide local excision with a safety margin of at least one centimeter all around the palpable edge of the tumor was included in resection. The specimen weight was recorded. Surgical margins were determined by histological examination of frozen sections of the breast specimens in the operating room. A macroscopic tumor– margin distance of less than 10 mm and a microscopic tumor– margin distance of less than 2mm were considered compromising. In both situations, the margin(s) in question was (were) re-excised. The shape, appearance and positions of the NAC and symmetry of the two breasts were evaluated. The aesthetic evaluation of these categories was performed by an independent observer. Acquired-informal questionnaire was used to grade the patient‘s level of satisfaction with the aesthetic results. All cases had eventually free margins. Definitive pathology confirmed free margins in all cases. The weight ranged from 65 to 565 grams with the average weight of 262.47 ± 165.31grams. Six different techniques were evaluated. Minor complications occurred in sixteen patients (53.3%). Seroma occurred in four patients, but eventually subsided after repeated office aspirations. Hematoma formation occurred in one patient.Minor skin dehiscence occurred in three patients. Five patients had wound infection; which resolved after two weeks of antibiotic treatment. Radiotherapy edema, skin telangiectasia, excoriations occurred in three cases. Fat necrosis complicated no cases. Follow up period ranged from 4 months to 24 months (mean of 17 months). Local recurrence did not occur in any case. Average result for shape was 3.5 out of four (87.5%) indicating good result. Average result for NAC was 3.0 out of four (75%) indicating good results. Average result for symmetry was 2.93 out of four (73.3%) indicating fair results. Total overall average score was 3.14 out of four (78.6%) indicating good results. Nineteen patients graded their results as very satisfying, ten patients were satisfied, and only one patient was disappointed; but no patients regretted their decision. The average score for patient satisfaction was 3.6 out of four. We concluded that oncoplastic resection was feasible. Larger margins could be obtained without serious deformity. Cosmetic results were well accepted by patients and surgeons. Learning curve rose while rate of complications felled. Longer follow up is needed to assess oncological safety. Further research should concentrate on each specific technique to assess the technical considerations. We now have the idea that there is no going back and a breast specialty is becoming a reality. |