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Patients’ perspectives on symmetrising breast reduction after oncoplastic surgery
S36
Abstracts
236A POSTER Patients’ perspectives on symmetrising breast reduction after oncoplastic surgery H. Smeele1 , E. Van der Does de Willebois1 , Y. Eltahir2 , T. De Bock3 , L. Jansen1 . 1 University Medical Center Groningen, Surgical Oncology, Groningen, Netherlands; 2 University Medical Center Groningen, Plastic Surgery, Groningen, Netherlands; 3 University Medical Center Groningen, Epidemiology, Groningen, Netherlands Background: Oncoplastic surgery aims at maintaining the shape of the breast when breast conserving surgery is performed. When larger volumes are excised it may also result in substantial asymmetry. Reduction mammoplasty for the controlateral breast is then offered. This study was performed to explore reasons why only 22% of our population proceeded with symmetrising surgery. Material and Methods: Semi-structured interviews were conducted with a purposive sample of 25 patients who had undergone oncoplastic surgery between 2010 and 2015 in a university hospital. The hospital policy was to perform symmetrising surgery after completion of breast cancer treatment. Nine of 25 patients had undergone symmetrising surgery, 16 did not. The interviews contained the following main themes: decision making, external influences (work / family), timing of the operation on the healthy breast, personal significance of symmetry. Results: The interviews revealed that key factors determining the decision to have symmetrising surgery were: the extent of postoperative breast asymmetry, adaption to asymmetry in daily life, self-esteem in relation to asymmetry, cosmetic outcome of oncoplastic surgery of the affected breast, complications of previous breast surgery. Of the 16 patients who did not have symmetrising surgery, 7 stated that they did not experience significant breast asymmetry, of whom 4 had a LTD-flap as oncoplastic technique. Four patients wished to have symmetrising surgery but were not yet scheduled. The interviewees frequently denied that offering symmetrising surgery simultaneously with the oncological breast surgery would have favored them. 22 of 25 patients stated that they felt they had sufficiently been informed on the options for symmetrising surgery. Conclusions: Patients who underwent oncoplastic surgery confirmed that asymmetry was the most important factor to decide to have symmetrising contralateral breast surgery. Complications of first surgery was a strong predictor of not proceeding with surgery on the contralateral breast. A broad range of motivations was encountered that contributed to their final decision. The extent to which patients turned out to be able to adapt to the asymmetry was influencing the perceived need for symmetrising surgery. No conflict of interest. 237 POSTER Breast reconstruction using modified inferior dermal flap, implant, and nipple areola complex repositioning technique. Experience at MISR Cancer Center G. Amira1 , A. Sherif2 , I. Sallam1 , M. Sherif2 , M. Youssif2 , K. Diab2 , W. Taher3 . 1 MISR Cancer Center, Surgical Oncology, Giza, Egypt; 2 MISR Cancer Center, General and Plastic Surgery, Giza, Egypt; 3 Royal Marsden Hospital, Breast Unit, London, United Kingdom Background: Immediate breast reconstruction is routinely used for mastectomy candidate patients at MISR Cancer Center. Due to the patient preferences and advanced professional patient care. More and more cosmetic expectations are demanded every other day. Inferior dermal flap with implant is widely practiced. We added modification to this procedure using the autologous tissue as an inferolateral local sling, avoiding the costs in the low resource setting and reducing the morbidity of lengthy operating time. After using this modification many patients avoided a second procedure for subsequent nipple reconstruction and re-positioning that will decrease further appointments and costs. Method: This study involved 24 patients (29 breasts) previously treated at our center from September 2014 to August 2016. Skin markings and a suitable nipple areola complex position is suggested. Reconstruction was performed following a periareolar skin deepethelialization to obtain the new nipple areola complex position. A Wise pattern skin incision and an inferior deepithelialized dermal sling was sutured to the pectoralis major to form a pocket for a silicone implant. And the nipple areola complex was sited at the time of reconstruction, with biopsies taken from retroareolar tissue before proceeding with the procedure. Results: Patient average age was 51 years (range 38−64). 11 mastectomies were for invasive carcinoma, 8 for ductal carcinoma in situ, 5 for lobular carcinoma, and 5 of 19 mastectomies were prophylactic (3 high risk and 2 Atypical lobular hyperplasia). Average operative time was 150 min. There were no immediate complications requiring reoperation. All retroareolar biopsies were benign and no locoregional recurrences have
Poster Session, Saturday 28 January 2017 occurred. 4 nipples had partial superficial necrosis of the lower pole but healed with conservative treatment. No patients required any subsequent procedures to their reconstructed breast. Conclusion: The modified inferior dermal flap with implant and nipple areola complex re-positioning is an excellent one stage reconstruction option. This method presents a potentially safe, trusted, and aesthetically accepted outcome for Egyptian women with large and ptotic breasts. No conflict of interest. 237A POSTER Breast magnetic resonance imaging (MRI) for local ductal carcinoma in-situ (DCIS) staging: Multicentric randomized controlled trial to assess the efficacy and cost-effectiveness of preoperative MRI to optimize breast surgery C. Balleyguier1 , A. Dunant2 , M. Kandel3 , L. Ceugnart4 , P. Cherel5 , P. Henrot6 , J. Chopier7 , C. Mazouni8 , M.C. Mathieu9 , F. Rimareix8 , J. Bonastre3 , J.R. Garbay8 . 1 Gustave Roussy, Radiology, Villejuif, France; 2 Gustave Roussy, Statistics, Villejuif, France; 3 Gustave Roussy, Medicoeconomy, Villejuif, France; 4 Centre Oscar Lambret, Radiology, Lille, France; 5 Curie, Radiology, Saint Cloud, France; 6 Alexis Vautrin, Radiology, Nancy, ˆ France; 7 Hopital Tenon, Radiology, Paris, France; 8 Gustave Roussy, Surgery, Villejuif, France; 9 Gustave Roussy, Pathology, Villejuif, France Background: This study was performed to determine whether the addition of MRI to standard radiological evaluation might help to evaluate tumor extension and reduce the reoperation rate in women with DCIS scheduled for conservative treatment (CT). To assess whether this strategy would be cost-effective from the French National Health Insurance was a secondary objective. Material and Methods: Women with a biopsy-proven breast DCIS, corresponding to an unifocal microcalcifications cluster or a mass <30 mm scheduled for CT were randomized in two arms: MRI (+/− biopsy) or standard evaluation (no MRI). Ten French hospitals participated in the trial. The primary end point was the reoperation rate at 6 months for non-safe margins (<2 mm). The objective of the study was to obtain a 50-percent reduction of the reoperation rate, estimated to be 25% in the control arm. Secondary outcomes included economic evaluation, mastectomy rate and specific MRI enhancement parameters. The main analysis was performed by stratification on center. Results: 360 patients were included in the study. 8 patients were excluded for major deviation in the trial. From a total of 352 analyzable patients, 178 were randomized in the MRI arm and 174 in the control arm (no MRI). 82/345 patients (7 endpoints missing) were reoperated for non safe margins at 6 months. The reoperation rates in both groups were respectively 20% in the MRI arm (35/173) and 27% in the control arm (47/172); difference of 7%, 95% confidence interval (CI) −2% to 16%, p = 0.13. This non significant absolute difference in the intention to treat analysis corresponds to a 26% relative difference. The analyses as treated and per protocol resulted in differences of 11%, (p = 0.02) and 9% (p = 0.05) respectively. The number of re-hospitalizations in the MRI arm was 45 and 59 in the no MRI arm. Despite an extra cost due to MRI (€ 300), difference in total costs between arms was not statistically significant (mean cost of € 9,266 in the no MRI arm and € 9,324 in the MRI arm, cost difference: € 58 [95% CI: −€ 754; € 850]). Mastectomy rates were 9% (16/176) in MRI arm versus 4% (7/173) in control arm, p = 0.06. For the 100 lesions seen by MRI, non mass enhancement was a more common criterion (82) as mass enhancement (20); nevertheless, no morphologic specific MRI subtype parameter was predominant. Conclusions: This study is inconclusive, with a 26% relative reduction in the reoperation rate in favor of MRI staging in local DCIS, but not statistically significant (p = 0.13). Our main objective (50% reduction rate in the re-intervention rate) was ambitious and it is likely that the study was underpowered. Economic evaluation is also in favor of MRI. These results encourage us to continue to evaluate the potential of breast MRI to stage these difficult patients for surgery. No conflict of interest. 238 POSTER Novel monastrol derivatives exert potent anti-breast cancer activity via inhibition of ubiquitin conjugating enzyme Rad6B U.P. Singh1 , J. Shrivastava1 , H.R. Bhat2 . 1 Sam Higginbottom Institute of Agriculture- Technology & Sciences, Department of Pharmaceutical Sciences, Allahabad/Uttar Pradesh, India; 2 Dibrugarh University, Department of Pharmaceutical Sciences, Dibrugarh, India Background: Rad6B is the first cloned ubiquitin-conjugating enzyme (E2) found to be essential for post-replication DNA repair. The over-expression of Rad6B is reported in breast cancer cell lines and tumours. Thus, interfering with Rad6B could serve as novel target for anticancer drugs that contribute
Abstracts
236A POSTER Patients’ perspectives on symmetrising breast reduction after oncoplastic surgery H. Smeele1 , E. Van der Does de Willebois1 , Y. Eltahir2 , T. De Bock3 , L. Jansen1 . 1 University Medical Center Groningen, Surgical Oncology, Groningen, Netherlands; 2 University Medical Center Groningen, Plastic Surgery, Groningen, Netherlands; 3 University Medical Center Groningen, Epidemiology, Groningen, Netherlands Background: Oncoplastic surgery aims at maintaining the shape of the breast when breast conserving surgery is performed. When larger volumes are excised it may also result in substantial asymmetry. Reduction mammoplasty for the controlateral breast is then offered. This study was performed to explore reasons why only 22% of our population proceeded with symmetrising surgery. Material and Methods: Semi-structured interviews were conducted with a purposive sample of 25 patients who had undergone oncoplastic surgery between 2010 and 2015 in a university hospital. The hospital policy was to perform symmetrising surgery after completion of breast cancer treatment. Nine of 25 patients had undergone symmetrising surgery, 16 did not. The interviews contained the following main themes: decision making, external influences (work / family), timing of the operation on the healthy breast, personal significance of symmetry. Results: The interviews revealed that key factors determining the decision to have symmetrising surgery were: the extent of postoperative breast asymmetry, adaption to asymmetry in daily life, self-esteem in relation to asymmetry, cosmetic outcome of oncoplastic surgery of the affected breast, complications of previous breast surgery. Of the 16 patients who did not have symmetrising surgery, 7 stated that they did not experience significant breast asymmetry, of whom 4 had a LTD-flap as oncoplastic technique. Four patients wished to have symmetrising surgery but were not yet scheduled. The interviewees frequently denied that offering symmetrising surgery simultaneously with the oncological breast surgery would have favored them. 22 of 25 patients stated that they felt they had sufficiently been informed on the options for symmetrising surgery. Conclusions: Patients who underwent oncoplastic surgery confirmed that asymmetry was the most important factor to decide to have symmetrising contralateral breast surgery. Complications of first surgery was a strong predictor of not proceeding with surgery on the contralateral breast. A broad range of motivations was encountered that contributed to their final decision. The extent to which patients turned out to be able to adapt to the asymmetry was influencing the perceived need for symmetrising surgery. No conflict of interest. 237 POSTER Breast reconstruction using modified inferior dermal flap, implant, and nipple areola complex repositioning technique. Experience at MISR Cancer Center G. Amira1 , A. Sherif2 , I. Sallam1 , M. Sherif2 , M. Youssif2 , K. Diab2 , W. Taher3 . 1 MISR Cancer Center, Surgical Oncology, Giza, Egypt; 2 MISR Cancer Center, General and Plastic Surgery, Giza, Egypt; 3 Royal Marsden Hospital, Breast Unit, London, United Kingdom Background: Immediate breast reconstruction is routinely used for mastectomy candidate patients at MISR Cancer Center. Due to the patient preferences and advanced professional patient care. More and more cosmetic expectations are demanded every other day. Inferior dermal flap with implant is widely practiced. We added modification to this procedure using the autologous tissue as an inferolateral local sling, avoiding the costs in the low resource setting and reducing the morbidity of lengthy operating time. After using this modification many patients avoided a second procedure for subsequent nipple reconstruction and re-positioning that will decrease further appointments and costs. Method: This study involved 24 patients (29 breasts) previously treated at our center from September 2014 to August 2016. Skin markings and a suitable nipple areola complex position is suggested. Reconstruction was performed following a periareolar skin deepethelialization to obtain the new nipple areola complex position. A Wise pattern skin incision and an inferior deepithelialized dermal sling was sutured to the pectoralis major to form a pocket for a silicone implant. And the nipple areola complex was sited at the time of reconstruction, with biopsies taken from retroareolar tissue before proceeding with the procedure. Results: Patient average age was 51 years (range 38−64). 11 mastectomies were for invasive carcinoma, 8 for ductal carcinoma in situ, 5 for lobular carcinoma, and 5 of 19 mastectomies were prophylactic (3 high risk and 2 Atypical lobular hyperplasia). Average operative time was 150 min. There were no immediate complications requiring reoperation. All retroareolar biopsies were benign and no locoregional recurrences have
Poster Session, Saturday 28 January 2017 occurred. 4 nipples had partial superficial necrosis of the lower pole but healed with conservative treatment. No patients required any subsequent procedures to their reconstructed breast. Conclusion: The modified inferior dermal flap with implant and nipple areola complex re-positioning is an excellent one stage reconstruction option. This method presents a potentially safe, trusted, and aesthetically accepted outcome for Egyptian women with large and ptotic breasts. No conflict of interest. 237A POSTER Breast magnetic resonance imaging (MRI) for local ductal carcinoma in-situ (DCIS) staging: Multicentric randomized controlled trial to assess the efficacy and cost-effectiveness of preoperative MRI to optimize breast surgery C. Balleyguier1 , A. Dunant2 , M. Kandel3 , L. Ceugnart4 , P. Cherel5 , P. Henrot6 , J. Chopier7 , C. Mazouni8 , M.C. Mathieu9 , F. Rimareix8 , J. Bonastre3 , J.R. Garbay8 . 1 Gustave Roussy, Radiology, Villejuif, France; 2 Gustave Roussy, Statistics, Villejuif, France; 3 Gustave Roussy, Medicoeconomy, Villejuif, France; 4 Centre Oscar Lambret, Radiology, Lille, France; 5 Curie, Radiology, Saint Cloud, France; 6 Alexis Vautrin, Radiology, Nancy, ˆ France; 7 Hopital Tenon, Radiology, Paris, France; 8 Gustave Roussy, Surgery, Villejuif, France; 9 Gustave Roussy, Pathology, Villejuif, France Background: This study was performed to determine whether the addition of MRI to standard radiological evaluation might help to evaluate tumor extension and reduce the reoperation rate in women with DCIS scheduled for conservative treatment (CT). To assess whether this strategy would be cost-effective from the French National Health Insurance was a secondary objective. Material and Methods: Women with a biopsy-proven breast DCIS, corresponding to an unifocal microcalcifications cluster or a mass <30 mm scheduled for CT were randomized in two arms: MRI (+/− biopsy) or standard evaluation (no MRI). Ten French hospitals participated in the trial. The primary end point was the reoperation rate at 6 months for non-safe margins (<2 mm). The objective of the study was to obtain a 50-percent reduction of the reoperation rate, estimated to be 25% in the control arm. Secondary outcomes included economic evaluation, mastectomy rate and specific MRI enhancement parameters. The main analysis was performed by stratification on center. Results: 360 patients were included in the study. 8 patients were excluded for major deviation in the trial. From a total of 352 analyzable patients, 178 were randomized in the MRI arm and 174 in the control arm (no MRI). 82/345 patients (7 endpoints missing) were reoperated for non safe margins at 6 months. The reoperation rates in both groups were respectively 20% in the MRI arm (35/173) and 27% in the control arm (47/172); difference of 7%, 95% confidence interval (CI) −2% to 16%, p = 0.13. This non significant absolute difference in the intention to treat analysis corresponds to a 26% relative difference. The analyses as treated and per protocol resulted in differences of 11%, (p = 0.02) and 9% (p = 0.05) respectively. The number of re-hospitalizations in the MRI arm was 45 and 59 in the no MRI arm. Despite an extra cost due to MRI (€ 300), difference in total costs between arms was not statistically significant (mean cost of € 9,266 in the no MRI arm and € 9,324 in the MRI arm, cost difference: € 58 [95% CI: −€ 754; € 850]). Mastectomy rates were 9% (16/176) in MRI arm versus 4% (7/173) in control arm, p = 0.06. For the 100 lesions seen by MRI, non mass enhancement was a more common criterion (82) as mass enhancement (20); nevertheless, no morphologic specific MRI subtype parameter was predominant. Conclusions: This study is inconclusive, with a 26% relative reduction in the reoperation rate in favor of MRI staging in local DCIS, but not statistically significant (p = 0.13). Our main objective (50% reduction rate in the re-intervention rate) was ambitious and it is likely that the study was underpowered. Economic evaluation is also in favor of MRI. These results encourage us to continue to evaluate the potential of breast MRI to stage these difficult patients for surgery. No conflict of interest. 238 POSTER Novel monastrol derivatives exert potent anti-breast cancer activity via inhibition of ubiquitin conjugating enzyme Rad6B U.P. Singh1 , J. Shrivastava1 , H.R. Bhat2 . 1 Sam Higginbottom Institute of Agriculture- Technology & Sciences, Department of Pharmaceutical Sciences, Allahabad/Uttar Pradesh, India; 2 Dibrugarh University, Department of Pharmaceutical Sciences, Dibrugarh, India Background: Rad6B is the first cloned ubiquitin-conjugating enzyme (E2) found to be essential for post-replication DNA repair. The over-expression of Rad6B is reported in breast cancer cell lines and tumours. Thus, interfering with Rad6B could serve as novel target for anticancer drugs that contribute