HEGAZY SURGERY

1. ONCOPLASTIC SURGERY
FOLLOWING BREAST
CONSERVATION FOR MALIGNANCY
By
Dr. KARIM FAHMY
DR.RANA YOUSSRY
Supervised by
Prof. Dr. FATEEN ANOUS

2. Definition of term ‘‘oncoplastic’’:
 Oncoplastic surgery defines the appropriate
adequate surgery to extirpate a cancer in the breast
combined with partial or total reconstruction

3. Indication for oncoplastic techniques
 10% volume resection.
 Central location.
 Lower pole location.
 Medial pole location.
 Ptotic small breasts.
 Multifocality
 UOQ lesions.? the gravity of the breast
parenchyma may stretch the skin over the
defect and may improve cosmesis without
using a local oncoplastic technique

4. Contraindications for oncoplastic techniques
Inflammatory carcinoma.
Multicentric carcinoma.
Progressive disease after neoadjuvant
therapy.
Without adjuvant radiotherapy.

5. Volume
displacement
• Level 1
•Intra-mammarian flap
Volume replacement
 TRAM
 MINI LD FLAP
 Prosthetic implant
Types
Level 2
•Inferior pedicle techniques
• Superior pedicle techniques
• Vertical scar techniques
•Round block techniques
• Grisotti flaps
•Doughnut mastopexy
•L mamoplasty
•S shaped mamoplasty
•Batwing mamoplasty

6. Advantage of oncoplastic techniques
*Increase Of Resection Volume
*Better Cosmetic Results

7. Disadvantages of oncoplastic techniques
 Prolongation of operative time.
 Increase local morbidities e.g.. Skin necrosis and
wound dehiscence

8. Different oncoplastic techniques
for Reconstruction of Partial
Mastectomy Defects

9. Superior Pedicle Reduction Mammaplasty
Preoperative Drawings
Drawings are done preoperatively
with the patient in an upright
standing position

10. Superior pedicle reduction mammaplasty

11. Superior pedicle reduction mammaplasty

12. Superior Pedicle Reduction Mammaplasty

14. Superior Pedicle Reduction Mammaplasty

15. Superior Pedicle Reduction Mammaplasty
Postoperative View 3 Years After
Partial Mastectomy And
Superior-based Pedicle
Reduction Mammaplasty.
56-year-old Woman With A 21
Mm Breast Cancer In The Lower
Quadrant Of The Left Breast.

16. Inferior Pedicle Mammaplasty for
Reconstruction of Partial
Mastectomy Defects

17. Inferior Pedicle Mammaplasty
Preoperative drawings

18. Inferior Pedicle Mammaplasty

19. Inferior Pedicle Mammaplasty

22. Medial or Lateral Pedicle Vertical
Breast Reduction(Hall-Findlay or
Snowman Technique)

23. Medial or Lateral Pedicle Vertical Breast
Reduction(Hall-Findlay or Snowman Technique

24. Medial or Lateral Pedicle Vertical Breast
Reduction(Hall-Findlay or Snowman Technique
Preoperative Drawings:

25. Medial or Lateral Pedicle Vertical Breast
Reduction(Hall-Findlay or Snowman Technique
.

26. Medial or Lateral Pedicle Vertical Breast
Reduction(Hall-Findlay or Snowman Technique

27. Round Block Technique (Doughnut Mastopexy):

28. Round Block Technique (Doughnut Mastopexy):

29. Round Block Technique (Doughnut Mastopexy)

31. Batwing Technique
Preoperative drawings

32. Batwing Technique

33. Batwing Technique

34. Batwing Technique

35. S-Shaped Oblique Reduction
Mammaplasty for Reconstruction
of Partial Mastectomy Defects

36. S-Shaped Oblique Reduction Mammaplasty
Concept
Serves to remove an S-shaped quadrant of
breast tissue. It allows resection of tumors
located in all upper breast quadrants as well
as retroareolar cancers

37. S-Shaped Oblique Reduction Mammaplasty

38. S-Shaped Oblique Reduction Mammaplasty

39. S-Shaped Oblique Reduction Mammaplasty
preoperative view of a 56-
year-old woman operated with
an S-shaped oblique reduction.
postoperative result 3
years after surgery and
radiation.

40. The Grisotti Technique
Preoperative drawings
• .

41. The Grisotti Technique

42. The Grisotti Technique

43. Volume replacement

44. TRAM

45. 40-year-old Woman With LTBreast Cancer underwent MRM and
immediate reconstruction using tram FLAP
TRAM

49. 35-year-old Woman With RT Breast phylloide tumor
underwent wide local excision and immediate reconstruction
using tram FLAP