285. Oncoplastic Surgical Techniques Are Safe for T2 and T3 Breast Cancers

824 Complete tumor removal with safe margins was achieved in 44/51 procedures (86.3%). Four patients (7.8%) had new foci of tumor not detected previously and required a new intervention for removing them. Only three patients (5.88%) had close margins and went into another surgery. Conclusions: Localization of impalpable breast cancer using a I-125 seed was safe and led to a high proportion of appropriate lumpectomies. Technical problems of first cases are easily solved and surgical approach is easy to achieve for surgeons with experience in radioguided surgery. Rates of removal with safe margins are better to the achieved with WL or ROLL. Comfort for the patient is higher. The surgeon is also more comfortable: lesser possibility of displacing than with WL or with high diffusion in ROLL, possibility of planning best cosmetic incision, short learning curve and better scheduling (seed could be placed even weeks prior to surgery). Cost is similar or less than WL. 285. Oncoplastic Surgical Techniques Are Safe for T2 and T3 Breast Cancers E.J.D. Massey1, H. Nina1, C. Nos1, K.B. Clough1 1 Paris Breast Centre - L’Institut du Sein, Paris, France Background: T2 and T3 tumours are often likely to be treated by mastectomy. Concerns of post-operative deformity, as well as those of adequate oncological control, reduce the rate of patients being offered breast conserving surgery for tumours of greater than 2cm. Oncoplastic surgical techniques offer a third option, extending the role of breast conserving surgery for larger tumours, with the use of glandular reshaping to prevent post-operative deformity. This paper analyses the outcomes of ~ quadrant-pera series of T2/T3 tumours treated according to this unitOs quadrant atlas of oncoplastic techniques. Materials and methods: A database was compiled retrospectively of all patients receiving oncoplastic surgery. From this, information regarding those patients with T2 and T3 tumours was analysed. Of particular interest were the oncological and cosmetic outcomes. Results: 308 patients received OPS between 2004 and March 2012 with a mean age of 57 years. 155 were for T2/T3 tumours, with 31.6% having received pre-operative chemotherapy. The mean follow up was 29 months (maximum 86 months). The median resection weight was 106g for tumours ranging in size from 3mm to 90mm. The margins were free in 140 cases (90.3%). There have been four cases of loco-regional recurrence (2.6%) and 10 of metastatic disease (6.4%). The cosmetic outcome was judged as good or excellent in 68 per cent of cases. Conclusion: Breast conserving surgery with adapted mammoplasty techniques is oncologically safe, giving free margins, and with a complication rate comparable to other published mammoplasty series. Resection volumes are large, however the breast retains a good shape and form and hence the cosmetic outcome is not compromised. 286. Implant-specific Complications in Breast Reconstruction- a Single Surgeon’s Experience H. McManus1, J. Ooi1, A. Volleamere1 1 The Royal Bolton Hospital, Breast Surgery, Bolton, United Kingdom Background: Subpectoral tissue expander and implant based breast reconstruction involves the insertion of a tissue expander under the pectoralis major muscle and overlying skin, which is gradually inflated with saline over a number of months. Following this, the expanders are replaced with definitive implants. Expander and implant based reconstruction can be undertaken at the time of mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). Implant related complications include implant displacement (requiring repositioning), infection (requiring antibiotics or implant removal) or implant rupture (requiring explantation).[1] According to the National Mastectomy Breast Reconstruction Audit published in 2010, 3.48% of 1207 women who underwent immediate expander/implant based breast reconstruction suffered an implant-related

ABSTRACTS complication. 2.14% of 280 women who underwent delayed expander/implant based breast reconstruction suffered an implant-related complication. Other studies showed an overall complication rate of 12.3-22.7%. Methodology: This was a retrospective analysis of all two-stage subpectoral tissue expander and implant based reconstructions performed by a single surgeon at the Royal Bolton Hospital (a busy district general hospital in the North of England) between 2007-2011. The aim was to assess the rate of implant-specific complications and compare this with national findings. All patients who underwent immediate or delayed subpectoral tissue expander and implant based reconstruction following mastectomy were selected. The details of any post operative implant-related complications were recorded. For patients who underwent bilateral reconstruction either simultaneously or at different times, each breast reconstruction was considered separately. Results: 37 subpectoral tissue expander and implant based reconstructions involving 30 patients were performed between 2007-2011. Of these, 25 (68%) were immediate reconstructions and 12 (32%) were delayed. Overall, 3 (8.11%) of the reconstructions resulted in an expander/implant-related complication. All of these involved inflammation or infection requiring expander removal and all occurred in immediate expander/implant reconstructions. There were no cases of implant rupture or displacement.

Complication

Percentage (%) of cases

Displacement Infection (requiring antibiotics) Infection (requiring implant removal) Implant rupture

0 0 8.11% 0

Conclusion: Overall 8.11% of all subpectoral tissue expander and implant based reconstructions performed by a single surgeon at the Royal Bolton Hospital between 2007-2011 resulted in implant-related complications. All of the complications occurred following immediate reconstruction. This compares to 3.48% for immediate and 2.14% for delayed expander/implant based breast reconstructions in the National Mastectomy Breast Reconstruction Audit. 287. Factors Associated with Undergoing Mastectomy at a Teaching Institution Within the State of Pennsylvania R.L. Yang1, C.E. Reinke1, H.L. Graves1, G.C. Karakousis1, B.J. Czerniecki1, R.R. Kelz1 1 University of Pennsylvania, Department of Surgery, Philadelphia PA, USA Background: Recent studies have shown that breast cancer patients treated at teaching hospitals have improved clinical outcomes. To understand what factors are associated with patients seeking surgical care at teaching hospitals, we examined the relationship between individual patient characteristics and hospital teaching status for patients undergoing mastectomy. Materials and Methods: Patients greater than 18 years old who had a mastectomy between 1994 and 2004 in the state of Pennsylvania were identified in the Pennsylvania Health Care Cost Containment Council inpatient database. Hospital teaching status was defined by the American Fellowship and Residency Electronic Interactive Database, which lists all hospitals in Pennsylvania affiliated with a general surgery training program. Number of mastectomies performed during the study time interval was calculated by hospital teaching status. Factors associated with teaching status were determined using the Chi Square test and ~ t-test. StudentOs Results: Patients underwent mastectomy at 200 different hospitals in the state of Pennsylvania, of which 36 were affiliated with a general