Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian.

Volume measurement of the breast allows for better surgical planning and implant selection in breast reconstructive and symmetrization procedures. The safety and accuracy of tumor removal, in accordance with oncoplastic principles, may be improved by knowing the true breast- and breast tumor volume. The authors discuss the methods of volume measurement of the breast and describe the method based on magnetic resonance imaging digital volume measurement in details. The volume of the breast parenchyma and the tumor was determined by processing the diagnostic magnetic resonance scans, and the difference in the volume of the two breasts was measured. Surgery was planned and implant selection was made based on the measured volume details. The authors conclude that digital volume measurement proved to be a valuable tool in preoperative planning of volume reducing mammaplasty, replacement of unknown size implants and in cases when breast asymmetry is treated.

We describe a 49-year-old female patient who was diagnosed with breast cancer in her left breast. The patient underwent a modified radical mastectomy and immediate reconstruction with the placement of an expander implant. Two years later, the patient suffered a minor trauma and began to feel the softening of her reconstructed breast, and a growing palpable mass appeared in the contralateral (right) axilla. Examinations revealed the intracapsular rupture of the expander implant. Aspiration cytology from the palpable axillary mass suggested silicone lymphadenopathy. We replaced the ruptured implant, and the lymph node from the contralateral axilla was removed. Silicone lymphadenomegaly in the right axilla was verified by a postoperative histopathological review. This case represents a rare manifestation of silicone lymphadenopathy caused by altered lymphatic drainage due to previous axillary lymphadenectomy. Level of Evidence: Level V, diagnostic study.

Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162-169.

A bőrtakarekos es emlőbimbo-megtarto mastectomiak az onkologiai emlősebeszetben lehetőve tettek a rendszerszintű azonnali emlő-helyreallitast. A nők leggyakoribb daganatos megbetegedese okan jelentkező tomeges rekonstrukcios igenyt az implantatumalapu technikak kepesek kielegiteni, kivalo kozmetikai eredmenyt es magas szintű betegelegedettseget garantalva. Ezen postmastectomias rekonstrukciok szamara a kihivast mar nem a bőrpotlas, hanem az implantatum jol vascularizalt, megfelelő minősegű lagy szovettel tortenő fedese jelenti. Az onkoplasztikus emlősebeszet napjainkra kepes arra, hogy a honaljarokban ejtett 6–10 cm-es bőrmetszesből onkologiailag radikalis komplett mirigyeltavolitast vegezzen, az emlő termeszetes bőrpalastjanak hegmentes, illetve minimalis heggel tortenő megtartasaval, emellett adekvat axillaris staginget (őrszemnyirokcsomo-biopszia/axillaris lymphadenectomia) folytasson, majd ugyanebből a feltarasbol egy- vagy tobblepeses emlő-helyreallitast vegezzen. Az ilyen komplex beavatkozasoknal kis terfogatu emlők teljes autolog rekonstrukciojara, a megkimelt bőrpalast ala az implantatumok komplett izomfedesere, a korabbi gyenge minősegű, elvekonyodott vagy sugarserult emlőbőr revitalizalasara jol alkalmazhato az endoszkopos technikaval asszisztaltan kialakitott – hati heg nelkul – es a hatrol az elulső mellkasfalra rotalt latissimus dorsi izomlebeny. Jelen kozlemenyben a szerzők – előszor hazankban – 4, endoszkoposan asszisztalt szeles hatizomlebennyel tortent emlőrekonstrukcios eset bemutatasa mellett reszletesen ismertetik a műteti technikat es irodalmi attekintest folytatnak. Orv. Hetil., 2014, 155(3), 106–113. | Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian. Orv. Hetil., 2014, 155(3), 106–113.

Introduction: With several decades of experience in breast conserving surgery it can be said that in early stage breast cancer approximately 30-40% of the oncologically successful locoregional surgeries followed by radiotherapy cause a significant decrease in esthetic and functional results, leading to poor quality of life and a challenge in reconstruction.

Az orvostudomany es az ipari technologiak fejlődesevel az emlő jo- es rosszindulatu daganatainak sebeszeteben is megjelentek a minimalisan invaziv eljarasok. Az ilyen beavatkozasokrol altalanossagban elmondhato, hogy jelentősen csokkentik az emlő es a mellkasfal hegeit, rovidebb hospitalizacioval, kisebb fajdalommal jarnak, de specialis, draga eszkozigennyel birnak, a nyitott műtetekhez kepest hosszabb műteti időt igenyelnek es jelenleg meg pontos indikacios koruk, onkologiai megbizhatosaguk nem igazolt. Az biztos, hogy a minimalisan invaziv műtetek – akarcsak az egyeb sebeszi szakteruleteken – a „high-tech” eszkozok reven fokozatosan elterjednek es idővel a rutin emlősebeszet reszet fogjak kepezni. A vakuumasszisztalt hengerbiopszia terapias indikacioval kepes az altalaban fiatalokat erintő benignus fibroadenomak szinte lathato heg nelkuli eltavolitasara, mig az endoszkoposan asszisztalt emlőműtetek soran a bőrtakarekos, illetve emlőbimbo-megtarto mastectomia, az axillaris staging es a latissimus dorsi izomlebennyel tortenő rekonstrukcio egyazon rovid honalji behatolasbol valosithato meg. Az egyre gyakoribb implantatumalapu emlő-helyreallito műtetek intrakapszularis szovődmenyeinek (implantatum koruli folyadek, ruptura, kapszularis kontraktura) diagnosztikajara es kezelesere, valamint a bizonytalan szovettanu intrakapszularis novedekek biopsziajara kivaloan alkalmasak az endoszkopos technikak. A radiofrekvencias tumorablatio szerepenek megitelese az emlőben tovabbi tapasztalatszerzest szuksegeltet, de a funkcionalis kepalkoto diagnosztika, valamint a tumorellenes gyogyszerek fejlődesevel valoszinű, hogy a jovőben a primer tumorok egy reszenel a sebeszi tumoreltavolitas kivaltasara szolgalhat. A duktoszkopok aranak csokkenesevel a ductalis agrendszer rutinszerű vizsgalata, az iranyitott microdochectomia, valamint a daganatos terminalis ductolobularis egysegek, illetve a „beteg lebeny” anatomiai egysegkent valo celzott sebeszi eltavolitasa valhat kivihetőve. Jelen kozlemenyukben a szerzők sajat tapasztalataik ismertetese mellett a tema irodalmi attekinteset vegzik, előszor magyar nyelven. Orv. Hetil., 2014, 155(5), 162–169. | Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices – similar to other surgical subspecialties –, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a „sick lobe” as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162–169.

Background: Breast cancer patients requiring mastectomy should be informed about the option of breast reconstruction, according to European guidelines. There are wide differences in the quality standard of oncoplastic care throughout Europe, with slight improvements in Central-European countries like Hungary. The aim of the present investigation was to evaluate patients' knowledge and demand for postmastectomy breast reconstruction and the psychosocial background in the decision making.

Today, as a result of the complex and coordinated medical treatment of breast malignancies the long-term survival rate reaches 80%. Modern breast surgery plays a prominent role in the multidisciplinary treatment of breast tumors. Breast surgery in the 21st century simultaneously performs medical and aesthetic procedures on the same organ. Modern day breast surgery is founded on a complex view of breast malignancies, multidisciplinary cooperation, oncoplastic practice, and selecting the optimal surgery techniques, based on state of the art tools and a detailed treatment plan. Authors present the evolution of modern breast surgery; discuss the procedures such as mastectomy, breast conservation surgery, axillary lymph node removal, prophylactic mastectomy, as well as possible versions of immediate or delayed breast reconstruction.

Recently an increasing number of reports of clinical experience have been published on nipple-sparing mastectomy. By the preservation of uninvolved skin and the nipple areola complex, this surgical technique greatly facilitates immediate reconstruction and optimal aesthetic outcome. However, the procedure raises serious oncologic concerns regarding the risk of an occult or a newly formed primary tumor due to parenchyma left behind in the nipple and the retroareola. Despite the ever increasing popularity of the method, there is still no evidence based confirmation to it. According to data from scientific literature on nipple-sparing mastectomy, there is no straightforward consequence to be drawn on oncologic safety; therefore the procedure is not generally considered to be alternative to standard mastectomy. In the indication of risk reduction, justification of the intervention seems to be well supported, and is expected to foster a greater rate of acceptance of surgical prophylaxis in patients with higher risk diseases. The procedure should be carried out possibly in the framework of clinical trials, in well selected patients with suitable preoperative and postoperative examinations, applying precise techniques and adequate patient education, according to international guidelines. Further long-term results are needed to form a substantive expert opinion. Authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language.

Despite its ever increasing popularity, there is no evidence-based confirmation so far on the results of skin-sparing mastectomy, introduced 20 years ago. However, the results of countless published retrospective, long-term trials seem to underpin the ability of the precisely implemeted procedure in early stage invasive and in situ breast cancers to yield the oncological results of modified radical mastectomy. As a result of the procedure involving special surgical techniques, the skin not affected by cancer can be preserved, which facilitates immediate reconstruction and improves cosmetic outcome. The effect of postmastectomy radiotherapy on the reconstruction needs to be considered at the time of the multidisciplinary design of the surgical procedure. The authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language.

Napjainkban egyre tobb klinikai tapasztalat kerul ismertetesre az emlőbimbo-megtarto mastectomiakrol. A műtet a tumorosan nem erintett bőr es emlőbimbo-areola komplex megőrzesevel nagyban elősegiti az azonnali rekonstrukciot es az esztetikai eredmenyesseget. A beavatkozas azonban komoly onkologiai aggalyokat is felvet az emlőbimboban es retroareolarisan visszamarado parenchyma esetleges okkult vagy uj primer tumoros rizikojaval kapcsolatosan. A modszer egyre fokozodo nepszerűsege ellenere nem all rendelkezesre bizonyitekon alapulo igazolas. Az irodalmi adatok alapjan az emlőbimbo-megtarto mastectomia onkologiai megbizhatosagarol egyertelmű kovetkeztetest nem lehet levonni, igy az eljaras jelenleg altalanosan nem kepezi alternativajat a standard mastectomianak. A kockazatcsokkentő indikaciokban a beavatkozas letjogosultsaga megalapozottnak tűnik es varhatoan elősegiti, hogy a nagy kockazatu betegek nagyobb aranyban elfogadjak a sebeszi profilaxist. Az eljaras jol szelektalt betegeknel, megfelelő pre- es intraoperativ vizsgalatokkal, preciz technikaval a beteg adekvat felvilagositasa mellett, a nemzetkozi ajanlasoknak megfelelően, lehetőseg szerint klinikai vizsgalatok kereteiben folytatando. Az erdemi velemenyalkotashoz tovabbi hosszu tavu eredmenyek szuksegesek. A szerzők kozlemenyukben magyar nyelven elsőkent ismertetik reszletesen a műtet technikajat es adnak szeles korű irodalmi attekintest. Orv. Hetil., 2011, 152, 1233–1249. | Recently an increasing number of reports of clinical experience have been published on nipple-sparing mastectomy. By the preservation of uninvolved skin and the nipple areola complex, this surgical technique greatly facilitates immediate reconstruction and optimal aesthetic outcome. However, the procedure raises serious oncologic concerns regarding the risk of an occult or a newly formed primary tumor due to parenchyma left behind in the nipple and the retroareola. Despite the ever increasing popularity of the method, there is still no evidence based confirmation to it. According to data from scientific literature on nipple-sparing mastectomy, there is no straightforward consequence to be drawn on oncologic safety; therefore the procedure is not generally considered to be alternative to standard mastectomy. In the indication of risk reduction, justification of the intervention seems to be well supported, and is expected to foster a greater rate of acceptance of surgical prophylaxis in patients with higher risk diseases. The procedure should be carried out possibly in the framework of clinical trials, in well selected patients with suitable preoperative and postoperative examinations, applying precise techniques and adequate patient education, according to international guidelines. Further long-term results are needed to form a substantive expert opinion. Authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language. Orv. Hetil., 2011, 152, 1233–1249.

Breast augmentation surgery involving the use of implants has been one of the most popular plastic surgical procedures for decades. As the multi-million female population who received breast implants ages, the risk of cancer is increasing rapidly, therefore the incidence of malignant disease in association with breast implants will increase as well. Although there is no relationship between tumor development and implants, these cases require special considerations in diagnostics, therapy and follow-up methods. Appropriate multidisciplinary treatment of tumors in augmented breasts corresponding with modern oncoplastic principles can only be accomplished based on adequate oncological, breast and plastic surgical knowledge. Supposing a possible increase of this condition in Hungary, too, authors provide a wide review of the literature on the special oncological and esthetic considerations, for the first time in Hungarian language.

Breast screening programs along with advances in diagnostic methods and oncologic treatment have resulted in full recovery for a decisive number of patients diagnosed with early-stage breast cancer. The results of the ultra-radical-, followed by the breast conserving era pose new opportunities and challenges for the oncologic breast surgeon. The focus of oncoplastic surgery is not only on the tumor, but also on the female patient, allowing for individualized immediate breast reconstruction with acceptable esthetic result following radical tumor exstirpation. Modern procedures differ both in concept and technique from that of traditional breast surgery. This paper provides a comprehensive and detailed overview of reconstructive and oncoplastic breast surgery.