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TIGR® Matrix Mesh in breast reconstruction – A single unit experience
S24 One patient required intravenous antibiotics for post-operative wound infection and 3 had superficial wound breakdown. Conclusions: The use of multiple iodine seeds in breast conservation surgery is relatively new technique in our institution, but has acceptable rates of re-excision and complications in our experience. http://dx.doi.org/10.1016/j.ejso.2017.01.097
P045. Vacuum assisted biopsy versus surgical excision for the diagnosis and monitoring of B3 papillary lesions Quratul Ain, John Canny, Bruce Tanchel, Balapathiran Balasubramanian Solihull Hospital, Heart of England Foundation Trust, Solihull, Birmingham, UK Introduction: B3 lesions are defined as those with uncertain malignant potential. Papillary lesions are one of these heterogenous groups of breast lesions. One of challenges of the breast MDT can be identifying which of these need to proceed to surgical excision to ascertain a histological diagnosis. Current practice in this unit tends to air towards excision of these lesions. Recently vacuum assisted biopsy (VAB) has been used to try to gain more tissue sample in order to avoid large numbers of unnecessary surgical excision biopsies. Methods: Patients who had B3 papillary lesions on core biopsy were identified from histopathology records. Trust medical records were searched to ascertain investigations performed and the results of these. Data was collected in a secure database and analysed statistically. Results: 125 patients were identified between January 2011 and November 2016 with B3 papillary lesions diagnosed by needle core biopsy. 15 of 125 patients did not have any subsequent procedures and were excluded from the analysis. Of the remaining 111 patients 92 proceeded to surgical excision biopsy without prior vacuum assisted biopsy (VAB). 12 of the 92 patients were diagnosed to have malignancy (in situ or invasive) making the upgrade rate for surgery 13.04%. 11 of 12 (91/ 67%) upgraded to DCIS and 1 (83.33%) had invasive carcinoma. 18 of 111 patients had VAB. 12 of these 18 patients went on to have subsequent excision biopsies and the other 6 were followed up on the basis of VAB alone. 3 of 18 who had VAB were upgraded to malignancy making the upgrade rate as 16.67% (3/18 DCIS). The patients who had VAB followed by surgery there were no malignancies giving the upgrade rate of 0%. Conclusion and recommendations: The results of this study show very identical upgrade rate for VAB group (16.67%) and surgical excision group (13.04%). Surgical excision following VAB had no additional yield of malignancy. The study demonstrates that VAB without surgical excision may be sufficient for managing B3 papillary lesions diagnosed with needle core biopsies. However, the numbers in the VAB group were small to reach a definite conclusion based on these figures alone. A more extensive interhospital study is to be planned for the future to address this issue. http://dx.doi.org/10.1016/j.ejso.2017.01.098
P046. TIGRÒ Matrix Mesh in breast reconstruction e A single unit experience Gareth Irwin1, Lynn Darragh2, Peter Mallon1, Stuart McIntosh1,3, Sam Sloan1, Sigi Refsum1 1 Belfast City Hospital, Belfast, UK 2 Ulster Hospital, Dundonald, UK 3 Queen’s University, Belfast, UK Introduction: Current guidelines recommend offering immediate reconstruction following mastectomy. Good cosmesis can be achieved with a one-stage submuscular implant based technique, but coverage of the lower pole for support and to maintain the inframammary fold is required. A range is available but these can be expensive and are not
ABSTRACTS without complications. This unit is amongst the first in the UK to use TIGRÒ matrix mesh. Methods: TIGRÒ matrix is made from synthetic reabsorbable polymers and is intended to provide support for 6e9 month and reabsorb completely by 3 years. TIGRÒ has been used in this unit over the last two years and follow up data recorded prospectively. Results: From June 2014 until Dec 2016 TIGR matrix mesh has been used in 63 patients (mean age 45.9 years, 27e73) for 94 breasts. 44 meshes were used for immediate implant reconstruction following therapeutic skinsparing mastectomy alone. 27 involved an additional axillary procedure (22 SLNB, 5 ANC). 20 were used in immediate reconstruction following riskreducing mastectomy and 3 in salvage procedures. Implant volume ranged from 140cc to 640cc. Current follow-up data ranges from 30 months to 14 days. Complications at 30 days include one return to theatre for evacuation of haematoma with no long-term consequences. At 90 days 77% of the breasts had settled with no long-term sequelae and good cosmetic outcome. 2 implants were salvaged with no long-term effects. Three wound scars needed revised and the implant was lost from 11 breasts. Conclusions: TIGRÒ matrix mesh is a novel product with versatile uses. These longer-term results are favourable in terms of cosmesis and complication rates. Follow up continues and will be updated. http://dx.doi.org/10.1016/j.ejso.2017.01.099
P047. Salvage of infected breast implants with continuous periprosthetic antibiotic irrigation: a retrospective audit Jennett Kelsall, Eleanor Gutteridge, Lisa Whisker Nottingham City Hospital, Nottingham, UK Introduction: Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/ exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion. Methods: A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected. Results: Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2e6 days, median ¼ 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S. aureus, 2 grew Propionibacterium, and in 9 no organism was cultured. Conclusion: Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients. http://dx.doi.org/10.1016/j.ejso.2017.01.100
P048. A retrospective study comparing early outcomes of prepectoral and subpectoral implant based breast reconstruction Kavitha Kanesalingam, Assad Khan, Isabella Karat, George Kousparos, Hisham Osman, Ian J Laidlaw, Raouf Daoud Frimley Park Hospital, Surrey, UK Introduction: Immediate implant based reconstruction is an established breast reconstruction technique where full implant coverage is achieved with
P045. Vacuum assisted biopsy versus surgical excision for the diagnosis and monitoring of B3 papillary lesions Quratul Ain, John Canny, Bruce Tanchel, Balapathiran Balasubramanian Solihull Hospital, Heart of England Foundation Trust, Solihull, Birmingham, UK Introduction: B3 lesions are defined as those with uncertain malignant potential. Papillary lesions are one of these heterogenous groups of breast lesions. One of challenges of the breast MDT can be identifying which of these need to proceed to surgical excision to ascertain a histological diagnosis. Current practice in this unit tends to air towards excision of these lesions. Recently vacuum assisted biopsy (VAB) has been used to try to gain more tissue sample in order to avoid large numbers of unnecessary surgical excision biopsies. Methods: Patients who had B3 papillary lesions on core biopsy were identified from histopathology records. Trust medical records were searched to ascertain investigations performed and the results of these. Data was collected in a secure database and analysed statistically. Results: 125 patients were identified between January 2011 and November 2016 with B3 papillary lesions diagnosed by needle core biopsy. 15 of 125 patients did not have any subsequent procedures and were excluded from the analysis. Of the remaining 111 patients 92 proceeded to surgical excision biopsy without prior vacuum assisted biopsy (VAB). 12 of the 92 patients were diagnosed to have malignancy (in situ or invasive) making the upgrade rate for surgery 13.04%. 11 of 12 (91/ 67%) upgraded to DCIS and 1 (83.33%) had invasive carcinoma. 18 of 111 patients had VAB. 12 of these 18 patients went on to have subsequent excision biopsies and the other 6 were followed up on the basis of VAB alone. 3 of 18 who had VAB were upgraded to malignancy making the upgrade rate as 16.67% (3/18 DCIS). The patients who had VAB followed by surgery there were no malignancies giving the upgrade rate of 0%. Conclusion and recommendations: The results of this study show very identical upgrade rate for VAB group (16.67%) and surgical excision group (13.04%). Surgical excision following VAB had no additional yield of malignancy. The study demonstrates that VAB without surgical excision may be sufficient for managing B3 papillary lesions diagnosed with needle core biopsies. However, the numbers in the VAB group were small to reach a definite conclusion based on these figures alone. A more extensive interhospital study is to be planned for the future to address this issue. http://dx.doi.org/10.1016/j.ejso.2017.01.098
P046. TIGRÒ Matrix Mesh in breast reconstruction e A single unit experience Gareth Irwin1, Lynn Darragh2, Peter Mallon1, Stuart McIntosh1,3, Sam Sloan1, Sigi Refsum1 1 Belfast City Hospital, Belfast, UK 2 Ulster Hospital, Dundonald, UK 3 Queen’s University, Belfast, UK Introduction: Current guidelines recommend offering immediate reconstruction following mastectomy. Good cosmesis can be achieved with a one-stage submuscular implant based technique, but coverage of the lower pole for support and to maintain the inframammary fold is required. A range is available but these can be expensive and are not
ABSTRACTS without complications. This unit is amongst the first in the UK to use TIGRÒ matrix mesh. Methods: TIGRÒ matrix is made from synthetic reabsorbable polymers and is intended to provide support for 6e9 month and reabsorb completely by 3 years. TIGRÒ has been used in this unit over the last two years and follow up data recorded prospectively. Results: From June 2014 until Dec 2016 TIGR matrix mesh has been used in 63 patients (mean age 45.9 years, 27e73) for 94 breasts. 44 meshes were used for immediate implant reconstruction following therapeutic skinsparing mastectomy alone. 27 involved an additional axillary procedure (22 SLNB, 5 ANC). 20 were used in immediate reconstruction following riskreducing mastectomy and 3 in salvage procedures. Implant volume ranged from 140cc to 640cc. Current follow-up data ranges from 30 months to 14 days. Complications at 30 days include one return to theatre for evacuation of haematoma with no long-term consequences. At 90 days 77% of the breasts had settled with no long-term sequelae and good cosmetic outcome. 2 implants were salvaged with no long-term effects. Three wound scars needed revised and the implant was lost from 11 breasts. Conclusions: TIGRÒ matrix mesh is a novel product with versatile uses. These longer-term results are favourable in terms of cosmesis and complication rates. Follow up continues and will be updated. http://dx.doi.org/10.1016/j.ejso.2017.01.099
P047. Salvage of infected breast implants with continuous periprosthetic antibiotic irrigation: a retrospective audit Jennett Kelsall, Eleanor Gutteridge, Lisa Whisker Nottingham City Hospital, Nottingham, UK Introduction: Infection in the setting of prosthetic breast reconstruction is a much feared complication as it may result in implant loss; causing psychological distress, poor cosmesis, further surgical procedures, and additional health care costs. Explantation in this setting has traditionally been the standard of care. Our institution has developed a protocol utilising intra-operative lavage, +/ exchange of the prosthesis, followed by continuous peri-prosthetic antibiotic irrigation for at least 48hrs; in order to attempt implant salvage in selected patients. We have audited our results and present our technique and outcomes for discussion. Methods: A retrospective audit was undertaken of all infected breast prosthesis irrigation cases over the preceding 5 yrs at our institution, including immediate and delayed reconstructions and revision surgery with either implants or tissue expanders. Patient demographics, surgical and perioperative data, and final outcomes following irrigation were collected. Results: Of 20 cases identified, 15 were successfully salvaged. Irrigation was undertaken for at least 48 hrs (range 2e6 days, median ¼ 3). 14 had undergone immediate reconstruction, 2 delayed, and 4 revision procedures. The most common risk factor was obesity (13/20); others included concurrent fat grafting (4/20), smoking (4/20), previous irradiation (3/20); and diabetes (2/20). 12 had either an acellular dermal matrix or synthetic mesh in situ. 9 grew sensitive S. aureus, 2 grew Propionibacterium, and in 9 no organism was cultured. Conclusion: Our protocol utilising intra-operative lavage and post-operative peri-prosthetic antibiotic irrigation is a simple technique. It offers an opportunity to salvage an infected implant reconstruction in selected patients. http://dx.doi.org/10.1016/j.ejso.2017.01.100
P048. A retrospective study comparing early outcomes of prepectoral and subpectoral implant based breast reconstruction Kavitha Kanesalingam, Assad Khan, Isabella Karat, George Kousparos, Hisham Osman, Ian J Laidlaw, Raouf Daoud Frimley Park Hospital, Surrey, UK Introduction: Immediate implant based reconstruction is an established breast reconstruction technique where full implant coverage is achieved with