الفهرس 
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Abstract
XI Abstract Objective : To evaluate the outcome of thoracodorsal artery perforator flap in oncoplastic procedures regarding operative time, post operative complications and cosmetic outcome Background : The advent of oncoplastic surgery in the early 1990s has revolutionized the concepts of breast reconstruction for breast cancer.This has been paralleled by a steep evolution of our understanding of the vascular anatomy of the various flaps used for reconstruction. Earlier when mastectomies where prevailing, it made perfect sense to look for flaps with large volumes of tissue and muscle bulk such as the TRAM or the conventional LD flaps. The harvest of these flaps often left significant morbidities such as the abdominal wall weakness and the seroma in the back Nowadays the breast surgeon is more than often faced with smaller defects for which such bulky flaps offer a surplus of tissue with unacceptable morbidities compared to the smaller defects these flapshave to reconstruct. Moreover the aesthetic result is often jeopardized by the bulge of the muscle. The advent of perforator flaps has enabled us to reconstruct these smaller breast defects with more limited flaps based on perforating branches of the main thoracodorsal pedicle. Thus the major part of the muscle with its main pedicle is saved for potential further reconstruction in case the patient develops recurrence requiring a total mastectomy. Methods: the study included 40 patients of stage I or II breast cancer who underwent partial or total mastectomy at the National Cancer Institute between 2011 and 2014. The patients were devided into two,XII groups .group A included 20 patients who underwent Thoracodorsal artery perforator flap reconstruction and group B included 20 patients who underwent latissimus dorsi flap reconstruction . Operative time and complication rates were recorded .The cosmetic and functional outcome were subjectively assessed through a questionnaire. Results: The mean operative time in group A was 227 minutes while that for groups B was 242 minutes.The total complication rate for group A was 55% with flap congestion as the most common complication, In group B complications occurred in 65% of patients with seroma in the back wound as the commonest complication.The cosmetic oucome was comparable for both techniques with 80% of patients of both groups rating their outcome as either good or excellent. The subjectively assessed functional outcome was favorable for the thoracodorsal artery perforator flap group with mean time of 15 days postoperative for patients to regain their full range of shoulder movements. Patients who underwent latissimus dorsi reconstruction needed on average 21 days to regain their full range of shoulder motion. The difference was however statistically not significant. Conclusion: Thoracodorsal artery perforator flap can play a significant role in oncoplastic surgery and breast reconstruction with acceptable cosmetic and functionl outcome. Key Word : Oncoplastic surgery-Perforator Flaps- Thoracodorsal Artery Perforator Flap-Breast cancer-Breast reconstruction.