Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

Introduction: Breast cancer patients with multicentric disease will require mastectomy advances of screening and genetics have ended in many ladies may needs prophylactic mastectomy nipple and areola sparing is good option for these patients with higher levels of psychosocial wellbeing. Patient and Methods: The 300 breast cancer patients all have NSM for the therapy of multicentric breast cancer. The primary end point was tumor recurrence post NSM either was local, regional or metastatic recurrence and, the Secondary end point for this study is to report disease free survival, loco-regional control and overall survival. Results: All cases were multicentric invasive duct carcinoma, 6 cases (33.3%) were reported to have distant metastases to lung and bone and 12 cases (66.7%) were reported to have local recurrence within nipple areola complex, among reported recurrence cases the interval time between primary treatment and recurrence was 28 months in 6 cases (33.3%), 43 months in 6 cases (33.3%) and 50 months in 6 cases (33.3%). Among 300 cases that did NSM, 6 cases (2%) died from heavy lung metastases and 294 cases (98%) still alive within period of follow up ranging from 40-96 months. Conclusion: This study revealed a low incidence of cancer recurrence at the NAC after NSM and immediate breast reconstruction. Patients with high stage disease, HER2 positive subtype, high grade lesions and extensive intraductal component had a significantly increased risk of cancer recurrence at the NAC.

Background Despite several improvements in surgical techniques, the intracorporeal division of the distal end of the rectum is still challenging, particularly when it is too deep in a narrow pelvis. Even though it helps avoid spillage, the double-stapling technique (DST) raises concerns regarding safety and anastomotic leakage if multiple stapler firings are essential to complete the rectal division. Objective To assess the feasibility of vertically dividing the rectum and its impact in reducing the number of reloads essential for that division in non-low rectal cancer patients undergoing total mesorectal excision (TME). Materials and Methods A retroprospective study. Results From January 2017 to November 2021, a total of 123 patients with sigmoid and rectal cancers were enrolled in the present study; their data were collected and analyzed, and 21 patients were excluded. The remaining sample of 102 subjects was composed of 47 male (46%) and 55 female (54%) patients with a median age of 54 years (range: 30 to 78 years). Only 1 reload was enough to complete the rectal division in 82 (80.39%) cases, and 2 reloads were used in the remaining 20 (19.61%) patients. Anastomotic leakage was clinically evident in 4 cases (3.9%). No statically significant difference was observed when firing one or two staplers. No 30-day mortality was recorded in this series. Conclusion Our early experience indicates that this type of division has a real advantage in terms of decreasing the number of reloads needed and, in turn, lowering the incidence of anastomotic leakage after partial mesorectal excision (PME) or TME when applied with proper patient selection.