P152. Is lipomodelling after breast cancer safe?

Abstract

S S69 on ANC. 9 elderly and frail patients chose to have ANC rather than SLNB to avoid a second operation. 2/9 patients in this group had positive nodes, 7 were negative for metastasis. Only 3/15 SLNB positive patient had ANC and would have benefitted from IOA. However 7/9 node negative elderly frail patients would have also benefitted with IOA by avoiding ANC with its potential complications. Conclusion: In our cohort only 10/97 (10%) patients would have benefitted from IOA. http://dx.doi.org/10.1016/j.ejso.2015.03.189 P152. Is lipomodelling after breast cancer safe? Stacey Jones, Tapan Sircar, Pilar Matey New Cross Hospital, Wolverhampton, UK Introduction: Lipomodelling is the process of relocating autologous fat and is now widely used in reconstruction following breast cancer surgery within the United Kingdom, despite limited data on long term safety and outcomes. The aim of this audit is to establish the main complications associated with lipomodelling especially the breast cancer recurrence rates. Method: We retrospectively audited 140 lipomodelling procedures carried out in a district general hospital over a 6 year period. Audit standards were based on the joint guidelines from the ABS and BAPRAS. Results: The majority of procedures 83% were performed for asymmetry after implant reconstruction followed by deformity after wide local excision in 9% of cases. Other indications included to improve soft tissue coverage after implant reconstruction (4%), to augment the volume after autologous reconstruction (3%) and lastly for contour deformity after breast reduction (1%). The number of lipomodelling procedures performed on a patient ranged from one to five sessions with 59/140 (42%) of patients only having one session. 81% of individuals did not report any recipient site complications. The main recipient site complications comprised of fat necrosis (9%), bruising (5%), pain (3%), infection (1%) and calcifications (1%). 9% of individuals had donor site complications which included bruising (6%), pain (2%) and infection (1%). 3/140 (2%) of individuals had a local recurrence. Overall, 88% of individuals had either a very good or good outcome. Conclusion: Lipomodelling after breast cancer is a safe procedure with no increase in local recurrence and providing a very good outcome. http://dx.doi.org/10.1016/j.ejso.2015.03.190 P153. Use of acellular dermal matrix (ADM) in nipple reconstruction following breast reconstruction; the ‘central-pillar technique’ Paul Thiruchelvam,MaeConcepcion, Russell Bramhall, GeraldGui 1 The Royal Marsden Hospital, London, UK The London Clinic, London, UK Introduction: A number of techniques for reconstructing the nippleareolar complex have been developed, but no single method reliably yields a consistent aesthetic result with low morbidity and durable nipple projection. In a recent retrospective study, the factor patients disliked most about their nipple reconstruction was the lack of projection. We propose the use of a nipple shaped cylinder of layered acellular dermal matrix (ADM) as an augment to nipple reconstruction. Methods: 10 patients were recruited to have nipple reconstruction following either skin sparing mastectomy, ADM and implant reconstruction or central excision. Nipple projection and diameter were recorded before, immediately after and following surgery at 6 and 12 months. Results: Of the 5 patients undergoing a nipple revision (one bilateral) e the average nipple height at the end of the procedure was 11.5mm. 12 months following revision surgery the average nipple height was 5.3mm. 3 patients had a further nipple revision between 6 and 12 months. In the nipple revision group, nipple diameter immediately following surgery was 11.5mm, and 9.2mm at 12 months. 4 patients undertaking a primary nipple reconstruction, 2 were bilateral, and of these, immediately following reconstruction the nipple height measured 10.2mm. At 12 months, the average nipple height was 5.2mm. Nipple diameter following surgery measured 10.2mm and 9.2mm at 12 months. Conclusion: We describe a case series of nipple reconstruction using an ADM as an augment, to improve durability of nipple height and diameter. Further improvements in surgical technique will hopefully result in better projection using this novel approach http://dx.doi.org/10.1016/j.ejso.2015.03.191 P154. Implant breast reconstruction with and without acellular dermal matrix e Audit and comparative analysis Velin Voynov, Sankaran Narayanan, Soni Soumian 1 The Royal Marsden NHS FT, London, UK University Hospital of North Midlands, Stoke on Trent, UK Introduction: The most common form of immediate breast reconstruction after mastectomy is implant based. Acellular dermal matrix (ADM) has become a very popular addition to this type of reconstruction. The vast majority of published data relates to an ADM product which is not in use in the UK. With this in mind we audited our initial experience with Strattice and compared the outcome to that of non-ADM implant breast reconstruction. Methods: All consecutive patients with ADM assisted implant breast reconstruction until July 2014 were retrospectively audited against ‘Oncoplastic breast reconstruction’ and ‘ADM assisted breast reconstruction’ guidelines. Furthermore a comparison was done to all non-ADM implant reconstructions. Group difference analysis and logistic regression were used to examine the data. Results: The audit showed that unplanned return to theatre (6.9%), implant loss (6.9%) and therapeutic antibiotic use (37.9%) were higher than the suggested targets. The analysis showed no significant difference between ADM and non-ADM cases for erythema, seroma, skin necrosis, infection, implant loss, re-operation, therapeutic antibiotic use, or time to start of adjuvant therapy (p > 0.05 for all). Postoperative clinic visits were increased for the ADM group and this was close to becoming statistically significant (p 1⁄4 0.053). On univariate and multivariate regression ADM was not a significant predictor for any of the above mentioned outcomes. On multivariate regression smoking was an independent predictor of infection (p 1⁄4 0.0103) and skin necrosis (p < 0.0001), and prior breast radiotherapy was an independent predictor of seroma (p 1⁄4 0.0054). Conclusions: ADM and non-ADM immediate implant breast reconstructions were comparable in terms of early postoperative complications and ADM (Strattice) did not significantly increase the complications. http://dx.doi.org/10.1016/j.ejso.2015.03.192 P155. The use of Titanium mesh (TiLOOP ) in immediate breast reconstruction; low cost, low complications Lisa Caldon, Clare Allison, Henry Cain, Joe O’Donoghue, Adam Critchley Newcastle Upon Tyne Trust, Newcastle, UK Introduction: Immediate Breast Reconstruction (IBR) is increasing. One-stage implant-based procedures are facilitated by non-autologous lower-pole coverage (Acellular dermal matrices and synthetic materials i.e. TiLOOP ). Published data regarding these materials is limited and costs vary. Methods: Consecutive series of short-term outcomes of mastectomy and definitive implant-based IBR with TiLOOP at a single institution. Patients were identified through theatre records and implant registries November 2013 to January 2015. Data was extracted from electronic