الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Breast cancer, according to national cancer institute, is the most common site of cancer in women in Egypt as it accounts for about 38.8% of total malignancies among Egyptian females; it is an important cause of mortality among women.
For many women with stage 1 or 2 breast cancer, the combination of partial mastectomy and radiation therapy – together referred to as breast- conserving therapy is preferable to total mastectomy because breast conserving surgery survival rates is equivalent to those after mastectomy while preserving the breast.
The goal of modern breast surgery is to cure patients with preservation of breast tissue as much as possible with satisfactory physical and psychological outcome. This goal has led to introduction of a new scope of surgery into our clinical practice called oncoplastic breast surgery, with the advantage of combining oncological safety and satisfactory cosmetic outcome.
Oncoplastic breast surgery is based on basic principles: ideal breast cancer surgery with wider excisions, immediate breast reconstruction. This is achieved through several techniques based on tumor location, characteristics of the breast, volume of mammary resection and clinical evaluation of the patient into volume displacement and volume replacement procedures. The volume displacement techniques uses the remaining breast tissue, while the second, the volume replacement technique, uses other autologous tissue to supplement the insufficient breast tissue.
Breast conservation therapy (BCT) which includes breast conservation surgery (BCS) and adjuvant radiation therapy (RT) is a standard protocol to achieve high local control with acceptable aesthetic outcomes.
Multiple prospective randomized trials, with a follow-up of 20 years, have established equivalent survival rates between mastectomy and breast conservation surgery (BCS) with negative margins.
At present, breast surgeons are attempting to extend the scope of breast conservation so as to include scenarios which are otherwise contraindicated for BCS particularly in multicentric (MC) or multifocal (MF) tumors. Clinical management of MF/MC breast tumors is a challenge since the choice of optimal surgical approach is controversial.
Previously mastectomy was considered as the standard choice. However, significant local recurrence rates (2.5% to 40%) have limited the utility of mastectomy in such scenarios. In contrast, breast cancer (BC) patients with large T2 and T3 tumors who underwent BCT were shown to have acceptable cosmesis without compromising locoregional control or survival.
Oncoplastic breast surgery (OBS) has emerged as an integrated approach to achieve optimal oncological outcomes and cosmesis. This approach allows tumor excision with wider margins during BCS without compromising the aesthetic outcome. In addition, OBS has shown comparable oncological efficacy with conventional BCS in achieving adequate surgical margins and recurrence rates.
The technique of “Extreme Oncoplasty” (EO) has emerged as a promising option in selective patients with adequate breasts (cup size ≥ C) where in BCS is possible inspite of large volume resections. Indeed, EO could be used to conserve breasts in scenarios for which mastectomy would be have been the treatment of choice offered by most surgeons. These situations include
1. Multicenteric (2-3 quadrants).
2. Multifocal.
3. Large breast mass not responding to neo-adjuvant chemotherapy.
4. T2 tumors in small breast.
5. Patient is accepting extreme oncoplasty in spite of knowing that mastectomy is the accepted treatment according to present guidelines.
This study was conducted on 30 female patients with stage T3 breast cancer not responding to neoadjuvant chemotherapy with no skin involvement or upper medial quadrant tumor, with large breast size (cup D), accepting both intervention modalities and fit for both anesthesia and radiotherapy. Aiming to asses feasibility of extreme oncoplasty using Reduction Mammoplasty and comparing early results and complication with modified radical mastectomy .It was performed at the (General Surgery Department) at Benha University Hospitals and El Haram specialized Hospital starting from December 2021. Approval of the Ethical Committee and written informed consent from all participants were obtained.
Patients were divide into two groups. group (1) includes 15 patients underwent Modified radical mastectomy with axillary clearance. group (2) includes 15 patient underwent Reduction Mammoplasty and axillary clearance. There was no significant statistical difference between the two groups regarding patients’ age. There was statistical difference regarding operative time being longer in oncoplastic reduction. Similar rates of complications regarding wound infection, wound dehiscence and hematoma development between both patient groups. Seroma formation was higher in MRM than TRM patients. There was no local recurrence during our period of follow up 3 months.