الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
This study was conducted at Surgical Oncology Unit, Oncology Centre - Mansoura University (OCMU) during the period between January 2005 & July 2007. One hundred patients with breast cancer were enrolled in this study. They were divided into main two groups; group I includes 50 patients who were treated with SSM, and group II includes 50 patients who were treated with ASM. The latter group was subdivided into two subgroups; subgroup ”A” includes 5 patients who were treated with classic ASM (without nipple preservation), and subgroup ”B” includes 45 patients who were treated with ASM with nipple preservation or NSM. Cosmetic factors in the treatment of breast diseases have long been neglected despite the fact that these patients are highly concerned about the aesthetic appearance and body image. Our study revealed that the aesthetic outcome of NSM is better than both ASM and SSM. We combined SSM, ASM or NSM with our modification of the technique of extended latissimus dorsi flap by harvesting the fat overlying the serratus anterior muscle with its own blood supply directly driven from the thoracic branch of the thoracodorsal artery. Addition of this richly vascularized fat with part of the serratus anterior muscle adds a significant bulk with decreasing incidence of fat necrosis enabling us to reconstruct larger breast sizes without a contralateral reduction operation and without an implant with a less flap complication rate. We have to recommend that the choice of the type of mastectomy (SSM, ASM or NSM), should be based on correlation of three main variables; the location of primary tumor, the stage at diagnosis, and the results of intraoperative frozen-section analysis (FSA) of the retroareolar tissue both in the undersurface of the nipple itself and in the en face retroareolar margin of the resected breast mound. The use of intraoperative FSA, which is the most important variable, as part of the decision-making process should be advocated. In brief; our combined procedure of NSM with immediate breast reconstruction by modified extended latissimus dorsi flap has the multiple modifications that increasing patient satisfaction with body image and the quality of life; ” Preservation of NAC on the oncologic safety base avoids the complications of nipple reconstruction, tattooing of areola which are common areas of dissatisfaction. ” The unique design of the Claw like incision attempts to preserve NAC innervation, thus resulting in better results sensation of the preserved NAC. Also it does not compromise blood flow to the nipple, thus minimizing the incidence of necrosis and partial loss of the NAC. Further study is needed to assess the long term follow up of these surgical procedures as regards the risk of local recurrence.