الفهرس 
Title pageOnly 14 pages are availabe for public view
 |  | from | 144 |  |  |
| | | from | 144 | | |
Abstract
Treatment of breast cancer should at all times be carried out in a multidisciplinary approachment. Whether after MRM or after breast conservative surgery coupled with radiotherapy, a surgical conflict arises between optimal oncological resection and the longing to minimize the chances of unacceptable local deformity; thus creating a dilemma. The cosmetic outcome is of great importance to women to restore femininity, and have upbeat impact on patients’ psychological welfare and her quality of life, especially in the young. So there has always been a dire need to overcome tissue irregularities, defects, asymmetry, localized corrections, and insufficient skin flap thickness, re-aligning of subcutaneous layer stubborn scar and implant contractures. There’s a direct connection between a unfortunate cosmetic outcome and elevated levels of negative psychological impact. Customarily, reconstructed breast contour deformities were tackled with oncoplastic procedures, like local tissue rearrangement and muscle flap reconstruction. Unfortunately, traditional breast reconstruction does not at all times fulfill the intended aesthetic outcome; specially in partly-breast reconstruction and tumors unfortunately located in upper/inner quadrants. Adjuvant radiation is at times a mandatory part of therapy; causing the resulting deformity being progressive and ugly within time. Radiodermatitis is a disconcerting side effect which may occur immediately or much later impacting the skin, breast tissue and muscles (degenerative effect). The chronic radio-damaged tissue may expand encompassing both superficial and deep tissues. Coleman published his lipofilling technique in breast reconstruction in 2007 to provide solution and decline in contralateral esthetic surgeries. Lipofilling is autologous, miniinvasive, low-traumatic, popular and oncologically safe implement to refine aesthetic outcomes in several previous reconstructive approaches, even more a generous opportunity to compliment autologous muscle flap reconstruction. With all these promises, still hung in the horizon the stubborn obstacles of hypoxia and ischemia, threatening the autograft viability. The lipoaspirate (preadipocytes and mature adipocytes), are sensitive to their local environment and initially survive via direct diffusion but need an extended helping hand for consequential neoangiogenesis, modulation of inflammation and edema. The angiogenic and nutritional support for the lipoaspirate are wavering to-be, unfolding the feared truth of
reabsorption. The autograft besides having local complications is notorious for high rate and duration of resorption in literature, dimming the aforementioned patient satisfaction. This aftermath simply means less patient satisfaction, decreased persuasion of the procedure; more sessions needed to attain respectful outcomes and overall increased local complications. A discovered goldmine of growth factors, of extended release nature, abundant resource, consistent continuity, amplification affect in time; is the dream scaffolding for the autograft. So the answer for this reconstructive and cosmetic ordeal is platelet rich plasma enhancement of the injected lipofilling. PRP reinforces the survival, maintenance of the autograft, and formation of de novo adipogenesis. In addition, PRP produces a number of chemokines implicated in tissue healing and inflammatory response. Working synergistically, PRP causes intensification of the autocrine system, which is essential in sustaining the wound-healing process. The efficacy of autografted fat on account of measures such as the extent of patient satisfaction, her quality of life,the surgeon satisfaction, volume retention, the requirement for procedure recurrence, any clinical/radiological complications.The golden discovery that the preponderance of our stem cells inhabit in the adipose tissue is a break-through for tissue engineering and regenerative medicine. Thus the combination of the qualities of the dynamic multipotent fat cell with the reconstructive and restorative qualities of PRP is of almost limitless capacity as a biomatrix modality. Using blunt-tipped small caliber infiltration cannula, PRP enhanced lipofilling was injected on withdrawing, a honeycomb of microtunnels by atraumatic gentle Coleman technique. Our study’s aim was to evaluate the delayed platelet rich plasma enhancement lipomodelling used for correction of deformities after different surgical procedures used for breast cancer, on account of esthetic outcome and patient satisfaction. The esthetic outcomes, patient satisfaction, and complications were evaluated subjectively after the finishing point of the procedure and at a number of post operative intervals by breast oncoplastic surgeons,
paying more attention to reabsorption rate and donor/recipient complications. Patient satisfaction was documented by KNUH questionnaire. The min. rate of resorption was 20%, while the max. rate was 40%, and was dealt with by repeated sessions with intervals in between accordingly. The minimum interval of time in months inbetween one session and its repeaition was 3 months, while the maximum time was 10 months. The intermission period was to seek inter-procedural healing and for the maximum resorption to happen prior to assessment. PRP being appealing for its easy preparation, availability and low cost characters has certainly enhanced the lipofilling procedure, added benefits for healing and regeneration aspects of the autograft and overall decreased complications rate; aiding to reach higher patient satisfaction.