A new method for partial breast reconstruction: 3-year New Zealand experience.

Abstract

89 Background: Most women in New Zealand undergo partial mastectomy (PM) and 6 weeks of whole breast irradiation for early breast cancer. Oncoplastic surgery (OPS) is common, however, reconstruction of the breast during partial mastectomy presents challenges for radiation targeting since tissues have been extensively rearranged. Further complicating matters, the seroma cavity is often absent, and many patients travel to different cities for radiation without much communication between the surgeon and radiation oncologist prior to treatment. Throughout the country there is interest in promoting hypofractionated or accelerated radiotherapy, however, these techniques cannot be popularized without accurate targeting to minimize complications. In this series of patients we studied a new method of breast reconstruction using a bioabsorbable implant that serves as a surgical site marker as well. Methods: Following informed consent, 15 women were studied in a prospective manner. The bioabsorbable implant was sutured into the tumor resection site, and tissue flaps were directly attached. Radiation treatment protocols followed ASTRO guidelines. Results: The implant provided volume replacement and acted as a scaffolding for the breast tissue flaps providing local reconstruction. Cosmetic outcomes were excellent in all patients, no device related or radiation complications occurred. One patient had a post-operative hematoma that resolved without intervention, there were no post-operative infections. 3 year follow up shows no tumor recurrences, and no untoward effects. When compared to conventional radiation targeting, use of the implant showed a > 50% reduction in treatment volume is possible. 3 year mammograms show normal regrowth of tissue without artifact and with minimal fibrosis. Conclusions: Three year follow-up shows this "mini" breast implant assists with oncoplastic breast reconstruction, while at the same time clearly marks the surgical site of tumor excision. Patients tolerated it well, and radiotherapy planning, positioning and treatment were all facilitated by the implant. Excellent patient outcomes in this pilot study have resulted in a national evaluation of this method in the public healthcare sector.