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Oncoplastic surgical techniques can reduce the need for mastectomy for periareolar tumours of the breast
ABSTRACTS expanding from simple volume replacement to the treatment of benign breast conditions and post-operative complications. We have shown that it is simple and safe to perform with low morbidity and high patient satisfaction. P42. High body mass index should not exclude women from undergoing immediate breast reconstruction Caroline Richardson, T. Sircar, P. Matey The Royal Wolverhampton Hospitals NHS Trust, Wednesfield Road, Wolverhampton, WV10 0QP
Introduction: Recent guidelines have acknowledged that women with breast cancer should be offered reconstructive surgery at the time of the initial diagnosis. Tumour characteristics or the need for adjuvant therapy often dictate which options are discussed, but some units use high body mass index (BMI) as a contraindication to offering immediate breast reconstruction. Literature is sparse on whether this group experiences higher complications. This study aimed to assess the rate of complications in women with a high BMI who underwent immediate breast reconstruction. Methods: We performed a retrospective review of a prospectively maintained database on all women undergoing immediate breast reconstruction in 2009 and 2010. All women with a primary diagnosis of breast cancer and a BMI > 28 were included. Demographics, co-morbidities, rate of complications, adjuvant therapy and outcome data were collected. Results: Thirty-eight women with BMI > 28 underwent immediate breast reconstruction. The majority of women (63%) underwent skin-reducing mastectomies with fixed volume implants or tissue-expanders, but 20% women underwent breast remodelling surgery. Two-thirds of women had contralateral surgery for therapeutic purposes, risk-reduction or symmetrisation. No woman experienced loss of the reconstructed breast. Two women (5%) developed minor haematomas, two (5%) developed wound problems (managed non-operatively) and 6 (16%) developed seromas. Eleven women (29%) have received radiotherapy and short term rates for capsular contracture are low. Follow-up ranges from 1 to 22 months and is ongoing. Conclusion: Women with a high body mass index should not be precluded from immediate breast reconstruction as major complication rates are low. P43. Oncoplastic surgical techniques can reduce the need for mastectomy for periareolar tumours of the breast Caroline Richardson, T. Sircar, P. Matey The Royal Wolverhampton Hospitals NHS Trust, Wednesfield Road, Wolverhampton, WV10 0QP
Introduction: The presence of breast cancer near the nipple has traditionally been viewed as a reason for mastectomy in order to obtain oncological clearance and prevent subsequent deformity. Oncoplastic techniques following breast conserving surgery including excision of the nipple-areola complex can avoid mastectomy and achieve good cosmetic outcome. The aim of this study was to present the various oncoplastic techniques that were adopted for periareolar tumours in our unit and also assess the oncological and cosmetic outcomes of these patients. Methods: We identified women who underwent breast conservation surgery including excision of nipple-areola complex between 2004 and 2010 from a prospectively maintained database. All women received adjuvant therapy according to local protocol. Data was collected on demographics, co-morbidities, surgical techniques and oncological outcome. Patient satisfaction was also assessed. Results: Seven women were eligible for inclusion. Oncoplastic techniques included local advancement flap, mini-latissimus dorsi flap and therapeutic mammoplasty. Histological excision was complete in all women. One woman underwent immediate full thickness nipple-areolar
S15 graft with loss of nipple but successful areolar grafting and two women underwent delayed nipple reconstruction. No patients developed local or distant recurrence during follow-up ranging from 3 to 84 months. All women reported high levels of satisfaction at their cosmetic outcomes. Conclusion: Various oncoplastic breast conserving surgical techniques can be performed for periareolar tumours. In our experience these techniques avoided mastectomy and achieved good cosmetic outcome without any increase in locoregional recurrence. Ongoing follow up is required to monitor long term oncological and cosmetic outcomes. P44. Keeping Abreast of Surgical Site Infection - Audit and Re-Audit at a Single Breast Unit over a Five Year Period Clare Rogers Doncaster and Bassetlaw NHS Foundation Trust, Jasmine Centre, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT Introduction: In 2005, we designed a post-operative integrated pathway of care (IPOC) to record post-operative complications in patients having breast surgery. A review of 136 IPOCs showed 15 infections (11%). A literature review revealed few papers with varying definitions of Surgical Site infection (SSI) following breast surgery. Studies showed infection rates ranging from 4% to 19%. No national guideline or audit standard existed for SSI. More recently, the National Mastectomy and Breast Reconstruction (NMBR) audit showed that 20% mastectomy patients and 25% reconstruction patients received antibiotics for confirmed or presumed post-operative infection. Methods: Each year from 2006 to 2010, the case notes of all breast surgery patients operated in January were reviewed to record SSI. We set our audit standard at 10% based on available evidence. Audit results were presented yearly and changes made to our practice following discussion with colleagues in microbiology. These changes were: 1. June 2006 Octenisan wash given pre-op 2. May 2007 Antibiotic prophylaxis with Augmentin 1.2g at induction of anaesthesia 3. July 2008 Antibiotic prophylaxis with Flucloxacillin 1g IV at induction of anaesthesia 4. January 2010 one surgeon stopped using drains January 2006
January 2007
January 2008
January 2009
January 2010
N ¼ 34 N ¼ 41 N ¼ 42 N ¼ 36 N ¼ 44 Infection (proven 7 (20.6%) 7 (17.1%) 6 (14.3%) 6 (16.7%) 3 (6.8%) or suspected) Infection proven 5 (14.7%) 1 (2.4%) 2 (4.8%) 0 (0%) 0 (0%) on wound swab
Conclusions: We have learnt from our audit results, made changes and re-audited to reduce SSI. Our results compare favourably with data from the NMBR audit. P45. One breast unit’s experience of re-excision rates and specimen weights in patients undergoing wide local excision when operated on by Oncoplastic Breast Surgeons and General Surgeons with an interest in breast disease Layth Tameema, R. Ainswortha, T. Longmana, M. Eveleighb, J. Gilla a Musgrove Park Hospital, Taunton, Somerset, TA1 5DA b Surgical Research Unit, University of Bristol Introduction: Oncoplastic Breast Surgeons and General Surgeons with an interest in breast surgery both operate on breast carcinomas in the UK. This study investigates whether there is a difference between the 2 groups in terms of specimen weight and re-excision rate following wide local excisions (WLE). Method: All WLE cases for 2 general surgeons and 2 oncoplastic surgeons within one unit were examined for 6 consecutive months each. Re-excision following WLE was performed if margins of less than 2mm
Introduction: Recent guidelines have acknowledged that women with breast cancer should be offered reconstructive surgery at the time of the initial diagnosis. Tumour characteristics or the need for adjuvant therapy often dictate which options are discussed, but some units use high body mass index (BMI) as a contraindication to offering immediate breast reconstruction. Literature is sparse on whether this group experiences higher complications. This study aimed to assess the rate of complications in women with a high BMI who underwent immediate breast reconstruction. Methods: We performed a retrospective review of a prospectively maintained database on all women undergoing immediate breast reconstruction in 2009 and 2010. All women with a primary diagnosis of breast cancer and a BMI > 28 were included. Demographics, co-morbidities, rate of complications, adjuvant therapy and outcome data were collected. Results: Thirty-eight women with BMI > 28 underwent immediate breast reconstruction. The majority of women (63%) underwent skin-reducing mastectomies with fixed volume implants or tissue-expanders, but 20% women underwent breast remodelling surgery. Two-thirds of women had contralateral surgery for therapeutic purposes, risk-reduction or symmetrisation. No woman experienced loss of the reconstructed breast. Two women (5%) developed minor haematomas, two (5%) developed wound problems (managed non-operatively) and 6 (16%) developed seromas. Eleven women (29%) have received radiotherapy and short term rates for capsular contracture are low. Follow-up ranges from 1 to 22 months and is ongoing. Conclusion: Women with a high body mass index should not be precluded from immediate breast reconstruction as major complication rates are low. P43. Oncoplastic surgical techniques can reduce the need for mastectomy for periareolar tumours of the breast Caroline Richardson, T. Sircar, P. Matey The Royal Wolverhampton Hospitals NHS Trust, Wednesfield Road, Wolverhampton, WV10 0QP
Introduction: The presence of breast cancer near the nipple has traditionally been viewed as a reason for mastectomy in order to obtain oncological clearance and prevent subsequent deformity. Oncoplastic techniques following breast conserving surgery including excision of the nipple-areola complex can avoid mastectomy and achieve good cosmetic outcome. The aim of this study was to present the various oncoplastic techniques that were adopted for periareolar tumours in our unit and also assess the oncological and cosmetic outcomes of these patients. Methods: We identified women who underwent breast conservation surgery including excision of nipple-areola complex between 2004 and 2010 from a prospectively maintained database. All women received adjuvant therapy according to local protocol. Data was collected on demographics, co-morbidities, surgical techniques and oncological outcome. Patient satisfaction was also assessed. Results: Seven women were eligible for inclusion. Oncoplastic techniques included local advancement flap, mini-latissimus dorsi flap and therapeutic mammoplasty. Histological excision was complete in all women. One woman underwent immediate full thickness nipple-areolar
S15 graft with loss of nipple but successful areolar grafting and two women underwent delayed nipple reconstruction. No patients developed local or distant recurrence during follow-up ranging from 3 to 84 months. All women reported high levels of satisfaction at their cosmetic outcomes. Conclusion: Various oncoplastic breast conserving surgical techniques can be performed for periareolar tumours. In our experience these techniques avoided mastectomy and achieved good cosmetic outcome without any increase in locoregional recurrence. Ongoing follow up is required to monitor long term oncological and cosmetic outcomes. P44. Keeping Abreast of Surgical Site Infection - Audit and Re-Audit at a Single Breast Unit over a Five Year Period Clare Rogers Doncaster and Bassetlaw NHS Foundation Trust, Jasmine Centre, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, DN2 5LT Introduction: In 2005, we designed a post-operative integrated pathway of care (IPOC) to record post-operative complications in patients having breast surgery. A review of 136 IPOCs showed 15 infections (11%). A literature review revealed few papers with varying definitions of Surgical Site infection (SSI) following breast surgery. Studies showed infection rates ranging from 4% to 19%. No national guideline or audit standard existed for SSI. More recently, the National Mastectomy and Breast Reconstruction (NMBR) audit showed that 20% mastectomy patients and 25% reconstruction patients received antibiotics for confirmed or presumed post-operative infection. Methods: Each year from 2006 to 2010, the case notes of all breast surgery patients operated in January were reviewed to record SSI. We set our audit standard at 10% based on available evidence. Audit results were presented yearly and changes made to our practice following discussion with colleagues in microbiology. These changes were: 1. June 2006 Octenisan wash given pre-op 2. May 2007 Antibiotic prophylaxis with Augmentin 1.2g at induction of anaesthesia 3. July 2008 Antibiotic prophylaxis with Flucloxacillin 1g IV at induction of anaesthesia 4. January 2010 one surgeon stopped using drains January 2006
January 2007
January 2008
January 2009
January 2010
N ¼ 34 N ¼ 41 N ¼ 42 N ¼ 36 N ¼ 44 Infection (proven 7 (20.6%) 7 (17.1%) 6 (14.3%) 6 (16.7%) 3 (6.8%) or suspected) Infection proven 5 (14.7%) 1 (2.4%) 2 (4.8%) 0 (0%) 0 (0%) on wound swab
Conclusions: We have learnt from our audit results, made changes and re-audited to reduce SSI. Our results compare favourably with data from the NMBR audit. P45. One breast unit’s experience of re-excision rates and specimen weights in patients undergoing wide local excision when operated on by Oncoplastic Breast Surgeons and General Surgeons with an interest in breast disease Layth Tameema, R. Ainswortha, T. Longmana, M. Eveleighb, J. Gilla a Musgrove Park Hospital, Taunton, Somerset, TA1 5DA b Surgical Research Unit, University of Bristol Introduction: Oncoplastic Breast Surgeons and General Surgeons with an interest in breast surgery both operate on breast carcinomas in the UK. This study investigates whether there is a difference between the 2 groups in terms of specimen weight and re-excision rate following wide local excisions (WLE). Method: All WLE cases for 2 general surgeons and 2 oncoplastic surgeons within one unit were examined for 6 consecutive months each. Re-excision following WLE was performed if margins of less than 2mm