Abstract
Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized study evaluating hydrogel application feasibility, post-operative hydrogel imaging characteristics, cavity healing following hydrogel absorption and the resulting breast cosmesis. Setting: Teaching hospital University of Essen, Germany. Patients: Seven (7) patients underwent unilateral or bilateral breast conservation surgery to remove cancerous or benign tumors. Interventions: All patients received hydrogel application following primary tumor excision. Imaging performed in the first postoperative week included ultrasound, MRI and CT. Breast cosmesis scores were obtained at one and three months following surgery. Measurements and Main Results: While preliminary, a relationship between percent cavity filling and drainage was observed, with 30% or more cavity filling resulting in decreased drainage. Additionally, the hydrogel was readily visible under ultrasound, MRI and CT imaging modalities. Finally, patients were satisfied and surgeons felt that patient cosmesis was improved relative to their prior experience. Conclusion: Initial data suggest that hydrogel filling may reduce excision cavity drainage, which may reduce seroma or hematoma formation. Additionally, these gels may improve cavity visibility and stability, furthering the use of partial breast irradiation. Finally, while more studies are required, these materials may have a role in improving long term patient cosmesis.
Highlights
The current standard of care for the surgical treatment of patients diagnosed with breast cancer is breast conservation surgery (BCS, frequently called lumpectomy) whenever it is possible
The course of healing for all patients was normal, one patient experienced a superficial wound infection that resolved within three weeks without further treatment
94% of the total study drainage came from the three patients with the largest lumpectomies
Summary
The current standard of care for the surgical treatment of patients diagnosed with breast cancer is breast conservation surgery (BCS, frequently called lumpectomy) whenever it is possible. For further reduction of local breast cancer recurrence, a radiation boost is applied to the tumor bed, which is guided by using metal clips as marker. This approach is justified since cancer recurrence is highest near the excision site, with 86% of recurrences in the same quadrant as the excision, as shown in one multicenter study [5]. Surgical clips are often used to mark discreet points within the cavity, but the vast majority of the cavity margins remain unmarked, and often difficult to delineate. Seromas and/or hematomas form within the excision cavities following surgery, assisting in cavity visualization, but seroma formation is an unpredictable complication of BCS and is not a reliable aid for visualization
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