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Prospective surveillance with bioimpedance spectroscopy to guide early treatment of breast cancer related lymphoedema.
ABSTRACTS P127. A comparative study of titanium-coated propylene mesh with acellular dermal matrix in implant based breast reconstruction Adrian McKenna, Werbena Hamilton-Burke, Sonia Bathla, Nicholas Bird, Anu Shrotri, Lee Martin Aintree University Hospital, Liverpool, UK Background: Breast cancer is the most common cancer affecting women in the Western world. Reconstructive surgery following mastectomy has been shown to improve self-esteem and quality of life. Implant based breast reconstruction (IBBR) is the most common approach used. Biological and synthetic meshes are utilised as adjuncts to reconstruction to improve aesthetic outcomes. The objective of this study was to evaluate the short and medium-term outcomes for patients undergoing IBBR utilising these adjuncts following mastectomy. Methods: A retrospective review of a single centre experience with implant based breast reconstruction was undertaken. Comparison of 2 consecutive cohorts of patients using either biological porcine acellular dermal matrix -StratticeTM (May 2010 to September 2013) or synthetic titanized TiLOOPÒBra mesh (Jan 2013 to August 2015) was undertaken. Patient demographics, complications, and outcomes were analysed. Results: One hundred and fourteen cases of implant based breast reconstructions were performed between 2010 and 2015 at a regional tertiary referral centre. Seventy-nine patients had TiLOOPÒBra based breast reconstructions and 35 had StratticeÔ ADM breast reconstructions. Median follow up was 37 months in the StratticeÔ ADM cohort and 18 months in the TiLOOPÒBra cohort. Implant explantation rate was 6% in both cohorts. Complication rates in the StratticeÔ ADM cohort was 22% and 18% in the TiLOOPÒBra cohort. There was no significant difference in post-operative complication rates between the 2 groups (p ¼ 0.608). Conclusion: This study suggests that there is no significant difference in post-operative outcome when using a synthetic TiLOOPÒBra mesh compared to a biological ADM mesh. http://dx.doi.org/10.1016/j.ejso.2017.01.180
P128. Prospective surveillance with bioimpedance spectroscopy to guide early treatment of breast cancer related lymphoedema. Etain McGuinness, Lynn Darragh, Stephen Kirk Ulster Hospital, Belfast, UK Introduction: Patients undergoing axillary surgery for breast cancer treatment are at risk of developing upper limb lymphoedema. Early detection and initiation of treatment can reduce the incidence of clinically significant disease. Bioimpedance spectroscopy (BIS) measures opposition to flow of electrical current in the upper limb, an indicator of increased extracellular fluid volume. The aim of this study was to determine the rates of lymphoedema identified by BIS using a prospective surveillance model and the effects of early treatment on patient outcomes. Methods: Retrospective review of prospectively collected data was performed. Patients undergoing axillary surgery for breast cancer, from 2008e2013 were included. BIS measurements were recorded pre-operatively and at 3 monthly intervals for one year. An abnormal reading instigated treatment with a compression sleeve, massage and exercise, regardless of clinical signs. Patients with continual abnormal BIS readings or development of clinical signs were referred to lymphoedema services. Results: 354 patients were included in the final analysis. 10.7% (n ¼ 38) of patients had an abnormal BIS reading indicating early lymphoedema whilst 6.5% (n ¼ 23) of patients required referral to specialist lymphoedema services. 75% (n ¼ 18) of patients referred to lymphoedema services had been initially identified by BIS. 58.8% (n ¼ 20) of patients who underwent early treatment did not require any long term management for lymphoedema. Conclusions: Abnormal BIS is a significant predictor for development of subsequent lymphoedema. This can be utilised in a prospective
S47 surveillance model, to direct early therapy. Whilst this does not completely negate the incidence of lymphoedema requiring specialist treatment, it can potentially be reduced. http://dx.doi.org/10.1016/j.ejso.2017.01.181 P129. Patient selection and outcome in one stage dermal sling assisted immediate breast reconstruction Ayesha Khan, George Hicks, Caroline Pogson, Wail Al-Sarakbi Croydon University Hospital, London, UK Background: One stage breast reconstruction with autologous inferior dermal flap has traditionally only been considered in women with high BMIs and macromastia. This study reports the use of this technique for large as well as smaller sized breasts in slimmer patients that traditionally would not be considered for this technique. We look at the complication rate post procedure, in particular implant loss rate and also patient satisfaction. Methods: A retrospective review of electronic medical records was used to identify all patients who had undergone skin sparing mastectomy and immediate reconstruction with a dermal sling and implant between Feb 2015 to Oct 2016. Patient demographics, intraoperative details, postoperative complications and patient satisfaction were all recorded. Results: In the defined study period, 49 dermal sling procedures were carried out on 45 patients. The mean patient age was 47 (range 35e68). The median patient BMI was 31 (range 19.9 to 47) with a median breast weight of 860g (range 372e2100g). Post operatively there were 3 cases of wound infections requiring antibiotics. Two cases of post-operative haematomas required a washout and only one patient lost their implant. Conclusions: Immediate breast reconstruction with inferior dermal sling and implant is a safe technique with low complication rates. Our unit has demonstrated that this technique can be used in patients with an array of BMIs and breast sizes with good outcomes. In the current economic climate this technique should be considered in a wider range of patients as it avoids the cost and also potential morbidity of acellular dermal matrices. In addition patients wishing to avoid the use of animal material or free flaps benefit from this technique. http://dx.doi.org/10.1016/j.ejso.2017.01.182 P130. Surgeon delivered intra-operative ultrasound: a safe and effective technique to enhance service delivery Pippa Leighton, Nikki Green, Sarah Vestey Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK Introduction: Wire-guided localisation (WGL) is standard for impalpable breast cancers. Surgeon delivered intra-operative USS (IOUS) is an alternative. WGL is resource intensive and uncomfortable. Locally a single imager has four localisation slots per session. With IOUS the surgeon may better appreciate tumour location, but there is no check mammogram. We asked, is it equivalent in terms of safety and quality? Methods: A 2-year retrospective review (single surgeon) was performed (October 2014e16), comparing outcomes of IOUS to WGL and standard palpable excision (WLE). Surgery took place at two hospital sites (WGL facilities at a third site). IOUS included insertion of Hawkins III wires. We measured tumour characteristics, re-excision rates, pre-operative radiological size, and specimen weight. Complete radiological excision was confirmed by specimen x-ray in all cases. Results: There were 117 invasive cancers localised, 56 by IOUS, 24 WGL, 83 WLE. Baseline characteristics, specimen weight and pre-operative radiological size were similar between IOUS and WGL groups. Reexcision rates were 21% (12/56) IOUS, 29% (7/24) WGL, 23% (19/83) WLE. A further 6 non-invasive lesions were also successfully localised by IOUS. No additional operating time was required. 15.5 outpatient
P128. Prospective surveillance with bioimpedance spectroscopy to guide early treatment of breast cancer related lymphoedema. Etain McGuinness, Lynn Darragh, Stephen Kirk Ulster Hospital, Belfast, UK Introduction: Patients undergoing axillary surgery for breast cancer treatment are at risk of developing upper limb lymphoedema. Early detection and initiation of treatment can reduce the incidence of clinically significant disease. Bioimpedance spectroscopy (BIS) measures opposition to flow of electrical current in the upper limb, an indicator of increased extracellular fluid volume. The aim of this study was to determine the rates of lymphoedema identified by BIS using a prospective surveillance model and the effects of early treatment on patient outcomes. Methods: Retrospective review of prospectively collected data was performed. Patients undergoing axillary surgery for breast cancer, from 2008e2013 were included. BIS measurements were recorded pre-operatively and at 3 monthly intervals for one year. An abnormal reading instigated treatment with a compression sleeve, massage and exercise, regardless of clinical signs. Patients with continual abnormal BIS readings or development of clinical signs were referred to lymphoedema services. Results: 354 patients were included in the final analysis. 10.7% (n ¼ 38) of patients had an abnormal BIS reading indicating early lymphoedema whilst 6.5% (n ¼ 23) of patients required referral to specialist lymphoedema services. 75% (n ¼ 18) of patients referred to lymphoedema services had been initially identified by BIS. 58.8% (n ¼ 20) of patients who underwent early treatment did not require any long term management for lymphoedema. Conclusions: Abnormal BIS is a significant predictor for development of subsequent lymphoedema. This can be utilised in a prospective
S47 surveillance model, to direct early therapy. Whilst this does not completely negate the incidence of lymphoedema requiring specialist treatment, it can potentially be reduced. http://dx.doi.org/10.1016/j.ejso.2017.01.181 P129. Patient selection and outcome in one stage dermal sling assisted immediate breast reconstruction Ayesha Khan, George Hicks, Caroline Pogson, Wail Al-Sarakbi Croydon University Hospital, London, UK Background: One stage breast reconstruction with autologous inferior dermal flap has traditionally only been considered in women with high BMIs and macromastia. This study reports the use of this technique for large as well as smaller sized breasts in slimmer patients that traditionally would not be considered for this technique. We look at the complication rate post procedure, in particular implant loss rate and also patient satisfaction. Methods: A retrospective review of electronic medical records was used to identify all patients who had undergone skin sparing mastectomy and immediate reconstruction with a dermal sling and implant between Feb 2015 to Oct 2016. Patient demographics, intraoperative details, postoperative complications and patient satisfaction were all recorded. Results: In the defined study period, 49 dermal sling procedures were carried out on 45 patients. The mean patient age was 47 (range 35e68). The median patient BMI was 31 (range 19.9 to 47) with a median breast weight of 860g (range 372e2100g). Post operatively there were 3 cases of wound infections requiring antibiotics. Two cases of post-operative haematomas required a washout and only one patient lost their implant. Conclusions: Immediate breast reconstruction with inferior dermal sling and implant is a safe technique with low complication rates. Our unit has demonstrated that this technique can be used in patients with an array of BMIs and breast sizes with good outcomes. In the current economic climate this technique should be considered in a wider range of patients as it avoids the cost and also potential morbidity of acellular dermal matrices. In addition patients wishing to avoid the use of animal material or free flaps benefit from this technique. http://dx.doi.org/10.1016/j.ejso.2017.01.182 P130. Surgeon delivered intra-operative ultrasound: a safe and effective technique to enhance service delivery Pippa Leighton, Nikki Green, Sarah Vestey Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK Introduction: Wire-guided localisation (WGL) is standard for impalpable breast cancers. Surgeon delivered intra-operative USS (IOUS) is an alternative. WGL is resource intensive and uncomfortable. Locally a single imager has four localisation slots per session. With IOUS the surgeon may better appreciate tumour location, but there is no check mammogram. We asked, is it equivalent in terms of safety and quality? Methods: A 2-year retrospective review (single surgeon) was performed (October 2014e16), comparing outcomes of IOUS to WGL and standard palpable excision (WLE). Surgery took place at two hospital sites (WGL facilities at a third site). IOUS included insertion of Hawkins III wires. We measured tumour characteristics, re-excision rates, pre-operative radiological size, and specimen weight. Complete radiological excision was confirmed by specimen x-ray in all cases. Results: There were 117 invasive cancers localised, 56 by IOUS, 24 WGL, 83 WLE. Baseline characteristics, specimen weight and pre-operative radiological size were similar between IOUS and WGL groups. Reexcision rates were 21% (12/56) IOUS, 29% (7/24) WGL, 23% (19/83) WLE. A further 6 non-invasive lesions were also successfully localised by IOUS. No additional operating time was required. 15.5 outpatient