Oncoplastic Breast Surgery in Egypt: The Impact on the Breast Multidisciplinary Team Service and on the Patients’ Pre- and Postoperative Peace of Mind as a Multicenter Experience. G. Amira, A. Sherif, I. Sallam, A. Noaman, K. Diab, M. Sherif, A. ELgohary, M. Youssif. MISR Cancer Center. MISR International Hospital. Giza.EGYPT BACKGROUND Oncoplastic Surgery (OPS) is becoming more popular in Egypt. Increased by 29% last year. Breast reconstruction is becoming increasingly important due to changes in patient expectations and demand. There is growing recognition that immediate reconstruction in appropriately selected women can combine an oncological and aesthetic procedure in one operation with excellent results. Because most breast surgery is performed by general surgeons, most reconstructions were performed as delayed procedures by plastic surgeons. Increasingly, breast surgery is being performed by breast surgeons trained in oncoplastic techniques who can offer immediate reconstruction with both therapeutic and economic benefits.What is the impact of OPS on the NHS and subsequently Breast services in todays’ financial difficulties? What’s the impact on Breast Cancer Patients (BCP)? METHODS

468 BCP underwent OPS at MISR Cancer Center from May 2012 to June 2015. Mean age at presentation was 43 years (29-63).the commonest OPS procedure was volume replacement n=304 (65%) and a contralateral mamoplasty. dermo-glandular rotation in 58 BCP, dermo- glandular advancement in 148 BCP and glandular displacement in 98 BCP, n=90 (19%) needed Silicone implants and n=74(16%) needed volume replacement by latissimus dorsi flap.

RESULTS

Excellent to good cosmetic outcome was more than 92% in 3 type of OPS and patients are satisfied. The rate of poor cosmetic result was less than 10%. The significant factors affecting cosmetic outcome were long scar, hypertrophic scar, pain and itching. Progressively Increased number of cases last year due to the raised awareness and acceptance of the OPS and prevalence of such surgeries. which Brought peace of mind for breast cancer patient about the cosmetic results of surgery. these results Together with the outstanding patient expectation which demand a more advanced training of the assigned dedicated team. The high rate increase in flow rate year by year, Recorded cases at June 2013 was 96 cases, June 2014 was 146 cases and by June 2015 was 226 cases, with increased financial demands and shortage in the resources CONCLUSIONS In this study, assessing the impact of OPS on the three National breast centers’ MDT service, we have seen an additional work load over the past three years with a challenging cosmetic demands. The increase in OPS is likely to have cost implications on limited resources which should be addressed. An urgent alarm mandating recruiting and giving new chances for training new oncoplastic surgeons. Also, it’s considered a strong motive among Egyptian women to encourage early management and increased the annual number of cases seeking advice and care with no more fear of the cosmetic outcomes as known in the past. REFERENCES

1. Malyon AD, Husein M, Weiler-Mithoff EM. How many procedures to make a breast? Br J Plast Surg 2001;54:227–31. 2. Rosenqvist S, Sandelin K, Wickman M. Patients psychological and cosmetic experience after immediate breast reconstruction. Eur J Surg Oncol 1996;22:262–3. Contant CME, van Wersch AMEA, Wiggers T, Wai RTJ, van Geel AN. Motivations, satisfaction and information of immediate breast reconstruction following mastectomy. Patient Education and Counselling 2000;40:201–8. 4. Harcourt D, Rumsey N. Mastectomy patients’ decision-making for or against immediate breast reconstruction. Psycho-Oncology 2004;13: 106–15. 5. Harcourt D, Rumsey N, Ambler N, et al. The psychological impact of mastectomy with or without immediate breast reconstruction: a prospective, multi-centred study. Plast Reconstr Surg 2003;111:1060–8. https://www.facebook.com/MISRCancerCenter.misrhospital.org-Email. [email protected]@outlook.com- Tel +20100313181. Fax.+20233356894