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Objectives: The management of breast cancer in patients with large breast carries a lot of difficulties; breast conservation therapy develop more complications and unacceptable cosmosis due to heterogeneous distribution of the radiation dose and improper positioning of the breast between treatments.Traditional mastectomy is associated with unacceptable asymmetry and unpleasant discomfort due to the huge volume and weight.Patients & Methods Three hundreds of large breasted women with stage Ⅰ to Ⅲ breast carcinoma have oncoplastic surgeries.Two hundred patients had sparing mastectomies with immediate reconstructin using extended LDF with added vascularized chest wall fat, fifty patients had therapeutic reduction mammoplasty, twenty patients had conventional conservative breast surgery, and thirty patients had myomammary flap reconstruction.Age ranges from 23 to 63 years (median =41.7).Results: The oncologic outcome of extended latissimus dorsi flap (LDF) with added vascularized chest wall tat in the reconstruction of the huge breast was superior to myomammary flap with near equal oncologic outcome.In special situation; the therapeutic reduction mammoplasty is employed with better outcome than conventional conservative breast surgery as the safety margin which in the first is wider (5-10 cm) and more confidential than the conventional conservative breast surgery (CBS), the aesthetic outcome is better than CBS but the operative time and hospital stay are longer than CBS.In comparison to sparing mastectomies with extended LDF with added vascularized chest wall fat which is aesthetically and oncologically near equal to therapeutic reduction mammoplasty.Conclusion: Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat is a single stage totally autologous breast reconstruction allows reconstruction without the additional cost of an implant, many complications of synthetic implants.Therapeutic reduction mammoplasty is an oncologically safe surgical procedure in special situations that yields satisfactory aesthetic results and low morbidity in large breasted women with cancer.