الفهرس 
MorphologyOnly 14 pages are availabe for public view
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Abstract
Breast cancer is a growing public health problem in many countries. Fortunately, this cancer can be diagnosed at an increasingly early stage. In 1980, 15% of breast cancers were diagnosed at stage T 0-1. This rate has increased to more than 50% and obviously the smaller the size of the cancer the easier control of the disease. Early mammographic screening detection , along with readily available information and general quality of life improvements, have all played a role in this evolution. As a consequence of the earlier diagnosis of breast cancer, aesthetic outcomes are becoming ever more important and, even if this has not yet become a legal requirement, our patients are legitimately ever more demanding in this regard.
The contribution of plastic surgery techniques to breast cancer has given birth to what is now referred to as “oncoplastic breast surgery” (OBS). however, a number of situations where mastectomy is required
Simply stated, oncoplastic surgery is defined as tumor excision with a wide free margin of resection followed by immediate reconstruction of the partial mastectomy defect.
In the last two decades, this new form of breast surgery has developed rapidly not only due to the improving scientific back ground with better clinical studies but also due to the increasing attention given by surgeons to their patients’ quality of life. Increasing numbers of scientific papers and meeting abstracts about oncoplastic techniques demonstrate the importance of and increasing attention given to this technique.
Oncoplastic techniques may be used during any kind of breast conserving surgery for breast cancer. However, with regards to breast reduction techniques there are several indications and contraindications The breast volume excised plays a central role for breast cosmesis after BCT. In patients with an expected volume reduction of more than 10%,Also Cosmetic results after breast conserving surgery of breast cancer is determined by the location of the tumor as tumors located in the medial, central or lower quadrant yields worse results compared with other locations.
While In patients with a mild to severe ptosis, even with smaller breasts, oncoplastic techniques by using breast lifting methods may be of advantage for the general cosmesis by lifting the nipple in the right place and keeping the scar around the areola.
Also simple lumpectomy in macromastia patients may reach good cosmetic results but when combining it with breast reduction of both sides the symptoms such as back and shoulder pain improve and may thus improve the quality of life. Moreover, the homogeneity of radiation dose distribution may be altered in large breast, thus breast reduction may improve adjuvant radiotherapy effects. , thus breast reduction may improve adjuvant radiotherapy effects.
The contraindications for oncoplastic surgery are generally the same contraindications for BCT.which include Inflammatory carcinoma of the breast, Multicenteric carcinoma, Progressive disease after neoadjuvant therapy And when there’s no possibility for using adjuvant radiotherapy.
The techniques that are currently used for the reconstruction of partial mastectomy defects are based on two different concepts: volume displacement and volume replacement.
Volume displacement procedures include local tissue rearrangement, reduction mamoplasty and mastopexy While, volume replacement procedures include local and remote flaps from various regions of the body and implant insertion.
In general women with smaller breasts ,with minimal ptosis were found to be better candidates for volume replacement procedures ,e.g. local flap and latissmus dorsi flap , were women with larger and more ptotic breast would be better candidates for volume displacement procedures ,e.g. adjacent tissue rearrangement, reduction mamoplasty and mastopexy