The Evaluation of a Cost-Effective Method for Tumour Marking Prior to Neo-Adjuvant Chemotherapy Using Silver Rods.

Objective: The lack of objective documentation of pre-neoadjuvant chemotherapy (NAC) tumour margins is a major constraint in performing safe breast conserving surgery (BCS) in patients with breast cancer. Using a novel method of marking pre-NACT tumour margins with indigenous silver wire markers, this retrospective observational study attempted to assess the feasibility of safe BCS in breast cancer patients by performing excision wide of the marked pre-NACT margins. Materials and Methods: This retrospective observational study was conducted on breast cancer patients who were attending our oncology centre between May, 2015 and April, 2022. All patients had received NAC followed by surgery as recommended by our multidisciplinary team. All the patients had a primary operable solitary breast cancer. We used radiopaque metallic rods made from silver to localize tumour margins prior to NAC. Results: Sixty-four breast cancer patients were included; none had marker-related complications. Following NAC, BCS could be easily performed in 60 patients guided by the silver markers, which were used as temporary implants and removed during surgery. Only 2 patients were seen with positive margins and were converted to mastectomy. Conclusion: Breast cancer localization using sterile silver markers before the initiation of NAC is safe, easy, inexpensive, and effective, causing no morbidity or significant pain to the patients.

Primary thyroid chondrosarcoma: a case report of an extremely rare malignancy.

INTRODUCTION: There are different types of malignant tumors that can affect the thyroid gland where differentiated thyroid carcinomas (papillary and follicular) are the most common representing nearly 90% of cases. Non-epithelial malignancies were also reported to affect the thyroid gland particularly lymphomas and sarcomas that were reported in literature to range from 0.01 to 1.5% of thyroid carcinoma. Herein, we present a case with primary thyroid chondrosarcoma, an extremely rare malignancy of the thyroid gland. CASE PRESENTATION: We present a 79-year-old female patient complaining of hard thyroid swelling that was proved to be primary thyroid chondrosarcoma after histopathological assessment. CONCLUSION: Chondrosarcoma of the thyroid gland is extremely rare either in the primary or metastatic setting. Although the prognosis is bad, surgery is the main line of treatment after early prompt diagnosis.

Pectoralis major myo-parenchymal flap for local reconstruction of partial mastectomy defects: Description of a new technique.

INTRODUCTION: Breast conservation is the standard of care for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects. PATIENTS AND TECHNIQUE: Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40-50% breast defect. The parenchymal defect was repaired with an advancement muscle flap of the ipsilateral pectoralis major muscle. RESULTS: All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient. CONCLUSION: The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A-B breasts.

Operative Feasibility and Short-Term Oncologic Outcome of Rigid Versus Flexible Platforms in Transanal Total Mesorectal Excision.

Several transanal platforms were used to perform transanal total mesorectal excision (TaTME). They can be classified into rigid reusable platforms or flexible single-use platforms. The choice of transanal platform usually depends on the availability and the surgeon's discretion. To the best of our knowledge, this is the first study to compare the operative and oncologic outcome of flexible and rigid platforms during TaTME. This is a retrospective cohort study in which rectal cancer patients operated by TaTME in two tertiary centers from June 2013 to April 2019 were included. They were classified into two groups according to the platform used either the rigid platform group (n = 17) or the flexible platform (n = 14). Operative feasibility and short-term oncologic data were analyzed and reported. A total number of 31 patients were divided into either the rigid platform group (n = 17) versus the flexible platform one (n = 14). Shorter operating time, less blood loss, better TME specimens, and lymph node yield were reported in the flexible platform group. Flexible platforms were associated with better operative outcomes. Although there were no differences in circumferential and distal margins between the two groups, better TME specimens' quality and lymph node yield were reported in the flexible platform group. Future prospective trials are encouraged to provide better evidence.

Electro-thermal bipolar vessel sealing versus clipping of the inferior mesenteric vessels during minimally invasive proctectomy.

INTRODUCTION: The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of electro-thermal bipolar vessel sealers (EBVS) in laparoscopic rectal cancer surgery is weak where most studies are retrospective with non-homogenous patient groups. METHODS: This is a retrospective cohort study where 40 rectal cancer patients operated by laparoscopic TME or laparoscopic assisted transanal total mesorectal excision were classified in two groups according to approach of inferior mesenteric vessels ligation (EBVS versus Clipping). RESULTS: The operative time was significantly longer and the blood loss was significantly more in the EBVS group. However, hospital stay, time to oral, time to starting stoma function, and number of retrieved lymph nodes were not significantly affected by the method of vascular control. CONCLUSION: Both methods for control of vascular pedicle during minimally invasive rectal cancer surgery are safe, as such it is at the discretion of the operating surgeon to which method to use. Prospective well-designed trials are awaited to provide stronger evidence.

ANTECEDENTES: La introducción de nuevos dispositivos de sellado de vasos energéticos en la proctectomía mínimamente invasiva condujo a un mejor efecto hemostático, una menor pérdida de sangre y un tiempo de operación más corto. Actualmente, la evidencia disponible en la literatura sobre el uso de EBVS (electro-thermal bipolar vessel sealers) en cirugía laparoscópica de cáncer rectal es débil, pues la mayoría de los estudios son retrospectivos con grupos de pacientes no homogéneos. MÉTODO: Estudio de cohorte retrospectivo con 40 pacientes con cáncer rectal operados por escisión mesorrectal total laparoscópica o asistida por laparoscopia, clasificados en dos grupos según el enfoque de la ligadura de los vasos mesentéricos inferiores (EBVS vs. recorte). RESULTADOS: El tiempo operatorio fue significativamente mayor y la pérdida de sangre fue significativamente mayor en el grupo EBVS. Sin embargo, el método de control vascular no afectó significativamente el tiempo de hospitalización, el tiempo hasta el inicio de la función del estoma ni el número de ganglios linfáticos recuperados. CONCLUSIÓN: Ambos métodos para el control del pedículo vascular durante la cirugía de cáncer rectal mínimamente invasiva son seguros, por lo que queda a discreción del cirujano el método a utilizar. Se esperan ensayos prospectivos bien diseñados para proporcionar pruebas más sólidas.

Early and Late Functional Outcomes of Anal Sphincter-Sparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma

BACKGROUND: The study aims to assess the functional outcome of anal sphincter sparing procedures (SSP) with TME for anorectal adenocarcinoma. METHODS: In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME (TATA). Using the Per Anal Examination Scoring System (PASS), postoperative anal function was assessed after one year. RESULTS: Bowel motility time was 50 (±19) hours. The time needed for narcotic analgesia was 54 (±18.8) hours. Mean hospital stay was 15.4 (±10.25) days. Incidence of evident fecal incontinence after ISR is 10.6% (7/67 cases). The Per Anal Examination Scoring System (PASS) findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in one case (1.4%). Temporary diversion was performed in 61 patients (87.1%). CONCLUSION: Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides a reasonable functional outcome. PASS is a new application for postoperative assessment of anal function.

Transanal Versus Laparoscopic Total Mesorectal Excision: A Comparative Prospective Clinical Trial from Two Centers.

Purpose: Laparoscopic total mesorectal excision (LapTME) faced many obstacles in obese male with narrow pelvis and bulky mesorectum with increased risk of incomplete mesorectal excision and positive circumferential resection margin (CRM) and distal resection margin (DRM). Transanal total mesorectal excision (TaTME) is reported to result in a better quality total mesorectal excision (TME) specimen, lower incidence of CRM and DRM involvement, and higher rates of sphincter preservation. To date, there is still a debate about the feasibility and efficacy of transanal versus the laparoscopic approach for TME in middle and low rectal cancer. Materials and Methods: This is a prospective controlled clinical trial where 38 patients of middle or low rectal cancer from two tertiary centers were nonrandomly assigned to either TaTME or LapTME. Results: Eighteen patients were operated by TaTME versus 20 patients by LapTME. Mean body mass index was significantly higher in the TaTME group (30.74 ± 7.79) than in the LapTME group (25.99 ± 4.68) (P = .03). TaTME was associated with more transanal specimen extraction (55.5% versus 20%, P = .06). No significant differences were detected in CRM, DRM, peri- or postoperative complications, or conversion rates with more reported Clavien-Dindo grade III complications in the TaTME group (P = .29). Conclusions: TaTME facilitated rectal cancer surgery in obese patients and increased the chance of transanal specimen extraction with equivalent oncological outcomes to conventional LapTME. Further studies are recommended to build better evidence.

A New Concept of Interval TRAM for Immediate Breast Reconstruction in Obese Women.

Performing pedicled TRAM in obese women carries risk of flap loss or native breast envelop necrosis. Our technique depends on performing total flap delay at the same setting with mastectomy with flap suture in situ to be followed 1 week later by flap transfer. This study included 24 operable women who were candidates for skin sparing or modified radical mastectomy. In one case, delay was only done and followed by mastectomy and flap transfer. In later experience, delay plus mastectomy was done first and followed later by flap transfer. Operative data and postoperative complications were recorded. The mean BMI was 37 ± 2.75. The mean total operative time was 200 ± 20.37. The mean total hospital stay was 9.1 ± 3.35 days. The mean total volume of blood loss was 380 ± 82.33 ml. Breast envelop necrosis was encountered in four cases; three of them were replaced by the TRAM skin. There was no total flap loss while partial loss was recorded in five cases. Fat necrosis occurred in eight cases. Most of mastectomy bed and abdominal complications were in average. Most of cases showed satisfactory esthetic outcome. Our new concept of "Interval TRAM" enables safe immediate breast reconstruction with pedicled TRAM in obese women and ensures presence of a skin pack up for the native breast envelop skin. We recommend this technique in every obese female who undergoes skin sparing mastectomy with immediate pedicled TRAM flap reconstruction.

A Totally Laparoendoscopic Approach for Low Rectal Cancer with Inguinal Nodal Metastasis.

BACKGROUND AND AIMS: Isolated inguinal nodal metastasis from rectal cancer is rare with better oncological outcome in case of surgical resection. METHODS: We report a rectal cancer case with inguinal nodal metastasis that was operated using a totally endoscopic approach. Laparoscopic intersphincteric resection was done for rectal cancer and video endoscopic inguinal lymphadenectomy (VEIL) for inguinal lymph nodes. The patient was presented to and managed in the Oncology Center, Mansoura University, Egypt. RESULTS: The patient had an uneventful postoperative course with better outcome than open surgery. CONCLUSIONS: Incorporation of minimally invasive approaches such as laparoscopy and VEIL in the management of inguinal nodal metastasis from rectal cancer can have a great impact on the patient's quality of life without affecting the oncologic outcome.

Parotid Quadrantectomy Is a Safe Management for Localized Pleomorphic Adenoma.

AIM: Pleomorphic adenoma is the most common benign tumor of the parotid gland and is classically treated with superficial or total parotidectomy. Less radical surgeries have been proposed to minimize the risk of facial nerve injury. The oncological safety of these procedures remains controversial. We conducted this study to evaluate the safety of superficial hemi-lobectomy (quadrantectomy). PATIENTS AND METHODS: Retrospective analysis was conducted on the paraffin sections of archived superficial parotidectomy specimens from 11 male and 6 female patients (median age 33 years). The microscopic extent of extra-capsular extension was determined on pathological revision. In addition, prospective evaluation of 12 quadrantectomy procedures (M/F = 7/5, median age = 36 years) compared to 24 radical surgeries (M = F, median age = 40 years) regarding temporary and persistent facial nerve dysfunction on routine clinical assessment and recurrence rate. RESULTS: On retrospective pathological revision, pleomorphic adenomata had a median microscopic spread of 3 mm beyond capsule in paraffin sections (SD = 3.6). On prospective analysis with a median follow-up of 33 months (range = 18-54 months), quadrantectomy had similar relative risk of temporary facial nerve dysfunction evaluated at the immediate postoperative period as well as persistent nerve dysfunction assessed at 3 months (P = 0.701 and P = 0.902, respectively). Of the whole study population, one case of recurrence after total parotidectomy was observed at mid-term follow-up (P = 1.000). CONCLUSION: Parotid quadrantectomy is a safe management for smaller pleomorphic adenomata localized close to one of the two divisions of the facial nerve.

Role of Hepatic Resection for HCC in the era of Transplantation; an Experience of Two Tertiary Egyptian Centers.

The surgical treatments of hepatocellular carcinoma (HCC) in a cirrhotic liver include both hepatic resection and liver transplant. While the liver transplant is considered as a golden therapy, it has some obstacles including shortage of organs especially living donors, economic circumstances, and the progression of a tumor while waiting for the transplant so the second choice which is resection should have a role. In this study, 84 patients with HCC (who were legible for transplant according to Milan and extended selection criteria) were enrolled for hepatic resection. The outcome including complication and the oncologic outcome was evaluated. We followed our patients for 15 months as a median follow-up (range from 3 to 50 months); we noticed 10 tumor relapse (11.7%) and seven lost (8.3%). We also noticed no recurrence. Patients' overall survival showed a median of 15 and 50 months, respectively. We can conclude that there is reasonability for HR as an effective optional treatment for patients with HCC who are legible for transplant particularly for patients with a Child-A scoring.

Compartmental tongue resection with submental island flap reconstruction for large carcinoma of the oral tongue.

BACKGROUND: Tongue resection is a surgical challenge because of its adverse effects on language articulation, swallowing, respiration, the eventual quality of life, and poor prognosis of advanced disease. To date, the currently accepted standard treatment has been based on excision of the primary lesion with a 1.5-2-cm circumferential macroscopic margin. Compartmental tongue surgery (CTS) is a surgical technique that removes an anatomo-functional compartment containing the primary tumor. METHODS AND TECHNIQUES: This is a prospective study that was carried out from June 2012 to January 2015 for patients with carcinoma affecting oral tongue. We enrolled all cases with ≥T2 tongue cancer with or without infiltration of floor of the mouth. Patients underwent compartmental tongue resection with reconstruction using island submental flap. RESULTS: Pharyngeal tear occurred in two cases that were repaired by simple suture. Bleeding occurred in two cases with control of the affected vessels. Loco-regional recurrence was detected only in two cases that underwent CTS, while 18 patients who underwent traditional tongue resection had local recurrence. CONCLUSION: CTS via pull through technique with submental island flap reconstruction for large tongue cancer has been evolved to improve oncologic resections, obtaining a better local control of disease and increased survival rate with concomitant successful functional and esthetic outcomes especially in elderly patients with serious comorbidities.

Genetic polymorphisms of NFκB1-94ins/delATTG and NFκBIA-881A/G genes in Egyptian patients with colorectal cancer.

To assess the association of genetic polymorphisms of NFκB1 and NFκBIA genes with the susceptibility to colorectal cancer (CRC). Subjects included 100 Egyptian patients with CRC (60 males and 40 females) in addition to 85 healthy controls (47 males and 38 females) from the same locality. For all participants, genetic polymorphisms of NFκB1-94ins/delATTG (rs28362491) and NFκBIA-881A/G (rs3138053) were detected by using restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR). CRC patients showed a significantly higher frequency of the NFκB1-94ins/ins genotype than controls (30 vs. 4.7%) that was significant in the recessive (OR 17.69, 95% CI 5.41-57.82, p < 0.0001) and codominant models (OR 18.28, 95% CI 4.87-68.6, p < 0.0001). The NFκB1-94ins allele frequency was significantly higher among patients than controls (58 vs. 39%, OR 2.18, 95% CI 1.4-3.3, p = 0.0004). We also noticed that the genotype G/G of NFκBIA-881 polymorphism was present in patients (4%) while it was absent (0%) in controls with increased frequency of the NFκBIA-881G allele in patients compared to controls (23 vs. 14%, p = 0.041). These polymorphisms were more associated with smoking and advanced tumor staging. This study indicates that the NFκB1-94ins/ins genotype was associated with the risk of developing colorectal cancer in Egyptian subjects. Also, CRC cases showed an increase in the frequency of NFκBIA-881G allele but not reaching statistical significance for multiple comparisons.

Outcome of Patients with Cervical and Vaginal Stump Carcinomas Treated with More Conservative Surgical Approaches: a 9-Year Experience of a Tertiary Oncology Center.

The surgical management of stump carcinoma includes the gold standard pelvic exenteration and more conservative approaches. This study aimed to investigate the outcome among a cohort of vaginal and cervical stump carcinomas that were treated with an intent of organ preservation. This is a prospective study of 60 patients with a biopsy confirmed stump carcinomas at a tertiary care oncology center in Egypt. The demographic, surgical, and pathological data were collected and patients underwent radical surgery with an intent of organ preservation guided by margin negativity. The pathologic data were correlated with the postoperative mortality. Correlation coefficients were calculated for simple correlation and regression analysis was used to investigate the independent predictors of survival. Pelvic exenteration was conducted in 30/60 (50%), while wide local excision with safety margins was possible in 26/60 (43%) and in two cases, resection was precluded. Mean hospital stay in days was 19 ± 9 (range 4-61). Overall operative morbidity was 83.3% (50/60). Perioperative mortality was 6.7% (4/60). Five-year disease-free survival was 40% (24/60). Five-year overall survival was 50% (30/60). The resection margin status and the perioperative therapy were independent prognostic factors of DFS (p = 0.003 and 0.02, respectively. Only the resection margin status was significantly associated with overall survival (p = 0.009). There was no increased mortality with introduction of more conservative surgical approaches. The resection margin status is the most important determinant of recurrence free and overall survivals.

Lateral Versus Anterior Approach Laparoscopic Splenectomy: A Randomized-controlled Study.

PURPOSE OF THE STUDY: The study compares prospectively the hospital stay and postoperative complications of anterior (ALS) versus lateral (LLS) approach for laparoscopic splenectomy. MATERIALS AND METHODS: Between September 2011 and April 2015, 94 patients with splenomegaly were referred to the surgical unit in the Oncology Center of Mansoura University, Egypt. Only 80 patients with splenomegaly <30 cm underwent an open-label randomized allocation into 2 equal parallel groups. Indications were hematological in 52 patients (65%) and malignant splenic conditions in 28 patients (35%). Two patients younger than 18 years, 4 patients with splenomegaly >30 cm, and 8 patients with associated surgical comorbidities were excluded. Three days' hospital stay reduction with LLS was suggested with a power of 80% and P-value of 0.05. RESULTS: The mean hospital stay was significantly shorter (P=0.001) after LLS. Laparoscopic splenectomy was completed in 68 patients (85%). Twelve patients (15%) required open splenectomy with no difference between groups. The operation time was significantly shorter in LLS (P=0.013). Blood loss (P=0.057) and blood transfusion (P=0.376) showed no difference between the two groups. The times until resumption of oral intake (P=0.019) and drain removal (P=0.011) were statistically shorter in LLS. CONCLUSIONS: LLS is more safe and feasible with shorter hospital stay compared with ALS.

Genital Sparing Cystectomy for Female Bladder Cancer and its Functional Outcome; a Seven Years' Experience with 24 Cases.

The surgical treatment of bladder cancer is the curative treatment especially in early cases. In this study, our aim was to assess the outcome of preservation of internal genital organs in selected females both oncologically and functionally, and to assess the feasibility of technique and its complication. 24 females with clinically and radiologically diagnosed T2 bladder cancer underwent gynecologic-tract sparing cystectomy (GTSC). Age ranged from 45 to 60 years. Patients with diffuse carcinoma-in-situ, those with tumors involving the bladder neck, those with poor general condition and those with preoperative incontinence were excluded. 1 patient, who developed local recurrence after 6 months. One patient lost follow up after 15 months. No recurrence developed in the retained genital organs. The remaining 20 patients remained free of disease. Among women who were eligible for functional evaluation, Daytime and nighttime continence were satisfactory in 21/22 (95.4 %) and in 20/22 (90.9 %) respectively. Chronic urinary retention, pouch-vaginal fistula was not noted. Most of patients showed superior Sexual Function index. Cystectomy with preservation of the internal genital organs is feasible in female with early, solitary or T2 bladder cancer with satisfactory functional and oncologic outcomes with proper case selection.

The outcome of oncoplastic techniques in defect reconstruction after resection of central breast tumors.

BACKGROUND: Traditionally, conservative breast surgery was contraindicated in centrally located breast tumors, with total mastectomy as the treatment of choice. However, restorations of the central defects by the oncoplastic volume displacement or replacement techniques have been shown to be effective. The aim of the current study was to assess the surgical outcome of oncoplastic techniques after central breast tumors resection. METHODS: Thirty patients with central breast cancer, including two patients with Paget disease, treated at the Oncology Center of Mansoura University (Egypt) between June 2011 and December 2014 were included in this study. The oncoplastic techniques performed were Grisotti advancement rotational flap in eight (26.7%) patients, classic skin-sparing mastectomy (SSM) with latissimus dorsi pedicled flap in 20 (66.7%) patients, and skin-reducing mastectomy (SRM) with latissimus dorsi pedicled flap using wise pattern inverted T incision in two (6.7%) patients. The choice of the oncoplastic techniques depends on the achievement of free safety margins, the breast volume, and its ptotic degree. RESULTS: The median age was 40.5 years (range; 23-55). There were no major complications that require repeating the oncoplastic techniques. Recorded complications included wound dehiscence (4/30, 13.3%) donor site seroma (4/30, 13.3%), and surgical site infection (1/30, 3.3%). The 6-month subjective patient satisfaction was excellent in 21 (70%) patients, good in 6 (20%) patients, and fair in 3 (10%) patients. There was no episode of local recurrence or systemic metastasis after an average follow-up duration of 24 months (range; 6-42). CONCLUSIONS: Restoring the central defect after resection of the central breast tumors can be safely achieved using oncoplastic procedures including the Grisotti technique or the design of SSM or SRM with immediate breast reconstruction. In our patients, these procedures yield a satisfactory esthetic outcome with lower morbidity.

Evaluation of the Quilting Technique for Reduction of Postmastectomy Seroma: A Randomized Controlled Study.

Background. Postmastectomy seroma causes patients' discomfort, delays starting the adjuvant therapy, and may increase the possibility of surgical site infection. Objective. To evaluate quilting of the mastectomy flaps with obliteration of the axillary space in reducing postmastectomy seroma. Methods. A randomized controlled study was carried out among 120 females who were candidates for mastectomy and axillary clearance. The intervention group (N = 60) with quilting and the control group without quilting. All patients were followed up routinely for immediate and late complications. Results. There were no significant differences between the two groups as regards the demographic characteristics, postoperative pathological finding, and the immediate postoperative complications. The incidence of seroma was significantly lower in the intervention group compared with the control group (20% versus 78.3%, P < 0.001). Additionally, the intervention group had a shorter duration till seroma resolution (9 days versus 11 days, P < 0.001) and a smaller volume of drainage (710 mL versus 1160 mL, P < 0.001) compared with the control group. Conclusion. The use of mastectomy with quilting of flaps and obliteration of the axillary space is an efficient method to significantly reduce the postoperative seroma in addition to significantly reducing the duration and volume of wound drainage. Therefore we recommend quilting of flaps as a routine step at the end of any mastectomy.

Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer.

BACKGROUND: Although therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. METHODS: The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. RESULTS: Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. CONCLUSION: TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations.