الفهرس 
Anatomy of the BreastOnly 14 pages are availabe for public view
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Abstract
Breast carcinoma is the most common female cancer. Worldwide, more than a million women are diagnosed every year. However despite this increase, the mortality rate is declining due to early diagnosis and effective treatment.
Diagnosis of carcinoma of the breast is carried out by triple assessment which includes clinical evaluation; breast imaging and tissue diagnosis (cytological or histological assessment). The diagnostic process for a breast mass includes assessment of various risk factors based on family history, personal history of breast problems, and physical examination.
Mammography still have a central role in breast carcinoma detection, introduction of digital mammography and other imaging modalities to improve the sensitivity, aid in detection of mammographically occult lesions and differentiation between benign and malignant lesion by generate detailed three-dimensional anatomic and physiologic images of the breast and adjacent structures. Ultrasound became an important adjunct to mam¬mography for the workup of breast cancer and is an excellent method for guiding some interventional procedures. MRI in breast imaging has undergone much advancement in the last 25 years. New diagnostic complementary techniques based on cancer metabolism could be used as adjunct for the staging, assessment of treatment response, and therapy monitoring of breast cancer.
For obtaining tissue samples either invasive diagnostic procedure as Fine-needle aspiration, Core needle biopsy, Incisional biopsy, Excisional biopsy, Frozen sections, Vaccum assisted biopsy, or image guidance minimally invasive procedure could be used. The main use of the tumor markers is follow up the breast carcinoma and the prognostic value of biomarker expression assessment are aiding diagnosis, assessing prognosis, and monitoring response to the therapy.
Early detection remains the primary defense available to patients in preventing development of life-threatening breast cancer. The early detection of breast carcinoma occurs through the screening program.
Over the last 30 years the major change in the surgical treatment of breast carcinoma has been the shift towards breast conservation treatment. Breast conserving surgery was introduced to reduce the physical and psychological consequences of removing the whole breast. Mastectomy, with or without immediate breast reconstruction, is the surgical approach for the patient with breast carcinoma who has contraindications to BCT or who prefers treatment with mastectomy. The long-term survival of women with early breast cancer who were treated with breast-conserving surgery and postoperative radiotherapy to the ipsilateral breast was virtually identical to the rate among women who underwent radical mastectomy. New surgical techniques have been emerged and includes; Moving window operation and Endoscope-assisted surgery to improve the cosmetic outcome.
Axillary staging provides the most important prognostic factor in the patients with breast carcinoma. Consequently, the status of axillary lymph nodes forms one of the main determinants of adjuvant treatment in these patients. There are two methods for surgical staging of the axilla; the axillary dissection and axillary sentinel lymph node biopsy.
Non- surgical minimally-invasive thermal ablation techniques have been explored with the intention of achieving equivalent efficacy to that achieved with breast conservation therapy, but with improved cosmoses.
The goal of radiation therapy is to reduce the rate of local or regional tumor recurrence by treating residual microscopic disease that may have spread beyond the margin of surgical resection and it is an integral part of breast conserving therapy.
Adjuvant chemotherapy and hormonal treatment have substantially reduced the risks of relapse and death that threaten breast cancer patients. Selection of chemotherapy and/or hormone therapy is based on several factors, including a patients’ age and tumor characteristics, such as nodal status, the presence of estrogen receptors and the Her-2/neu status.
The survival benefits of adjuvant chemotherapy for patients with early-stage breast cancer are well established. The 15-year survival results from a combined regimen of cyclophosphamide, methotrexate, and fluorouracil reduce the annual recurrence and death rates.
For postmenopausal women with hormone receptor positive breast carcinoma, adjuvant endocrine therapy is the most important systemic treatment following surgical intervention, based on inhibition of hormone stimulation.
Trastuzumab is a humanized monoclonal antibody that binds to the extracellular domain of the HER2 transmembrane protein, trastuzumab in combination with chemotherapy has demonstrated a high improvement of survival in HER2-positive patients with breast carcinoma.
Breast conservation surgery (BCS) combined with postoperative radiotherapy has become the preferred locoregional treatment for the majority of patients with early-stage breast cancer, with equivalent survival to that of mastectomy and improved body image and lifestyle scores. The success of BCS for breast cancer is based on the tenet of complete removal of the cancer with adequate surgical margins, while preserving the natural shape and appearance of the breast. Achieving both goals together in the same operation can be challenging, and BCS has not always produced good cosmetic results in all patients.
One of the limiting factors is the amount of tissue removed, not only in terms of absolute volume but also in relation to tumor location and relative size of breast. If either of these two goals is not obtainable, mastectomy is often proposed to the patient. An alternative is to downsize the tumor preoperatively with either chemotherapy or hormone therapy. However, not all tumors respond to neoadjuvant treatment. The failure of classical BCS techniques to offer solutions for challenging scenarios has stimulated the growth and advancement of new techniques in breast surgery during the past decade.
Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and reexcision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer.
Oncoplastic surgery allows for wide resections with favorable cosmesis and integrates into a standard multidisciplinary approach for BCS. The ultimate goal is to allow large-volume resections with free margins and fewer re-excisions and mastectomies than is obtainable with standard BCS.
Atlas and guideline for oncoplastic surgery (OPS) developed to help in patient selection and choice of optimal surgical procedure for breast cancer patients undergoing BCS.
OPS divided into two levels based on excision volume and the complexity of the reshaping technique. For resections less than 20% of the breast volume (level I OPS), a step-by-step approach allows easy reshaping of the breast. For larger resections (level II OPS), a mammoplasty technique is required.
Three elements can be used for patient selection and for determination of the appropriate OPS technique: excision volume, tumor location, and glandular density. For level II techniques, quadrant per quadrant Atlas that offers a different mammoplasty for each quadrant of the breast.
OPS is the ‘‘third pathway’’ between standard BCS and mastectomy. The OPS classification and Atlas improves patient selection and allows a uniform approach for surgeons. It proposes a specific solution for different scenarios and helps improve breast conservation outcomes to avoid complications and obtain the best oncologic and cosmetic results.