- Email: [email protected]
Titanized polypropylene mesh Tiloop®Bra in reconstructive breast surgery – Indication and complication rate
622 P042. Titanized polypropylene mesh TiloopÒBra in reconstructive breast surgery e Indication and complication rate Stefan Paepke1, Evelyn Klein1, Daniela Paepke1, Marion Kiechle1, Max Dieterich2 1 Interdisziplin€ares Brustzentrum und Frauenklinik der Technischen Universit€at M€ unchen, Roman Herzog Comprehensive Cancer Center, M€ unchen, Germany 2 Universit€atsfrauenklinik Rostock, Rostock, Germany Introduction: Breast cancer surgery has taken a turn over the past decades. Quite a few publications outlined that the application of tissue-supporting materials result in improved cosmetic outcome, as shaping of the breast mound and implant bed can be optimized. Even the German AGO guidelines have added the usage of tissue-supporting extraneous materials to the section of reconstructive breast surgery in the year 2011 (Oxford LoE 2b). Considering the insertion of the titanized polypropylene meshs into breast reconstructive surgery, shape and size were optimized specifically for breast surgery. Material and Methods: Postoperative maintenance of drainage, antibiotic application, hematoma, seroma, infection, capsule and necrosis rate were documented. In 65.5% of the cases an immediate reconstructive procedure and in 34.5% a secondary/delayed reconstructive procedure was done. Immediate reconstruction via nipple sparing or skin sparing mastectomy and implant placement was performed in 40.2%; with expander placement in 23%; modified radical mastectomy and immediate implant or expander placement took place in 2.2%. Exchange from expander to implant was performed in 11.5% and accordingly 16%. In 231 mesh based procedures complications occurred in 4.8% seroma, in 9.5% superficial hematoma, in 6.1% skin infection, in 3.9% skin necrosis, in 3.5% partial nipple necrosis, in 7.8% re-operations with removal of the mesh and in 2.2% capsular fibrosis. Neither nicotine abuse, hypertension, diabetes mellitus, age > 50 years, BMI > 27, nor radio- or chemotherapy are significant factors for complications. Discussion: All in all long term data of our collective is now required to provide more detailed information about cosmetic outcome and longterm patient satisfaction. Questions about patient satisfaction with immediate implant reconstruction with titanized polypropylene mesh will be part of further follow up in a prospective trial (ProBra Surveillance). http://dx.doi.org/10.1016/j.ejso.2014.02.042
P043. Outcome after dermal sling-assisted immediate breast reconstruction Valentina Lefemine1, Lynda Wyld2, Vidya P. Chandran1, Malcom W.R. Reed2 1 Breast Unit, Royal Hallamshire Hospital, Sheffield, UK 2 Department of Oncology, University of Sheffield, Sheffield, UK Introduction: Dermal sling (DS) assisted immediate breast reconstruction is an alternative to Acellular Dermal Matrix (ADM) for patients with breast ptosis. Previous data from our Unit showed that patient satisfaction was high in the initial period. We now report longer follow up. Methods: Patients were identified from an electronic prospective database and their records reviewed. Patient satisfaction and quality of life were determined using the BREAST-QÓ questionnaire. Results: Between October 2008 and August 2012, 44 patients underwent 58 DS assisted breast reconstruction procedures. Their median follow up was 29 (range 7e55) months. The most common immediate postoperative complication were superficial T-junction breakdown in 16 (27%) DS, superficial wound infection in 13 (22%) DS and seroma in eight (13%) DS. Only one patient required implant removal due to infection. At long term follow up two patients had their reconstruction converted to Latissimus dorsi flap for persistent asymmetry. Two further patients underwent mastectomy, one for pain and one for local recurrence. BREAST-QÓ scores for outcome were 79.2 in 2011 and 71.8 in 2013.
ABSTRACTS Conclusions: DS is an effective and safe alternative to ADM with less than 10 per cent conversion rate at 4.5 years. BREAST-QÓ responses in 2013 indicated sustained high satisfaction with the reconstructed breast, that dropped only slightly at longer follow up. The BREAST-QÓ scores were consistently superior when compared to the data of National Mastectomy and Breast Reconstruction Audit. http://dx.doi.org/10.1016/j.ejso.2014.02.043
P044. What happens to the axilla in patients with a complete pathological response following NACT at surgery: Experience from Leeds Nisha Sharma, Michelle McMahon, Barbara Dall, Kieran Horgan, Abeer Shaaban, David Dodwell Leeds Teaching Hospital NHS Trust, Leeds, UK Introduction: There is an increasing use of neoadjuvant chemotherapy (NACT) and radiological assessment during NACT is a common practice. We attempted to correlate radiological (MRI) and pathological response in both breast and axilla in patients receiving NACT in Leeds. Method: At diagnosis the axilla was assessed with US. If axillary US was benign then an upfront sentinel lymph node (SLN) procedure was performed prior to NACT. If the axilla was initially positive on FNAC for malignancy an axillary node clearance (ANC) at the time of breast surgery was performed. Patients receiving NACT were monitored during treatment with MRI which was performed prior to NACT and then after 2 cycles to assess response. A further MRI scan was performed if the chemotherapy regimen was changed based on a stable or minimal response. The MRI was used to assess breast lesions and response within the axilla. The MRI responses were categorised as stable, minimal, partial, almost complete or complete. Pathological complete response is defined as no residual invasive disease being present after surgery. Retrospective data were obtained from the radiology MRI database from January 2010 to December 2012. The baseline imaging features, MRI imaging and core and final surgical histology were documented. Results: 150 cases of NACT were identified over this 3 year period. 41 cases of pCR were identified (27%). All cases had no residual invasive disease and 16 cases had residual DCIS present. Of these patients who achieved pCR 28 patients had a positive axilla (25 on FNA and 3 SLN) prior to starting NACT. At the time of final surgery all 28 patients had ANC. In 21 patients the lymph nodes were negative with evidence of tumour regression. 7 patients had a positive axilla (2 had micrometastasis, 3 had one lymph node positive, 1 case 2 lymph nodes and 1 case 15 lymph node.) MRI showed the lymph nodes to be responding and in the majority of cases return to normal appearance. The case with 15 lymph nodes still had abnormal nodes on MRI. Conclusion: This retrospective study suggests that women with a positive axilla prior to NACT who have a pathological complete response often have minimal residual disease burden in the axilla. MRI may play a key role in tailoring surgical management of the axilla. With the use of MRI and repeat US FNA /core of the axilla select cases may be subject to a SLN or no axillary surgery rather than ANC. This would reduce the morbidity of ANC associated with this good prognostic group. http://dx.doi.org/10.1016/j.ejso.2014.02.044
P045. Outcomes following implant-based breast reconstruction using StratticeÔ acellular dermal matrix Simon Pilgrim, Elizabeth Ball, Jane Aitken West Suffolk Hospital, Bury St Edmunds, UK Introduction: StratticeÔ acellular dermal matrix can be used in implant-based breast reconstruction following mastectomy to facilitate
P043. Outcome after dermal sling-assisted immediate breast reconstruction Valentina Lefemine1, Lynda Wyld2, Vidya P. Chandran1, Malcom W.R. Reed2 1 Breast Unit, Royal Hallamshire Hospital, Sheffield, UK 2 Department of Oncology, University of Sheffield, Sheffield, UK Introduction: Dermal sling (DS) assisted immediate breast reconstruction is an alternative to Acellular Dermal Matrix (ADM) for patients with breast ptosis. Previous data from our Unit showed that patient satisfaction was high in the initial period. We now report longer follow up. Methods: Patients were identified from an electronic prospective database and their records reviewed. Patient satisfaction and quality of life were determined using the BREAST-QÓ questionnaire. Results: Between October 2008 and August 2012, 44 patients underwent 58 DS assisted breast reconstruction procedures. Their median follow up was 29 (range 7e55) months. The most common immediate postoperative complication were superficial T-junction breakdown in 16 (27%) DS, superficial wound infection in 13 (22%) DS and seroma in eight (13%) DS. Only one patient required implant removal due to infection. At long term follow up two patients had their reconstruction converted to Latissimus dorsi flap for persistent asymmetry. Two further patients underwent mastectomy, one for pain and one for local recurrence. BREAST-QÓ scores for outcome were 79.2 in 2011 and 71.8 in 2013.
ABSTRACTS Conclusions: DS is an effective and safe alternative to ADM with less than 10 per cent conversion rate at 4.5 years. BREAST-QÓ responses in 2013 indicated sustained high satisfaction with the reconstructed breast, that dropped only slightly at longer follow up. The BREAST-QÓ scores were consistently superior when compared to the data of National Mastectomy and Breast Reconstruction Audit. http://dx.doi.org/10.1016/j.ejso.2014.02.043
P044. What happens to the axilla in patients with a complete pathological response following NACT at surgery: Experience from Leeds Nisha Sharma, Michelle McMahon, Barbara Dall, Kieran Horgan, Abeer Shaaban, David Dodwell Leeds Teaching Hospital NHS Trust, Leeds, UK Introduction: There is an increasing use of neoadjuvant chemotherapy (NACT) and radiological assessment during NACT is a common practice. We attempted to correlate radiological (MRI) and pathological response in both breast and axilla in patients receiving NACT in Leeds. Method: At diagnosis the axilla was assessed with US. If axillary US was benign then an upfront sentinel lymph node (SLN) procedure was performed prior to NACT. If the axilla was initially positive on FNAC for malignancy an axillary node clearance (ANC) at the time of breast surgery was performed. Patients receiving NACT were monitored during treatment with MRI which was performed prior to NACT and then after 2 cycles to assess response. A further MRI scan was performed if the chemotherapy regimen was changed based on a stable or minimal response. The MRI was used to assess breast lesions and response within the axilla. The MRI responses were categorised as stable, minimal, partial, almost complete or complete. Pathological complete response is defined as no residual invasive disease being present after surgery. Retrospective data were obtained from the radiology MRI database from January 2010 to December 2012. The baseline imaging features, MRI imaging and core and final surgical histology were documented. Results: 150 cases of NACT were identified over this 3 year period. 41 cases of pCR were identified (27%). All cases had no residual invasive disease and 16 cases had residual DCIS present. Of these patients who achieved pCR 28 patients had a positive axilla (25 on FNA and 3 SLN) prior to starting NACT. At the time of final surgery all 28 patients had ANC. In 21 patients the lymph nodes were negative with evidence of tumour regression. 7 patients had a positive axilla (2 had micrometastasis, 3 had one lymph node positive, 1 case 2 lymph nodes and 1 case 15 lymph node.) MRI showed the lymph nodes to be responding and in the majority of cases return to normal appearance. The case with 15 lymph nodes still had abnormal nodes on MRI. Conclusion: This retrospective study suggests that women with a positive axilla prior to NACT who have a pathological complete response often have minimal residual disease burden in the axilla. MRI may play a key role in tailoring surgical management of the axilla. With the use of MRI and repeat US FNA /core of the axilla select cases may be subject to a SLN or no axillary surgery rather than ANC. This would reduce the morbidity of ANC associated with this good prognostic group. http://dx.doi.org/10.1016/j.ejso.2014.02.044
P045. Outcomes following implant-based breast reconstruction using StratticeÔ acellular dermal matrix Simon Pilgrim, Elizabeth Ball, Jane Aitken West Suffolk Hospital, Bury St Edmunds, UK Introduction: StratticeÔ acellular dermal matrix can be used in implant-based breast reconstruction following mastectomy to facilitate