Abstract P3-13-06: Breast conserving surgery by periareolar mammoplasty – Surgical and oncological outcomes

Background

Periareolar mammoplasty is a volume displacement oncoplastic technique for patients with small to medium sized breasts. This approach provides good access for a safe excision for both central and peripheral lesions, especially for those in the upper half of the breast. Cosmetically it allows good reshaping of the breast, and contralateral symmetrisation is rarely required. This technique has the potential to replace the standard wide local excision for breast cancer. There is scarcity of data about the results of this procedure in the literature. We present a single surgeon experience with this technique in terms of surgical and oncological outcomes.

Methods

Retrospective review of patients' records from October 2013 to December 2017 was performed. The patients' demographics, tumour characteristics and the early oncological outcomes were studied. The postoperative complications and rate of symmetrisation were also studied.

Results

-There were 110 patients in this study period. The median age was 60 years (range 36 – 82 years) and screen detected tumours accounted for 66% (72 patients) of cases.

-Neoadjuvant therapy was given in 14 patients (endocrine therapy – 12, chemotherapy – 1, dual targeted therapy – 1).

-Most patients had the lesion in the upper half of the breast (upper outer-71, upper inner-33).

-The average size of the tumour was 18.9mm (range 1.8 – 70mm) and the average weight of the excised specimen was 47.2gm (range 11-190gms). Invasive carcinoma was seen in 94 patients (85%) of which 86 patients had invasive ductal carcinoma, 4 had invasive lobular carcinoma and 4 had special type. Pure DCIS was present in 16 patients (15%). Most patients had grade 2 cancers (45%). DCIS was present with invasive carcinoma in 55% of cases.

-Thirteen patients had positive margins (<1mm) and DCIS coexisted with invasive carcinoma in 7 of 13 patients. Four patients with pure DCIS had positive margins.

-Of the 13 patients with positive margins: 5 required margin re-excision, 6 had completion mastectomy and 2 received only radiotherapy.

-The median follow-up was 25 months (range 3 – 53 months).

Seven patients developed complications which included 3 hematomas (2 requiring evacuation) and 4 wound infection which were treated with antibiotics. Only two patients required contralateral symmetrisation and no local recurrences were encountered in this study period.

Conclusion

Periareolar mammoplasty is a robust, easily adaptable and reproducible oncoplastic technique allowing for safe wide local excision of breast cancer. The margin re-excision, postoperative complication and recurrence rates in this study are acceptable and low compared to standard wide local excision. This technique gives excellent access, and allows better breast reshaping resulting in pleasing aesthetic outcome. Contralateral symmetrisation is rarely required with this technique.

Citation Format: Burrah R, Vinayagam R, James K. Breast conserving surgery by periareolar mammoplasty – Surgical and oncological outcomes [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-13-06.

Abstract P5-15-07: Breast surgery – Is routine 'group & save' required? A quality improvement project

Introduction

Breast surgery, especially for malignant disease, is not associated with significant blood loss and therefore rarely requires blood transfusions. Pre-operative protocols in our hospital and in most other centers routinely require a blood group screening process (group and save) for elective breast cancer surgery. The process of group and save (G&S) in our hospital requires two blood samples to be drawn with at least 30 minute interval in-between. It takes at least 40 minutes for the samples to get processed and the cost for each test is £2.12. The test is valid for a period of 5 days after which time it needs to be repeated. This process in busy hospitals is clearly time consuming, results in delays and is inconvenient for patients and medical staff.

The aim of this study was to ascertain the number G&S performed and rate of post-operative blood transfusion for patients undergoing surgery for malignant breast disease. This was to establish if mandatory pre-operative G&S is necessary in all cases, and if the number of tests performed can be reduced. The second part of the study was to analyze the outcome after implementation of changes to reduce the number of G&S tests.

Method

Retrospective review of patient records who had surgeries for malignant breast disease from December 2015 to November 2016. Exclusion criteria included benign disease, flap reconstruction and breast surgery combined with another major procedure. Following the initial analysis, it was proposed that only the operating surgeon will request the test and that it will not be routinely requested by the pre-op assessment team. A re-audit was done prospectively to study the outcome of change in practice and close the audit loop.

Results

151 cases were eligible for review. 97.35% (147 patients) had G&S, and the post-operative transfusion rate was 1.32% (2 patients). Following a change in protocol a significant fall in the testing (97.35% to 35.5%) was seen and there were no post-operative blood transfusions in this period.

Conclusion

This simple yet important audit showed that routine G&S did not contribute to the patient management, increased cost of treatment, caused patient inconvenience and consumed hospital personal time. The changes we implemented significantly reduced the frequency of this test and was cost effective to the trust. This study has now been converted into a Quality Improvement Project and through this we will continue to improve the results further. This project has also stimulated an interest in the General Surgery department, and other units are now considering changing their practice based on our results.

Citation Format: Burrah R, Chicken W, Sathananthan S. Breast surgery – Is routine 'group & save' required? A quality improvement project [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-07.