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P167. Patient satisfaction following immediate breast reconstruction using 2 stage implants
ABSTRACTS Conclusion: There is a growing body of literature regarding 3D-SI. However, evidence of its superiority over current methods of clinical decision making, surgical planning, communication and evaluation of outcome is required before it can be accepted into mainstream practice. http://dx.doi.org/10.1016/j.ejso.2015.03.204
P167. Patient satisfaction following immediate breast reconstruction using 2 stage implants Claire Quinnell1, Eifion Vaughan-Williams2 1 Cardiff University, Cardiff, UK 2 Breast Unit, Royal Glamorgan Hospital e Cwm Taf NHS Trust, Llantrisant, UK Introduction: Studies have shown that breast reconstruction is an important determinant of long-term health, and is recommended for all patients without contraindications following mastectomy. The aim of this study was to ascertain the level of patient satisfaction with the cosmetic outcomes following immediate breast reconstruction (IBR). Methods: Data was collected for 127 patients, treated by IBR under a single surgeon between January 2009 and May 2014. Nineteen patients were excluded (10 failed IBRs, 9 expanders not exchanged), the remaining 108 were sent the BREAST-Q questionnaire; 74 were returned, 5 were unanswered. Results: Sixty nine questionnaires were included (64%) with a mean patient age 49 (30e73) years. Forty four (64%) reconstructed breasts matched or superseded the patients’ natural cup size; the largest implant used was 795cc e which gave its recipients at the most, a DD cup. Of the patients whose reconstructions did not match, 68% had at least a D cup naturally. Following IBR, thirty three (48%) women had further elective surgery to the contralateral breast. With regards to shape, size and alignment, 57 (83%), 50 (72%) and 37 (54%) of patients reported that they are at least somewhat happy with each of these elements respectively, and no patients reported very unsatisfactory results with their appearance when clothed. Despite encouraging results only 75% reported their reconstructions matched their expectations Conclusion: This study has shown that IBR offers cosmetically acceptable results, especially if the natural breast was small. However there is clearly an opportunity for progress with regards to meeting patient expectations. http://dx.doi.org/10.1016/j.ejso.2015.03.205
P168. The ability of human observers to discriminate cosmetic outcomes of DIEP breast reconstruction following mastectomy Andrew Clayton Lee1,2, Justin Chatterjee2,3, Andrew Devine4 1 Changi General Hospital, Singapore 2 NHS Tayside, Dundee, UK 3 Department of Plastic Surgery, University of British Columbia, British Columbia, Canada 4 Dundee University School of Medicine, Dundee, UK Aim: Most systems for assessing cosmetic outcomes of breast reconstructions use humans as assessors. The validity of such systems was dependent on the ability of individuals to discriminate between good and bad cosmetic outcomes consistently within individuals and between individuals, which had never been studied. The aim of this study was to test the hypothesis that individuals were capable to discriminate cosmetic outcomes with strong intra-assessor and inter-assessor reliabilities. Methods: Clinical photographs of 20 women who underwent free DIEP-flap breast reconstruction were selected from a series of 96 to ensure a full range of aesthetic outcomes. 24 assessors ranked the clinical photographs in order according to the following parameters on 2 separate occasions: (A) Overall appearance, differences in size, shape and position between the reconstructed and natural breasts, and (B) Overall appearance, shape, deformity and scarring of the reconstructed breast.
S73 Each photo received a score from each ranking activity, which was equivalent to the respective rank position. The primary endpoints were (a) median Spearman’s rank correlation coefficients (rs) between the 1st and 2nd rankings of each individual assessor and (b) Kendall’s coefficient of concordance for ranks (W) for inter-observer concordance, for all of the above parameters. For the hypothesis to be accepted, median rs and W had to be greater than 0.70 and 0.50 respectively for each of the cosmetic parameters. Results: Median rs and W for each parameter were recorded in Table 1. Table 1
Bilateral breasts Overall appearance Difference in size Difference in shape Difference in position Reconstructed breast Overall appearance Shape Deformity Scarring
rs
W
0.85 0.86 0.89 0.87
0.75 0.75 0.79 0.77
0.88 0.92 0.90 0.80
0.74 0.80 0.83 0.62
The median rs and W of all parameters were >0.70 and 0.50 respectively, thus supporting the hypothesis. Conclusion: Human assessors were capable to distinguish cosmetic outcomes of breast reconstructions with strong intra-assessor and interassessor reliabilities thus validating their ability in assessing cosmetic outcomes of breast reconstructions. http://dx.doi.org/10.1016/j.ejso.2015.03.206 P169. In patients with micrometastatic sentinel lymph node biopsies, involvement of the non-sentinel lymph nodes cannot be predicted by clinicopathological variables Muhammad Chauhan, Rajiv Dave, Maria Ghaus, Sana Ahmed, Shiv Sapra, Creig Sayers, Zbigniew Kryjak, Deedar Ali Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK Background: The Sentinel Lymph Node Biopsy (SLNB) procedure is recognised to be an accurate method of staging the axilla in patients with early stage breast cancer. There remains a debate as to whether patients with micrometastases should undergo completion axillary lymph node dissection (CALND). We aimed to assess the indicators for positive nonsentinel lymph nodes (n-SLN) following CALND. Methods: We retrospectively analysed our experience of SNLB between July 2008 to July 2013. A total of 1152 breast cancer patients underwent SLNB. Statistical analysis was performed using Fisher’s exact and c2 for categorical data. Results: Out of 1152 SLNBs performed, 224 (19.5%) were positive for metastatic disease; macrometastases in 150 (67%), micrometastases in 72 (32%) and ITC in 2. CALND was not performed in 20 cases, largely due to concerns regarding fitness for anaesthesia. Macrometastases on SNLB were more likely to predict positive n-SLN on ANC {macrometastases; 39/141 (27.7%) vs micrometastases; 9/62 (14.5%), p ¼ 0.029}. On univariate analysis, positive n-SLN in CALND for patients with micrometastases on SLNB was not predicted by grade (G0-G2; 6/43, and G3; 3/19, p ¼ 0.565), size of primary breast tumour (<40mm; 8/58, 40mm; 1/4, p ¼ 0.475), lymphovascular invasion (5/30 vs 4/31,), age (<50 years; 3/24 vs 50 years; 6/ 38, p ¼ 0.496), or number of positive SLNB. Recurrences were detected in 4 patients, of which 1 was in a patient with micrometastases on SLNB. Conclusion: In our series, 14.5% (9/62) of patients with micrometastases had positive n-SLB on CALND, which was not predicted by any clinicopathological characteristics. http://dx.doi.org/10.1016/j.ejso.2015.03.207
P167. Patient satisfaction following immediate breast reconstruction using 2 stage implants Claire Quinnell1, Eifion Vaughan-Williams2 1 Cardiff University, Cardiff, UK 2 Breast Unit, Royal Glamorgan Hospital e Cwm Taf NHS Trust, Llantrisant, UK Introduction: Studies have shown that breast reconstruction is an important determinant of long-term health, and is recommended for all patients without contraindications following mastectomy. The aim of this study was to ascertain the level of patient satisfaction with the cosmetic outcomes following immediate breast reconstruction (IBR). Methods: Data was collected for 127 patients, treated by IBR under a single surgeon between January 2009 and May 2014. Nineteen patients were excluded (10 failed IBRs, 9 expanders not exchanged), the remaining 108 were sent the BREAST-Q questionnaire; 74 were returned, 5 were unanswered. Results: Sixty nine questionnaires were included (64%) with a mean patient age 49 (30e73) years. Forty four (64%) reconstructed breasts matched or superseded the patients’ natural cup size; the largest implant used was 795cc e which gave its recipients at the most, a DD cup. Of the patients whose reconstructions did not match, 68% had at least a D cup naturally. Following IBR, thirty three (48%) women had further elective surgery to the contralateral breast. With regards to shape, size and alignment, 57 (83%), 50 (72%) and 37 (54%) of patients reported that they are at least somewhat happy with each of these elements respectively, and no patients reported very unsatisfactory results with their appearance when clothed. Despite encouraging results only 75% reported their reconstructions matched their expectations Conclusion: This study has shown that IBR offers cosmetically acceptable results, especially if the natural breast was small. However there is clearly an opportunity for progress with regards to meeting patient expectations. http://dx.doi.org/10.1016/j.ejso.2015.03.205
P168. The ability of human observers to discriminate cosmetic outcomes of DIEP breast reconstruction following mastectomy Andrew Clayton Lee1,2, Justin Chatterjee2,3, Andrew Devine4 1 Changi General Hospital, Singapore 2 NHS Tayside, Dundee, UK 3 Department of Plastic Surgery, University of British Columbia, British Columbia, Canada 4 Dundee University School of Medicine, Dundee, UK Aim: Most systems for assessing cosmetic outcomes of breast reconstructions use humans as assessors. The validity of such systems was dependent on the ability of individuals to discriminate between good and bad cosmetic outcomes consistently within individuals and between individuals, which had never been studied. The aim of this study was to test the hypothesis that individuals were capable to discriminate cosmetic outcomes with strong intra-assessor and inter-assessor reliabilities. Methods: Clinical photographs of 20 women who underwent free DIEP-flap breast reconstruction were selected from a series of 96 to ensure a full range of aesthetic outcomes. 24 assessors ranked the clinical photographs in order according to the following parameters on 2 separate occasions: (A) Overall appearance, differences in size, shape and position between the reconstructed and natural breasts, and (B) Overall appearance, shape, deformity and scarring of the reconstructed breast.
S73 Each photo received a score from each ranking activity, which was equivalent to the respective rank position. The primary endpoints were (a) median Spearman’s rank correlation coefficients (rs) between the 1st and 2nd rankings of each individual assessor and (b) Kendall’s coefficient of concordance for ranks (W) for inter-observer concordance, for all of the above parameters. For the hypothesis to be accepted, median rs and W had to be greater than 0.70 and 0.50 respectively for each of the cosmetic parameters. Results: Median rs and W for each parameter were recorded in Table 1. Table 1
Bilateral breasts Overall appearance Difference in size Difference in shape Difference in position Reconstructed breast Overall appearance Shape Deformity Scarring
rs
W
0.85 0.86 0.89 0.87
0.75 0.75 0.79 0.77
0.88 0.92 0.90 0.80
0.74 0.80 0.83 0.62
The median rs and W of all parameters were >0.70 and 0.50 respectively, thus supporting the hypothesis. Conclusion: Human assessors were capable to distinguish cosmetic outcomes of breast reconstructions with strong intra-assessor and interassessor reliabilities thus validating their ability in assessing cosmetic outcomes of breast reconstructions. http://dx.doi.org/10.1016/j.ejso.2015.03.206 P169. In patients with micrometastatic sentinel lymph node biopsies, involvement of the non-sentinel lymph nodes cannot be predicted by clinicopathological variables Muhammad Chauhan, Rajiv Dave, Maria Ghaus, Sana Ahmed, Shiv Sapra, Creig Sayers, Zbigniew Kryjak, Deedar Ali Pinderfields Hospital, Mid Yorkshire NHS Trust, Wakefield, UK Background: The Sentinel Lymph Node Biopsy (SLNB) procedure is recognised to be an accurate method of staging the axilla in patients with early stage breast cancer. There remains a debate as to whether patients with micrometastases should undergo completion axillary lymph node dissection (CALND). We aimed to assess the indicators for positive nonsentinel lymph nodes (n-SLN) following CALND. Methods: We retrospectively analysed our experience of SNLB between July 2008 to July 2013. A total of 1152 breast cancer patients underwent SLNB. Statistical analysis was performed using Fisher’s exact and c2 for categorical data. Results: Out of 1152 SLNBs performed, 224 (19.5%) were positive for metastatic disease; macrometastases in 150 (67%), micrometastases in 72 (32%) and ITC in 2. CALND was not performed in 20 cases, largely due to concerns regarding fitness for anaesthesia. Macrometastases on SNLB were more likely to predict positive n-SLN on ANC {macrometastases; 39/141 (27.7%) vs micrometastases; 9/62 (14.5%), p ¼ 0.029}. On univariate analysis, positive n-SLN in CALND for patients with micrometastases on SLNB was not predicted by grade (G0-G2; 6/43, and G3; 3/19, p ¼ 0.565), size of primary breast tumour (<40mm; 8/58, 40mm; 1/4, p ¼ 0.475), lymphovascular invasion (5/30 vs 4/31,), age (<50 years; 3/24 vs 50 years; 6/ 38, p ¼ 0.496), or number of positive SLNB. Recurrences were detected in 4 patients, of which 1 was in a patient with micrometastases on SLNB. Conclusion: In our series, 14.5% (9/62) of patients with micrometastases had positive n-SLB on CALND, which was not predicted by any clinicopathological characteristics. http://dx.doi.org/10.1016/j.ejso.2015.03.207