الفهرس 
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Abstract
The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy.
This study was conducted at Beni-Suef University Hospital to compare between the Oncoplastic breast surgery using the pedicled latissimus dorsi flap and the traditional conservative breast surgery in upper outer quadrant breast cancer. The mean age of patients managed with local tissue displacement was 41.50 ± 12.576 years with a mean BMI 28.11 ± 3.011 while patients managed with latissimus dorsi flap had a mean age 41.55 ± 11.199 years with average BMI 27.72 ± 3.021.
Better aesthetic outcomes were significantly higher among patients with LD flap. LD flap was able to maintain the breast shape in (90%), the breast volume (85%) and the NAC direction in (90%) of patients. Surgeons’ evaluation of both techniques reported a significant higher satisfaction for the results of LD flap than local tissue replacement. Patients satisfaction was significantly higher among patients with LD flap where (80%) showed very good satisfaction.
As regards to the postoperative complications, there was no significant differences between both groups in early complications, however higher rates of postoperative lymphedema (15% Vs 5%), wound seroma (25% Vs 10%) and wound infection (30% Vs 5%) were observed in patients with local tissue displacement than those in LD flap group.
Evaluating the delayed complications revealed that there were no significant differences between both groups regarding the delayed postoperative complications. Recurrence of the tumor, resistance to chemotherapy or radiotherapy and persistence of seroma after month were detected in patients with local tissue displacement only.
The mean tumor size was significantly larger among patients managed with LD flap (3.6 ± 0.52 cm) compared to those managed with local tissue displacement (2.4 ± 0.56 cm). The distance between the tumor and the NAC didn’t differ significantly between both groups.
According to the IDC classification of the tumors, the majority of patients (60%) managed with local tissue displacement was class II compared (35%) of patients managed with latissimus dorsi flap with no significant differences between both groups. After dissection of lymph nodes staging was done and revealed that (55%) were stage N0 and the remaining (45%) were stage N1 in patients managed with local tissue displacement.
The mean operative time was significantly longer among patients managed with LD flap (86.75 ± 13.206) min while in patients managed with local tissue displacement it was (50.75 ± 5.200) min. The operative blood loss was significantly increased in patients managed with LD flap compared to those managed with local tissue displacement (570.00 ± 136.594 Vs 276.25 ± 74.549) ml respectively. Postoperative hospital stay was significantly longer in patients with LD flap Vs local tissue displacement (4.50 ± 1.051 Vs 1.60 ± 1.353 days) respectively. After discharge patients in LD flap group returned to normal activity in average (14.85 ± 3.200) days while patients managed with local tissue displacement their mean recovery time was (11.45 ± 2.874) days. The average postoperative VAS score over 48 hours was significantly higher in patients with LD flap group 6.50 ± 1.606 compared to 4.55 ± 1.276 in patients with local tissue displacement group.
Post-operative adjuvant therapy included chemotherapy and hormonal therapy. Chemotherapy was indicated for 10 patients (50%) managed with local tissue displacement and only 1 patient (5%) managed with latissimus dorsi flap with significant difference between both groups. On the other hand, hormonal therapy was indicated for 8 patients (40%) managed with local tissue displacement and 6 patients (30%) managed with latissimus dorsi flap with no significant difference between both groups.