- Email: [email protected]
P308 Comparison of implant-based immediate breast reconstruction with and without vicryl mesh
S132
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
Surgery P306 Preoperative diagnosis for metastasis of sentinel lymph node (SLN) using 3D CT lymphography (CTLG) M. Nakagawa *, M. Morimoto, H. Takechi, Y. Tadokoro, A. Tangoku. Thoracic, Endocrine Surgery and Oncology, The University of Tokushima, Tokushima, Japan Goals: ACOSOG Z0011 showed the possibility of omitting axillary lymph node dissection in T1–2 breast cancer with SLN metastasis. CTLG with a nonionic water-soluble iodinated contrast medium allows quick visualization of direct connection between primary SLN and its afferent lymphatic channels with providing detailed anatomy at the time of preoperative CT scan. We hypothesize that LN metastasis can be diagnosed using CTLG by detecting the obstruction of the lymph vessel and tumor replacement, and established the criteria for diagnosis of metastatic SLN. According to the criteria, 467 patients’ CTLG showed accuracy of preoperative diagnosis for metastasis was 87.3%, sensitivity was 58.8% and specificity was 92.4%. To improve the accuracy rate, we examined by diagnose into three categories; metastasis, equivocal and non-metastasis. Our objective is to evaluate the accuracy for diagnosis of SLN metastasis using CTLG by comparing with pathological results. Methods: From Nov 2013 to Oct 2014, 120 patients with breast cancer underwent surgery in Tokushima University Hospital. CTLG was applied to all patients, and 100 patients who did not receive primary chemotherapy were studied. SLN metastasis was diagnosed according to the following criteria: (A) Defect of the SLN, scissor clubbed defect sign or mottled stain of the LN, (B) Stagnation and (C) Interruption of the lymph vessels, (D) Abnormal rerouting of the lymphatic route. Preoperative diagnosis was compared to pathological report after operation. Results: Twelve of 100 patients proved metastatic SLN pathologically. We diagnosed 57 cases as non-metastasis, 7 cases as metastasis and 36 cases as equivocal. 64 cases that diagnosed as non-metastasis and metastasis was correctly diagnosed. Conclusion: CTLG shows number and position of SLN with surrounding detailed anatomy. Moreover non-metastatic SLN can be correctly diagnosed by CTLG. Patients with non-metastatic SLN diagnosed by CTLG might avoid SLN biopsy. Disclosure of Interest: No significant relationships. P307 Basic approaches of oncoplastic breast surgery: which operation to which patient? T. Colakoglu *, H.O. Aytac, T.Z. Nursal, S. Yildirim. General Surgery, Baskent University, Faculty of Medicine, Adana, Turkey Goals: Oncoplastic procedures can be summarized as volume fillings/shiftings, flaps, implants and reduction mammoplasties. Surgical algorithms should be developed regarding patient satisfaction respecting oncological principals and cosmetic expectations for oncoplastic operations. Methods: In this cohort study, data of 147 patients operated on for breast cancer with oncoplastic methods at our tertiary-referral center between January 2008 and December 2013 were assessed in the context of demographics, surgical techniques, pathologic and cosmetic results. Results: Oncoplastic procedures offered by our breast surgeons was accepted by 147 (83%) of the 177 patients. Type of the procedure applied was decided in collaboration with the patients. Immediate Latissimus dorsi mini flap reconstruction after lumpectomy was carried out to 46 (31.3%) of the cases. Thirty (20.4%) patients
were treated with lumpectomy and volume shifting by areolar transposition, 22 (15%) with skin sparing mastectomy and immediate implant placement, 21 (14.3%) with Modified Radical Mastectomy (MRM) followed by immediate reconstruction with TRAM flap. Immediate reconstruction with Latissimus Dorsi Myocutaneous flap following subcutaneous mastectomy was applied to 11 (7.5%) cases. Seven (4.8%) patients were treated with MRM and immediate expander placement, 5 (3.4%) with bilateral reduction mammoplasty. Late reconstruction was applied to 5 (3.4%) patients who had previous MRM history. Late complementary mastectomy was performed on three (2%) cases due to presence of DCIS at the surgical margin and on two (1.3%) cases due to local recurrence. No distant metastasis or complications related to radiotherapy was observed during follow-up. Ninety percent (127/141) of the patients declared their satisfaction state as “like” or “admire”. Aesthetic evaluation by an independent observer surgeon ended as “good” or “very good” in 85% (114/134) of the patients. Bilateral reduction mammoplasty was the favorite both from the patients’ and observers’ point of view. Conclusion: Oncoplastic procedures designed suitably for breast cancer cases in terms of patient factors and disease features can result oncology safe, acceptable cosmetic results. Disclosure of Interest: No significant relationships. P308 Comparison of implant-based immediate breast reconstruction with and without vicryl mesh H. Karanlik *, S. Bayrak, M. Fayda, I. Ozgur, S. Kurul. Department of Surgical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey Goals: Vicryl mesh can be used for implant based breast reconstruction but only limited clinical data are available. The aim of this study whether adding Vicryl mesh in implant based immediate reconstruction improved outcomes when compared with non-Vicryl mesh reconstruction. Methods: Patients undergoing implant based immediate breast reconstruction at a single university hospital were evaluated. Aesthetic outcomes and postoperative complications were assessed and direct comparisions were made between Vicryl mesh and nonVicryl mesh cohorts. Results: A total of 82 surgical procedures were performed in 70 patients during the study period. Of all the procedures, Vicryl mesh technique was used in 35 (43%), non-vicryl mesh techniques were used in 47 (57%) of them. 12 patients (15%) were operated for recurrent breast cancer had previous history of the whole breast radiation therapy. Duration of the hospitalization was not different between two groups (p > 0.05). Overall complications encountered in 22% of patients and were not different between two groups (p > 0.05). However, capsular contracture (p = 0.04), inframammary fold problems (p = 0.04) and bottoming-out (p = 0.04) were all more frequent in the non-Vicryl mesh group compared with Vicryl mesh reconstruction. The incidence of the seroma/hematoma, infection, wound problems/dehiscence, skin necrosis and implant failure were similar between groups (p > 0.05). Overall and inframammarian fold aesthetic outcome of immediate implant based breast reconstruction was higher in the Vicryl mesh than non-Vicryl group (p < 0.001). Conclusion: Optimizing the inframamarian fold with Vicryl mesh creates a superior aesthetic result. Its use appears safe and is associated with less capsular contracture and bottoming-out and improvement in the inframammary fold appearance, without increasing postoperative complications. Disclosure of Interest: No significant relationships.
Poster Abstracts II / The Breast 24S1 (2015) S87–S150
Surgery P306 Preoperative diagnosis for metastasis of sentinel lymph node (SLN) using 3D CT lymphography (CTLG) M. Nakagawa *, M. Morimoto, H. Takechi, Y. Tadokoro, A. Tangoku. Thoracic, Endocrine Surgery and Oncology, The University of Tokushima, Tokushima, Japan Goals: ACOSOG Z0011 showed the possibility of omitting axillary lymph node dissection in T1–2 breast cancer with SLN metastasis. CTLG with a nonionic water-soluble iodinated contrast medium allows quick visualization of direct connection between primary SLN and its afferent lymphatic channels with providing detailed anatomy at the time of preoperative CT scan. We hypothesize that LN metastasis can be diagnosed using CTLG by detecting the obstruction of the lymph vessel and tumor replacement, and established the criteria for diagnosis of metastatic SLN. According to the criteria, 467 patients’ CTLG showed accuracy of preoperative diagnosis for metastasis was 87.3%, sensitivity was 58.8% and specificity was 92.4%. To improve the accuracy rate, we examined by diagnose into three categories; metastasis, equivocal and non-metastasis. Our objective is to evaluate the accuracy for diagnosis of SLN metastasis using CTLG by comparing with pathological results. Methods: From Nov 2013 to Oct 2014, 120 patients with breast cancer underwent surgery in Tokushima University Hospital. CTLG was applied to all patients, and 100 patients who did not receive primary chemotherapy were studied. SLN metastasis was diagnosed according to the following criteria: (A) Defect of the SLN, scissor clubbed defect sign or mottled stain of the LN, (B) Stagnation and (C) Interruption of the lymph vessels, (D) Abnormal rerouting of the lymphatic route. Preoperative diagnosis was compared to pathological report after operation. Results: Twelve of 100 patients proved metastatic SLN pathologically. We diagnosed 57 cases as non-metastasis, 7 cases as metastasis and 36 cases as equivocal. 64 cases that diagnosed as non-metastasis and metastasis was correctly diagnosed. Conclusion: CTLG shows number and position of SLN with surrounding detailed anatomy. Moreover non-metastatic SLN can be correctly diagnosed by CTLG. Patients with non-metastatic SLN diagnosed by CTLG might avoid SLN biopsy. Disclosure of Interest: No significant relationships. P307 Basic approaches of oncoplastic breast surgery: which operation to which patient? T. Colakoglu *, H.O. Aytac, T.Z. Nursal, S. Yildirim. General Surgery, Baskent University, Faculty of Medicine, Adana, Turkey Goals: Oncoplastic procedures can be summarized as volume fillings/shiftings, flaps, implants and reduction mammoplasties. Surgical algorithms should be developed regarding patient satisfaction respecting oncological principals and cosmetic expectations for oncoplastic operations. Methods: In this cohort study, data of 147 patients operated on for breast cancer with oncoplastic methods at our tertiary-referral center between January 2008 and December 2013 were assessed in the context of demographics, surgical techniques, pathologic and cosmetic results. Results: Oncoplastic procedures offered by our breast surgeons was accepted by 147 (83%) of the 177 patients. Type of the procedure applied was decided in collaboration with the patients. Immediate Latissimus dorsi mini flap reconstruction after lumpectomy was carried out to 46 (31.3%) of the cases. Thirty (20.4%) patients
were treated with lumpectomy and volume shifting by areolar transposition, 22 (15%) with skin sparing mastectomy and immediate implant placement, 21 (14.3%) with Modified Radical Mastectomy (MRM) followed by immediate reconstruction with TRAM flap. Immediate reconstruction with Latissimus Dorsi Myocutaneous flap following subcutaneous mastectomy was applied to 11 (7.5%) cases. Seven (4.8%) patients were treated with MRM and immediate expander placement, 5 (3.4%) with bilateral reduction mammoplasty. Late reconstruction was applied to 5 (3.4%) patients who had previous MRM history. Late complementary mastectomy was performed on three (2%) cases due to presence of DCIS at the surgical margin and on two (1.3%) cases due to local recurrence. No distant metastasis or complications related to radiotherapy was observed during follow-up. Ninety percent (127/141) of the patients declared their satisfaction state as “like” or “admire”. Aesthetic evaluation by an independent observer surgeon ended as “good” or “very good” in 85% (114/134) of the patients. Bilateral reduction mammoplasty was the favorite both from the patients’ and observers’ point of view. Conclusion: Oncoplastic procedures designed suitably for breast cancer cases in terms of patient factors and disease features can result oncology safe, acceptable cosmetic results. Disclosure of Interest: No significant relationships. P308 Comparison of implant-based immediate breast reconstruction with and without vicryl mesh H. Karanlik *, S. Bayrak, M. Fayda, I. Ozgur, S. Kurul. Department of Surgical Oncology, Istanbul University Institute of Oncology, Istanbul, Turkey Goals: Vicryl mesh can be used for implant based breast reconstruction but only limited clinical data are available. The aim of this study whether adding Vicryl mesh in implant based immediate reconstruction improved outcomes when compared with non-Vicryl mesh reconstruction. Methods: Patients undergoing implant based immediate breast reconstruction at a single university hospital were evaluated. Aesthetic outcomes and postoperative complications were assessed and direct comparisions were made between Vicryl mesh and nonVicryl mesh cohorts. Results: A total of 82 surgical procedures were performed in 70 patients during the study period. Of all the procedures, Vicryl mesh technique was used in 35 (43%), non-vicryl mesh techniques were used in 47 (57%) of them. 12 patients (15%) were operated for recurrent breast cancer had previous history of the whole breast radiation therapy. Duration of the hospitalization was not different between two groups (p > 0.05). Overall complications encountered in 22% of patients and were not different between two groups (p > 0.05). However, capsular contracture (p = 0.04), inframammary fold problems (p = 0.04) and bottoming-out (p = 0.04) were all more frequent in the non-Vicryl mesh group compared with Vicryl mesh reconstruction. The incidence of the seroma/hematoma, infection, wound problems/dehiscence, skin necrosis and implant failure were similar between groups (p > 0.05). Overall and inframammarian fold aesthetic outcome of immediate implant based breast reconstruction was higher in the Vicryl mesh than non-Vicryl group (p < 0.001). Conclusion: Optimizing the inframamarian fold with Vicryl mesh creates a superior aesthetic result. Its use appears safe and is associated with less capsular contracture and bottoming-out and improvement in the inframammary fold appearance, without increasing postoperative complications. Disclosure of Interest: No significant relationships.