Evaluation of Platelet Rich Plasma Enhanced Lipoinjection for Correction of Deformities after Different Surgical Procedures Used for Breast Cancer

**In the Name of Allah, the Most Gracious, the Most Merciful** I would like to express my sincere gratitude to my esteemed supervisor, Prof. Dr. Ahmed Saad Ahmed,. His invaluable guidance, meticulous supervision, and unwavering support throughout this thesis journey were instrumental in achieving this work. I am also deeply grateful to Prof. Dr. Mohamed Atef Motawei. His continuous encouragement, generous assistance, and insightful guidance played a pivotal role in the successful completion of this study. My sincere appreciation extends to Prof. Dr. Yasser Sayed Hamed. His constant support, patience, and willingness to provide guidance were invaluable throughout this research. Furthermore, I would like to thank Assis. Prof. Dr. Ahmed Farouk El Qaramoty, for his invaluable assistance in providing the necessary facilities for the immunological study. Finally, my deepest gratitude goes to my beloved family for their unwavering support and encouragement throughout this endeavours..

Evaluation of Immediate Breast lipomodelling with Breast conserving surgery in Breast Cancer Patients.

Professor, Department of Experimental and Clinical Surgery Medical Research Institute - Alexandria University Prof. Dr. Ahmed Saad Ahmed.

Introduction. [image].

Breast Cancer *The most common malignancy affecting females worldwide in 2018. *11.6% of all newly diagnosed cancer patients worldwide. *6.6% of deaths among all. (Bary et al.,2018).

Restoring an acceptable cosmetic outcome after breast cancer surgery now constitutes a crucial element of the treatment process *Restoring body image, improves vitality, femininity and sexuality *Will have positive impacts on patients' psychological well-being and quality of life, especially in young women.

*Treatment has been evolved from aggressive to minimally invasive techniques over the last century *OPS became a revolution in conservative management of breast cancer in the last two decades However,….

Longer duration of intervention and well-trained surgeons are required to obtain optimal results..

BCT(BCS+RT) *Appropriate for most women with early-stage Breast cancer. *Is the standard for tumour < 3cm. *Many series adopt BCT for up to 4 cm tumors,or even larger for intraductal cancer with the use of neoadjuvant therapy..

*BCS main issue is to remain the compromise between wide excision with clear margin and a satisfactory aesthetic result. *Although defects can be managed with primary closure BUT cosmetic outcome may be unpredictable and frequently achieve unsatisfactory outcome *10 to 30% of patients submitted to BCS are not satisfied with their aesthetic outcome. (Losken et al;2009).

*The main reasons of such poor aesthetic results are related to the tumour resection. *Asymmetry retraction and volume changes. In addition, radiation can also have a negative effect on the native breast *The idea to substitute the removed volume immediately by successful application of immediate lipomodelling as a method for replacing lost volume is a recent development, signifying an innovative approach to volume replacement procedures.(Biazus et al;2015).

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THE AIM OF THE WORK WAS. Evaluate efficacy, complications, patient satisfaction, and esthetic outcomes of immediate Lipomodelling used for correction of deformities resulting from breast conserving surgery for breast cancer patients. To.

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Graph and note paper pads with pencil. Admitted to the surgical department of Medical Research Institute Hospital, Alexandria University operable early breast cancer..

Eligibility criteria: *female patients with breast cancer eligible to conservative breast surgery according to National Comprehensive Cancer Network (NCCN) guidelines. *Small and moderate size breasts. *Solitary mass (maximum tumor size is 3 cm). *Clinical stage I, and II..

Exclusion criteria: *Centrally located tumour. *Bleeding disorders *DCIS more than 40% in tru-cut biopsy *Large breasts *Multicentric tumour. *Smokers.

5. Pre-operative work up. 1 Complete history taking stress on previous anti-cancer therapy.

*Tumor sites marked and injected with methylene blue to detect sentinel lymph nodes in cases of clinically and radiologically negative axilla. *The donor site for fat harvesting was prepared *Surgical excision of the mass with adequate safety margins. *The lipomodeling was prepared using the Coleman technique.

Infiltration of Klein's solution containing local anesthetic 10cc lignocaine + 0.25 mg adrenaline in 500 cc Ringer's solution..

Liposuction by slight negative pressure by blunt tipped Coleman's cannula 2 mm mounted over 50 cc Luer Lock syringe.

After centrifugation at 3000 rpm for 3 minutes the fat is separated into 3 layers: upper oily layer, middle purified fat and lower blood and debris..

Purified fat is transferred to 3 and 1 cc Luer Lock syringes.

*Closure of primary defect directly by glandular flap advancement of the breast tissue. This leads to a defect in the shape of breast *Correction by injection of fat in the subcutaneous tissue in different tunnels away from tumor cavity to restore the contour of the breast.

[image] Q 00 Q 0000 ooo ooo. We avoid lipoinjection in the same region of lumpectomy (upper right). Instead of that, we perform the lumpectomy and close the cavity created with absorbable stitches, deforming areas distant from the lumpectomy bed (lower left). The lipoinjection is performed in the deformity areas, distant from the tumor bed (lower right)..

*The amount of injected fat was guided by many factors as weight of the specimen, backflow of injected fat from subcutaneous tissue, and whiteness or firmness of the skin *This was followed by the closure of the skin in a neat way..

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Patients were followed up for early and late postoperative complications. Patients were followed up at 3, 6, 12, and 24 months for the detection of oncological recurrence. Mammography at 12,24 months The statistical analysis of data was done.

volumetric CT to determine the fat absorption. one month following the procedure and 6 months after the first to allow the patients to finish their adjuvant therapy..

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Weight resected ranged from 52-128 gm with mean value 93.7 ± 21.73 gm. Volume injected ranged from 65-159 ml with mean value 105.04 ± 27.26 ml. The period of follow up ranged from 24 –38 months with a mean of 31.02 ± 4.47 months..

Regarding the clinical part of the research. Regarding the site of tumor %.

Regarding the clinical part of the research. Regarding the Histopathological type %.

Regarding the clinical part of the research. Regarding the Clinical Stage %.

Regarding the clinical part of the research. Regarding the early post operative complications %.

Regarding the clinical part of the research. Regarding the late post operative complications %.

Local recurrence, occurred in 1 case (2%),13 months after the surgical procedure The primary tumor was (ILC) in the (UOQ). Recurrence was in the (UIQ) away from the site of the primary tumor (other quadrant) but at the quadrant of fat injection. The patient was effectively treated with mastectomy..

The mean absorption rate measured by CT volumetric study of the breast pre and post Radiotherapy revealed a volume reduction of the injected fat graft ranging from 10% to 52% (mean 28 ±9%)..

Series 1 Excellent Good Fair Poor 0.36 0.4 0.16 0.08 Series 2 Excellent Good Fair Poor Series 3 Excellent Good Fair Poor.

5 4 3 2 1 32 46 14 8 0.

Series 1 Excellent Good Fair Poor 0.1 0.46 0.36 0.08 Column1 Excellent Good Fair Poor Column2 Excellent Good Fair Poor.

Relation between patients’ satisfaction and doctor satisfaction.

Relation between Esthetic results by BCCT core program and Patients satisfaction.

[image]. Before. Case 1. After. Age 47,UIQ Mass wt. 95 gm Vol. of injected fat 115 ml.

[image]. Case 2. Before. After. Age 39,UQO Mass wt. 80 gm Vol. of injected fat 95 ml.

Case 3. A person's chest with a yellow substance Description automatically generated.

A close-up of a person's breast Description automatically generated.