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    • Oncoplastic versus breast conservativesurgery in surgical management of aggressive breast cancer

    Ehab H. Abd El-Wahab,MD; Ahmad Gamal El Deen,MD; Amr H. Afifi,MD
    Department of General Surgery, Ain Shams University,Cairo, Egypt

    Background Breast cancer is a clinically and biologically heterogeneous disease, characterized by dysregulation of multiple cellular pathways and different sensitivities to treatment. Some types of breast cancers are more aggressive than others such as triple negative, high grade and high Ki 67 proliferation index. The aim of surgery for breast cancer have remained consistent over the time , to eliminate breast cancer with the least degree of deformity. With improved survival after aggressive breast cancer treatment, more attention has turned to the cosmetic result of the surgical treatment. Patient and methods The study included 30 patients with features of aggressive breast cancer including: triple negative, grade three or high Ki67 proliferation index. They were distributed into 15 patients who underwent conservative breast surgery and 15 patients who underwent oncoplastic breast surgery. Postoperative outcome and follow up were compared and evaluated. Results The age of the patients varied from 30 to 65 years old (mean age 48.7).Five patients among patient population s had medical co morbidities . The oncoplastic group included six patients who underwent superior pedicle flap procedure, five patients who underwent donut mastopexy and four patients who underwent inferior flap reconstructive breast surgery. The mean operating time for the conservative group was 1 hour and 30 minutes versus 2 hours and 15 minutes for the oncoplastic group (P value 0.53).The mean post-operative stay period for the oncoplastic group was 35 hours versus 28 hours for the conservative group surgery (P value 0.48).No statistical significance regarding short and long term surgical complications or locoregional recurrence with considerable statistical significance regarding the cosmetic outcome in favor of the oncoplastic group (P value 0.03). Conclusion Aggressive breast cancer surgical options has evolved recently and as regarding the comparable oncological outcome and low complication rates with considerable superior cosmetic outcome , oncoplastic breast surgery can be a preferred option in surgical management of aggressive breast cancer. Keywords: Aggressive breast cancer, triple negative, grade three breast cancer,Ki 67, oncoplastic breast surgery, breast conservative surgery. 

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