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Donor site complications and remnant of rectus abdominis muscle status following transverse rectus abdominis myocutaneous flap reconstruction
15th St.Gallen International Breast Cancer Conference / The Breast 32S1 (2017) S78–S132
(25%) were ductal carcinoma in situ. One subareola base tissue was found an occult cancer and NAC was then removed. Three locoregional recurrence were observed after median follow-up time of 24 months (range 2–104 months). NAC sensation was evaluated in total 36 patients. Twenty-six patients (47%) were serial evaluated after the first 6 month of operation, and another 10 patients evaluated at more than 1 year after operation. At the first 6 months, 12 patients (46.2%) shown partial sensation recovery, and more 2 patients had partial recovery after 1-year follow-up. Only one patient (3.8%) had complete sensation recovery in all area of the NAC. In late evaluation group, 7 out of 10 patients had partial recovery. Mostly pain sensation remains at lower aspect of the areola away from surgical incision. Conclusion: NSM is technically feasible in select patient with low rate of NAC removal. Some patient can preserve NAC sensation. Long term outcome should be closed follow up. Disclosure of Interest: No significant relationships. P308 Donor site complications and remnant of rectus abdominis muscle status following transverse rectus abdominis myocutaneous flap reconstruction P. Chirappapha1 *, N. Trikunagonvong2, D. Prapruttam1, S. Rongthong1, P. Lertsithichai1, T. Sukarayothin1, M. Leesombatpaiboon1, R. Panawattanakul3. 1Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 2 Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, 3Department of Surgery, Udonthani Hospital, Udonthani, Thailand Aims: There are several harvesting techniques for transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after mastectomy, which have been used to minimize untoward complications. We present the whole muscle with partial sheath sparing technique that focusing on the anatomy of arcuate line and the technique of the anterior abdominal wall closure with mesh. To determine postoperative results, complications and factors that associated with complications after performed pedicled TRAM flap reconstruction. Methods: We retrospectively and prospectively reviewed 30 pedicled TRAM flaps, which performed between November 2013 to March 2016, focusing on outcomes and complications. Results: Among the 30 pedicled TRAM flap procedures in 30 patients, there were complications occurred in 5 patients (17%). Most common complications were surgical site infection (SSI) (7%). After a median follow-up time of 15 months, no patient developed abdominal wall hernia or bulging in daily activities, but there were 6 patients (20%) who had asymptomatic abdominal wall bulging when exercised. Factors related to asymptomatic exercised abdominal wall bulging were significantly related to BMI more than 23 kg/m2. Conclusion: Pedicled TRAM flap using the whole muscle with partial sheath sparing technique combined with mesh reinforcement above the arcuate line can reduce the occurrence of abdominal bulging and hernia. Disclosure of Interest: No significant relationships. P309 The impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers P. Valkovic Zujic1 *, D. Grebic1, I. Pozdreac2. 1Clinical Hospital Center Rijeka, Rijeka, Croatia, 2School of Medicine, University of Rijek, Rijeka, Croatia Aim: Accurate staging of breast cancer is important in predicting prognosis and clinical outcome. The tumor, node, metastasis (TNM) system is the most clinically relevant as it incorporates both, clinical and pathological features. Tumor size is one of the most important factors in determining disease-free and cause-specific survival in invasive breast cancer. The tumor stage is determined by tumor size
S125
which can be assessed by imaging modalities such as mammography (MMG), ultrasound (US), or magnetic resonance imaging (MRI). In cases of node-negative breast cancers, the tumor size becomes of utmost importance in determining type and extent of subsequent surgical and oncological management. Today, breast MRI is routinely used in the preoperative evaluation of diagnosed breast cancer in selected cases such as assessment of the disease, detection of satellite lesions. MRI is much more useful in determine size than MMG or US, even though over and underestimation still occur in up to 15% of patients. Pathology however is considered to be the gold standard method for final tumor size determination. There are various methods to determine tumor size including palpation on physical examination and breast-imaging studies such as MMG, US, and MRI. The aim of our study is to determine the influence of preoperative MRI measurement of tumor size as MRI serves as an additive tool not only to assess the size, multifocality, or multicentricity of lesions but also to help clinicians in making a preoperative treatment plan. Methods: A review of 145 patients with newly diagnosed breast cancer underwent mammography, US, and MR imaging as part of the study. Among 145 lesions, 108 (75%) were invasive ductal carcinoma (IDC), 22 (15%) were invasive lobular carcinoma (ILC) and 15 (10%) were in situ ductal carcinoma (DCIS). Results: The MRI overestimated tumor size in 11% of patients in comparison to pathology size estimation and in 14% of patients the MRI underestimated the tumor size regarding T stage. Mammography, on other hand, overestimated tumor size in 42% of patients and underestimated in 21% of patients. Conclusion: preoperative MRI is recommended in selected case for evaluation of the newly diagnosed breast cancer patient for locoregional staging as it changes subsequent course of action if only mammography tumor size is taken into consideration. Disclosure of Interest: No significant relationships. P310 A retrospective study of comparing the accuracy of ultrasoundguided breast-conserving surgery with palpation-guided excision in the determination of adequate surgical margins for early-stage palpable breast cancer W. Wang*, H. Xing, K. Wang, X. Luo, L. Tang. Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, China Aims: Resection margin residual tumor is the most significant risk factor for local recurrence after breast-conserving surgery (BCS). One promising method for obtaining clear surgical margins during BCS is the intraoperative ultrasonography. The aim of this study was to compare the efficacy of ultrasound-guided BCS of palpable breast cancer in predicting the accurate excision margins, and obtaining clear surgical margins with the standard palpation-guided BCS. Methods: We retrospectively studied 423 consecutive female patients with palpable clinical T1-T2 primary breast cancer who underwent preoperative core-needle biopsy followed by palpationguided or ultrasound-guided BCS from June 2011 to May 2016. In the palpation-guided group, the completeness of tumor removal was evaluated by palpation; in the ultrasound-guided group, the excision surgical margins were determined by intraoperative ultrasound scanning. The surgical margins achieved after BCS were separately assessed by frozen section analysis of shaved margins. The positive surgical margins and re-excision rates were investigated, and the clinicopathological features were compared in the negative margin and positive margin cases. Results: Of the total cohort, 205 patients were treated with palpation-guided BCS and 218 underwent ultrasound-guided BCS. Positive excision margins were noted in 37 patients (18.0%) in the palpation-guided BCS group and 23 patients (10.6%) in the ultrasound-guided group, and ultrasound-guided BCS was associated with significantly more clear surgical margins (P < 0.001). The patients
(25%) were ductal carcinoma in situ. One subareola base tissue was found an occult cancer and NAC was then removed. Three locoregional recurrence were observed after median follow-up time of 24 months (range 2–104 months). NAC sensation was evaluated in total 36 patients. Twenty-six patients (47%) were serial evaluated after the first 6 month of operation, and another 10 patients evaluated at more than 1 year after operation. At the first 6 months, 12 patients (46.2%) shown partial sensation recovery, and more 2 patients had partial recovery after 1-year follow-up. Only one patient (3.8%) had complete sensation recovery in all area of the NAC. In late evaluation group, 7 out of 10 patients had partial recovery. Mostly pain sensation remains at lower aspect of the areola away from surgical incision. Conclusion: NSM is technically feasible in select patient with low rate of NAC removal. Some patient can preserve NAC sensation. Long term outcome should be closed follow up. Disclosure of Interest: No significant relationships. P308 Donor site complications and remnant of rectus abdominis muscle status following transverse rectus abdominis myocutaneous flap reconstruction P. Chirappapha1 *, N. Trikunagonvong2, D. Prapruttam1, S. Rongthong1, P. Lertsithichai1, T. Sukarayothin1, M. Leesombatpaiboon1, R. Panawattanakul3. 1Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 2 Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand, 3Department of Surgery, Udonthani Hospital, Udonthani, Thailand Aims: There are several harvesting techniques for transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after mastectomy, which have been used to minimize untoward complications. We present the whole muscle with partial sheath sparing technique that focusing on the anatomy of arcuate line and the technique of the anterior abdominal wall closure with mesh. To determine postoperative results, complications and factors that associated with complications after performed pedicled TRAM flap reconstruction. Methods: We retrospectively and prospectively reviewed 30 pedicled TRAM flaps, which performed between November 2013 to March 2016, focusing on outcomes and complications. Results: Among the 30 pedicled TRAM flap procedures in 30 patients, there were complications occurred in 5 patients (17%). Most common complications were surgical site infection (SSI) (7%). After a median follow-up time of 15 months, no patient developed abdominal wall hernia or bulging in daily activities, but there were 6 patients (20%) who had asymptomatic abdominal wall bulging when exercised. Factors related to asymptomatic exercised abdominal wall bulging were significantly related to BMI more than 23 kg/m2. Conclusion: Pedicled TRAM flap using the whole muscle with partial sheath sparing technique combined with mesh reinforcement above the arcuate line can reduce the occurrence of abdominal bulging and hernia. Disclosure of Interest: No significant relationships. P309 The impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers P. Valkovic Zujic1 *, D. Grebic1, I. Pozdreac2. 1Clinical Hospital Center Rijeka, Rijeka, Croatia, 2School of Medicine, University of Rijek, Rijeka, Croatia Aim: Accurate staging of breast cancer is important in predicting prognosis and clinical outcome. The tumor, node, metastasis (TNM) system is the most clinically relevant as it incorporates both, clinical and pathological features. Tumor size is one of the most important factors in determining disease-free and cause-specific survival in invasive breast cancer. The tumor stage is determined by tumor size
S125
which can be assessed by imaging modalities such as mammography (MMG), ultrasound (US), or magnetic resonance imaging (MRI). In cases of node-negative breast cancers, the tumor size becomes of utmost importance in determining type and extent of subsequent surgical and oncological management. Today, breast MRI is routinely used in the preoperative evaluation of diagnosed breast cancer in selected cases such as assessment of the disease, detection of satellite lesions. MRI is much more useful in determine size than MMG or US, even though over and underestimation still occur in up to 15% of patients. Pathology however is considered to be the gold standard method for final tumor size determination. There are various methods to determine tumor size including palpation on physical examination and breast-imaging studies such as MMG, US, and MRI. The aim of our study is to determine the influence of preoperative MRI measurement of tumor size as MRI serves as an additive tool not only to assess the size, multifocality, or multicentricity of lesions but also to help clinicians in making a preoperative treatment plan. Methods: A review of 145 patients with newly diagnosed breast cancer underwent mammography, US, and MR imaging as part of the study. Among 145 lesions, 108 (75%) were invasive ductal carcinoma (IDC), 22 (15%) were invasive lobular carcinoma (ILC) and 15 (10%) were in situ ductal carcinoma (DCIS). Results: The MRI overestimated tumor size in 11% of patients in comparison to pathology size estimation and in 14% of patients the MRI underestimated the tumor size regarding T stage. Mammography, on other hand, overestimated tumor size in 42% of patients and underestimated in 21% of patients. Conclusion: preoperative MRI is recommended in selected case for evaluation of the newly diagnosed breast cancer patient for locoregional staging as it changes subsequent course of action if only mammography tumor size is taken into consideration. Disclosure of Interest: No significant relationships. P310 A retrospective study of comparing the accuracy of ultrasoundguided breast-conserving surgery with palpation-guided excision in the determination of adequate surgical margins for early-stage palpable breast cancer W. Wang*, H. Xing, K. Wang, X. Luo, L. Tang. Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, China Aims: Resection margin residual tumor is the most significant risk factor for local recurrence after breast-conserving surgery (BCS). One promising method for obtaining clear surgical margins during BCS is the intraoperative ultrasonography. The aim of this study was to compare the efficacy of ultrasound-guided BCS of palpable breast cancer in predicting the accurate excision margins, and obtaining clear surgical margins with the standard palpation-guided BCS. Methods: We retrospectively studied 423 consecutive female patients with palpable clinical T1-T2 primary breast cancer who underwent preoperative core-needle biopsy followed by palpationguided or ultrasound-guided BCS from June 2011 to May 2016. In the palpation-guided group, the completeness of tumor removal was evaluated by palpation; in the ultrasound-guided group, the excision surgical margins were determined by intraoperative ultrasound scanning. The surgical margins achieved after BCS were separately assessed by frozen section analysis of shaved margins. The positive surgical margins and re-excision rates were investigated, and the clinicopathological features were compared in the negative margin and positive margin cases. Results: Of the total cohort, 205 patients were treated with palpation-guided BCS and 218 underwent ultrasound-guided BCS. Positive excision margins were noted in 37 patients (18.0%) in the palpation-guided BCS group and 23 patients (10.6%) in the ultrasound-guided group, and ultrasound-guided BCS was associated with significantly more clear surgical margins (P < 0.001). The patients