169 Can Volume Replacement with Local Perforator Flaps Reduce the Trauma to Patients Caused by Mastectomies and Cost of Reconstructions in Breast Cancer Treatment?

Abstract

Abstract Aim National reported mastectomy rate varies from 25% - 45%. Improved screening and raised breast awareness raise the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. We would like to investigate if the technique of local perforator flaps can reduce the volume of mastectomies. Method Retrospective review of yearly breast cancer treatment operations from 2016 to 2020 in Ipswich Hospital. Results 1367 surgical operations performed for breast cancer.In 2016,52/273(19%) patients had mastectomy and 8/273(2.9%) underwent a perforator flap operation. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed. Conclusions Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.