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A study of oncoplastic breast reconstruction by a general surgery breast unit
S12 Methods: Z0011 eligibility criteria (no neoadjuvant chemotherapy, T1 - T2 tumours, breast-conserving surgery and 1-3 positive SLNs on H&E) were applied to all Royal Marsden Hospital (RMH) patients who underwent SLNB for invasive breast cancer between June 2006 and September 2009. Patient characteristics and results were compared using Fisher’s exact test. Results: From 834 SLNB, we identified 75 (9%) patients who met Z0011 eligibility criteria. The Z0011 cohort (n¼891) contained more T1 tumours (p¼0.0001) and used less adjuvant systemic therapy (p¼0.0001) but no other significant differences were noted in either patient or tumour characteristics. Micrometastasis were found in 45% and 27% of Z0011 and RMH patients respectively (p¼0.005) but there was no significant difference in the proportion with additional positive nodes on cALND (23% v 33%, p¼0.08). Conclusions: Fewer than 10% of RMH SLNB patients matched the Z0011 cohort, in addition a greater proportion had macrometastases. Consequently the Z0011 results will only support a change of practice for the minority of SLNB positive patients. P31. Cavity clips following CLE in breast cancer - Does size matter? Wail Al Sarakbi, P. Bentley, P. Tallett Kent & Sussex Hospital, Mount Ephraim Road, Tunbridge Wells, TN4 8AT
Background: Cavity clips are used in conservative breast surgery to mark the tumour bed and plan subsequent adjuvant Radiotherapy field. The general consensus is to mark the cavity with 5 clips corresponding to the deep margin and the 4 quadrants. Cavity clips can cause significant acoustic shadowing on ultrasound and may hinder using this technique in evaluating possible recurrences. The aim of our study is to evaluate the various clips used in clinical practice. Methods: We use Titanium clips (LIGACLIP EXTRA) with non-disposable clip applicator which come in 3 sizes. Some surgeons use disposable single use Titanium clips and applicator. We applied the 3 different sizes of clips to a 3 pieces of Turkey breast wrapped in cling film and compared them in terms of acoustic shadowing and CT appearances for Radiotherapy field marking. We used following sizes: - SmallLT100 - Medium LT300 - Large LT400 3 pieces of Turkey breast were used to apply each of the above clips. Results: The single use clip applicator is more expensive than the reusable applicator and clips (£4 Vs £12). Both medium and large clips produce more acoustic shadowing that the small clips. CT scan of the 3 breasts with the different clips show similar localization characteristics and no perceived advantage of using the larger clips. Conclusion: Small Titanium clips seem to be sufficient for pre-operative field marking for adjuvant Radiotherapy in breast cancer. They also produce less acoustic artefact on Ultrasound than the larger clips hence allowing for accurate ultrasonic assessment. P32. A new technique for partial muscular cover in immediate implant-based reconstruction Peter Barrya, A. Collinsb a The Canberra Hospital, Yamba Drive, Garran ACT 2605, Australia b Bega District Hospital
Introduction: To determine efficacy, safety, aesthetic and functional outcomes after immediate breast reconstruction using a segmented lateral thoracic artery-based pectoralis major muscle flap for partial dual-plane cover of implants. This technique was designed to minimize lateral implant
ABSTRACTS displacement, provide complete separation of the wound / incision from the implant and a vascularised base for the NAC if needed. Methods: A new technique using a partial pectoralis muscle flap (based on the lateral thoracic artery) for partial cover of implants in patients undergoing immediate reconstruction after skin (or nipple)-sparing mastectomy for breast cancer is described. A prospectively designed pilot study in consecutive patients suitable for implant-only immediate reconstruction was undertaken. Patient demographics, tumour pathology and treatments factors were documented. All outcomes including implant infection, flap necrosis and any other complications were included as well as patient satisfaction and functional outcomes. Results: From April 2008 to November 2010 a total of 45 procedures were performed in 39 patients (6 bilateral). Mean age was 43 years (29 71) and no early implant loss or infection was encountered. Three patients experienced prolonged seroma formation (>3 months) and had their implants exchanged resulting in seroma resolution. Seven patients underwent post-mastectomy radiotherapy. Post-operative functional assessments on pectoral girdle function is described. Patient satisfaction ranged from moderately to very high in all patients. Conclusions: This technique is safe and well-tolerated by patients and may serve as an adjunct or alternative to the use of Alloderm or other methods of immediate implant reconstruction using partial muscular cover. P33. A study of oncoplastic breast reconstruction by a general surgery breast unit Duncan Lighta, K. Carneyb, C. Parmara, V. Kurupa a North Tees and Hartlepool NHS Trust, Hardwick Road, Stockton on Tees, TS19 8PE b Wansbeck General Hospital, Ashington, Northumberland
Aims: To investigate the outcomes of oncoplastic breast reconstruction performed by consultant breast surgeons from a general surgery background in a district general hospital. Methods: A retrospective study of 45 patients who underwent breast reconstruction from 2002 to 2010 was performed. Patient notes, histology database and theatre records were consulted. Results: Of 45 patients all were female and the mean age was 50 years old (range 35 to 68). 5 patients were current smokers and 1 patient was diabetic. 42 patients had pedicled latissimus dorsi reconstruction and 3 patients had pedicled transverse rectus abdominis myocutaneous reconstruction. 22 were immediate reconstruction, 19 were delayed and 4 were prophylactic mastectomy with reconstruction. Mean post operative stay was 4 days (range 2 to 6). Pathology showed ductal carcinoma in 27 cases, DCIS in 13 cases and normal tissue in 5 cases. No patients required return to theatre for complications. No patients suffered partial or total loss of flap. 3 patients developed wound infection (2 of whom were smokers). 8 patients developed seroma at 2 weeks post operatively. 4 patients developed small areas of superficial necrosis (which was managed conservatively). 9 patients had balancing mastopexy at a mean of 9 month following their reconstruction. 17 patients went on to have a nipple reconstruction. Conclusions: Oncoplastic breast reconstruction is a safe procedure for breast surgeons to perform in general surgery with good results. Smoking and diabetes are associated with a higher incidence of complications. P34. Immediate Nipple Reconstruction with Skin-sparing Mastectomy and Sub-pectoral Tissue Expansion Karina Coxa, P. Burgessb, L. Whiskerb, A. Baildamb a The Royal Marsden, Downs Road, Sutton, SM2 5PT b UHSM NHS Foundation Trust, Manchester
Introduction: In selected patients, skin-sparing therapeutic mastectomy with preservation of the nipple areola complex (NAC) can be
Background: Cavity clips are used in conservative breast surgery to mark the tumour bed and plan subsequent adjuvant Radiotherapy field. The general consensus is to mark the cavity with 5 clips corresponding to the deep margin and the 4 quadrants. Cavity clips can cause significant acoustic shadowing on ultrasound and may hinder using this technique in evaluating possible recurrences. The aim of our study is to evaluate the various clips used in clinical practice. Methods: We use Titanium clips (LIGACLIP EXTRA) with non-disposable clip applicator which come in 3 sizes. Some surgeons use disposable single use Titanium clips and applicator. We applied the 3 different sizes of clips to a 3 pieces of Turkey breast wrapped in cling film and compared them in terms of acoustic shadowing and CT appearances for Radiotherapy field marking. We used following sizes: - SmallLT100 - Medium LT300 - Large LT400 3 pieces of Turkey breast were used to apply each of the above clips. Results: The single use clip applicator is more expensive than the reusable applicator and clips (£4 Vs £12). Both medium and large clips produce more acoustic shadowing that the small clips. CT scan of the 3 breasts with the different clips show similar localization characteristics and no perceived advantage of using the larger clips. Conclusion: Small Titanium clips seem to be sufficient for pre-operative field marking for adjuvant Radiotherapy in breast cancer. They also produce less acoustic artefact on Ultrasound than the larger clips hence allowing for accurate ultrasonic assessment. P32. A new technique for partial muscular cover in immediate implant-based reconstruction Peter Barrya, A. Collinsb a The Canberra Hospital, Yamba Drive, Garran ACT 2605, Australia b Bega District Hospital
Introduction: To determine efficacy, safety, aesthetic and functional outcomes after immediate breast reconstruction using a segmented lateral thoracic artery-based pectoralis major muscle flap for partial dual-plane cover of implants. This technique was designed to minimize lateral implant
ABSTRACTS displacement, provide complete separation of the wound / incision from the implant and a vascularised base for the NAC if needed. Methods: A new technique using a partial pectoralis muscle flap (based on the lateral thoracic artery) for partial cover of implants in patients undergoing immediate reconstruction after skin (or nipple)-sparing mastectomy for breast cancer is described. A prospectively designed pilot study in consecutive patients suitable for implant-only immediate reconstruction was undertaken. Patient demographics, tumour pathology and treatments factors were documented. All outcomes including implant infection, flap necrosis and any other complications were included as well as patient satisfaction and functional outcomes. Results: From April 2008 to November 2010 a total of 45 procedures were performed in 39 patients (6 bilateral). Mean age was 43 years (29 71) and no early implant loss or infection was encountered. Three patients experienced prolonged seroma formation (>3 months) and had their implants exchanged resulting in seroma resolution. Seven patients underwent post-mastectomy radiotherapy. Post-operative functional assessments on pectoral girdle function is described. Patient satisfaction ranged from moderately to very high in all patients. Conclusions: This technique is safe and well-tolerated by patients and may serve as an adjunct or alternative to the use of Alloderm or other methods of immediate implant reconstruction using partial muscular cover. P33. A study of oncoplastic breast reconstruction by a general surgery breast unit Duncan Lighta, K. Carneyb, C. Parmara, V. Kurupa a North Tees and Hartlepool NHS Trust, Hardwick Road, Stockton on Tees, TS19 8PE b Wansbeck General Hospital, Ashington, Northumberland
Aims: To investigate the outcomes of oncoplastic breast reconstruction performed by consultant breast surgeons from a general surgery background in a district general hospital. Methods: A retrospective study of 45 patients who underwent breast reconstruction from 2002 to 2010 was performed. Patient notes, histology database and theatre records were consulted. Results: Of 45 patients all were female and the mean age was 50 years old (range 35 to 68). 5 patients were current smokers and 1 patient was diabetic. 42 patients had pedicled latissimus dorsi reconstruction and 3 patients had pedicled transverse rectus abdominis myocutaneous reconstruction. 22 were immediate reconstruction, 19 were delayed and 4 were prophylactic mastectomy with reconstruction. Mean post operative stay was 4 days (range 2 to 6). Pathology showed ductal carcinoma in 27 cases, DCIS in 13 cases and normal tissue in 5 cases. No patients required return to theatre for complications. No patients suffered partial or total loss of flap. 3 patients developed wound infection (2 of whom were smokers). 8 patients developed seroma at 2 weeks post operatively. 4 patients developed small areas of superficial necrosis (which was managed conservatively). 9 patients had balancing mastopexy at a mean of 9 month following their reconstruction. 17 patients went on to have a nipple reconstruction. Conclusions: Oncoplastic breast reconstruction is a safe procedure for breast surgeons to perform in general surgery with good results. Smoking and diabetes are associated with a higher incidence of complications. P34. Immediate Nipple Reconstruction with Skin-sparing Mastectomy and Sub-pectoral Tissue Expansion Karina Coxa, P. Burgessb, L. Whiskerb, A. Baildamb a The Royal Marsden, Downs Road, Sutton, SM2 5PT b UHSM NHS Foundation Trust, Manchester
Introduction: In selected patients, skin-sparing therapeutic mastectomy with preservation of the nipple areola complex (NAC) can be