BackgroundBone metastasis is the most common site of distant metastasis in breast cancer. Patients with bone metastasis have their quality of life and survival rate threatened. This study aims to develop a practical nomogram for predicting the risk of bone metastasis in breast cancer by integrating clinical data, assisting doctors in making more scientific clinical decisions.MethodsWe conducted a retrospective analysis of the data of newly diagnosed breast cancer patients from the database of the Affiliated Hospital of Qingdao University from January 2015 to December 2017. The cohort is divided into training set and validation set in a ratio of 7.5:2.5. Determine independent risk factors through Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis and logistic regression, and develop a nomogram prediction model. The model's performance and clinical utility were evaluated by Receiver Operating Characteristic (ROC) curve analysis, Area Under the Curve (AUC), calibration curves, and Decision Curve Analysis (DCA).ResultsDuring the 5-year follow-up period, bone metastases developed in 48 of 421 patients (11.40%). Ultimately, six independent risk factors were identified: neoadjuvant chemotherapy, family history of cancer, distant metastasis in other locations, axillary lymph node metastasis, marital status, and primary tumor site. The nomogram demonstrated excellent predictive performance, with AUC values of 0.89 and 0.86 in the training and validation cohorts, respectively.ConclusionsThis pioneering nomogram, incorporating baseline, tumor characteristics, and therapeutic parameters, provides visual guidance for breast surgeons to assess bone metastasis risk in breast cancer patients. It enables clinicians to prioritize high-risk patients through early identification, thereby optimizing surveillance protocols and therapeutic strategies to safeguard patients' quality of life.

Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures-one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons.

Frequently, the breast surgeon must employ complex oncoplastic techniques (OBS) to guarantee optimal cosmetic results. The success of the REGENERA™ implant in combining the benefits of OBS with the simplicity of breast conserving surgery (BCS) has been previously reported in five patients with short follow-up. The goal of this study was to build on these promising data by reporting safety and efficacy results in a larger population with a longer follow-up. Fifteen females with non-malignant breast lesions who underwent lumpectomy and implantation of REGENERA™ device, followed-up for six months, were included in this interventional FIH study. Fourteen of these, were included in a long-term observational study (LTFU) and followed-up for 24 months. Safety (incidence of adverse events [AEs]) and performance (changes in breast appearance, interference with imaging) of the device, and investigator and patient satisfaction were evaluated. Data from these two studies are reported herein. (Registered on clinicaltrials.gov: NCT05533099 and NCT04131972). A total of 113 AEs were reported. Only 3 (2.6%) were considered possibly device-related. The great majority (91,2%) were mild/moderate and only in one case the device was explanted. The REGENERA™ implant demonstrated high levels of performance, with an aesthetic score of 'Excellent' in 85.7% of patients, no interference with imaging, and high levels of patients and investigator satisfaction. Data continue to be strongly supportive of the use of the REGENERA™ implant in BCS, further paving the way for an innovative surgical approach.

BackgroundVirtual teleconsultation plays a pivotal role in managing diseases requiring long‐term communication between patients and treatment teams, such as breast diseases. The Ruban Virtual Breast Clinic in Iran offers teleconsultation services focusing on nonurgent chronic complaints through offline messaging. This study aimed to evaluate patient satisfaction with these teleconsultation services.MethodsA comprehensive questionnaire was designed with three sections: identifying the individual interacting with the clinic and prior teleconsultation use; collecting demographic data and reasons for consultation; and assessing satisfaction using 16 items rated on a Likert scale from 1 (poor) to 10 (excellent). The study included patients who received at least one consultation by a breast surgeon through the Ruban platform.ResultsOf 583 eligible cases, 367 (62.9%) consented to participate. The average satisfaction score was 91.6 out of 100, indicating a high level of patient satisfaction.ConclusionsThe high satisfaction rates suggest that telehealth services, particularly virtual consultations, are feasible and highly acceptable in meeting patients′ healthcare needs. These findings underscore telehealth′s potential to improve access to care, though further research is required to establish its clinical effectiveness.

What makes a 'good' mastectomy? - A national qualitative study of health care professionals opinions on mastectomy without reconstruction.

Assessing the Role of Presurgical Information on Patient-Reported Outcomes: A Causal Analysis.

Summary: Patients undergoing breast reconstruction face many decisions. A generative pretrained transformer (GPT) tool was custom built to assist patients at their initial reconstructive consultation. Twenty patients undergoing immediate breast reconstruction were enrolled, and 10 were randomized to interact with this GPT for 10 minutes at most before seeing the surgeon who was blinded. Patients then completed the 4-item abbreviated Decisional Conflict Scale SURE survey, the 12-item preoperative Consumer Assessment of Healthcare Providers and Systems survey, and a 3-item GPT-specific survey. Patients spent an average of 6.79 minutes asking an average of 6.5 questions, which were most commonly about recovery (34%), autologous reconstruction (23%), and complications (17%). With a 100% response rate (20 of 20), patients in the GPT cohort experienced less decisional conflict (Decisional Conflict Scale SURE—GPT: 3.9 versus control: 3.1, P = 0.03), had a shorter consultation time (GPT: 21.7 min versus control: 28.4 min, P = 0.02), and were more satisfied with surgical care across multiple domains, including shared decision-making ( P = 0.04) and preoperative communication ( P = 0.04). All patients (100%, 10 of 10) found this GPT to be very helpful and thought it should be made available for other patients. To our knowledge, custom GPTs built and trained by surgeons have not yet been studied in this setting, making this an innovation in our field. Other reconstructive breast surgeons may consider implementing this publicly available GPT into their practice to increase efficiency and satisfaction in patient care.

Breast cancer survival rates are improving, increasing focus on post-treatment quality of life. Oncoplastic breast surgery (OPS), which combines plastic and reconstructive techniques during breast conservation surgery, has emerged as an important approach to optimize both oncologic safety and cosmetic outcomes. However, data comparing complication rates across different OPS levels are limited. We conducted a retrospective cohort study using the ACS-NSQIP database (2007-2020) to analyze OPS outcomes using the American Society of Breast Surgeons oncoplastic surgery classification system. OPS techniques are categorized into Level-1, Level-2, and volume-replacement (VR) procedures. Post-operative complications were assessed within 30 days. A total of 9647 patients underwent OPS between 2007 and 2020: 3917 (40.6%) Level-1, 5078 (52.6%) Level-2, and 652 (6.8%) VR surgeries. Mean age differed across groups (61.7, 60.4, and 56.9 years for Level-1, Level-2, and VR, respectively; p < 0.001). Overall complication rates were 3.8% for Level-1, 5.2% for Level-2, and 4.8% for VR, with wound complications more frequent in Level-2 procedures (3.3% vs. 1.7% for Level-1). Compared to Level-1, Level-2 OPS had higher odds of wound complications (OR = 1.472, 95% CI: 1.095-1.979), while VR procedures had lower odds than Level-2 (OR = 0.525, 95% CI: 0.305-0.902), driven mainly by wound dehiscence and superficial surgical site infections, respectively. Operative times increased with complexity (77.7, 110.6, and 171.7 min for Level-1, Level-2, and VR), and length of stay was longest for VR procedures (0.89 vs. 0.05 days for Level-1). BMI ≥ 30 (overall complications, OR = 1.485, 95% CI: 1.203-1.833; p < 0.001; wound complications, OR = 2.202, 95% CI: 1.642-2.951; p < 0.001) and diabetes (overall complications, OR = 1.311, 95% CI: 1.011-1.700; p = 0.041) were independently associated with complications, while smoking was not. VR procedures had lower odds of superficial surgical site infections compared to Level-2 (OR = 0.379, 95% CI: 0.186-0.760; p = 0.006). Level-2 and VR procedures had higher odds of wound dehiscence compared to Level-1 (OR = 1.223, 95% CI: 1.015-1.335; p = 0.039 and OR = 4.274, 95% CI: 1.880-12.154; p = 0.004, respectively). The ASBrS classification system predicts post-operative complications and operative times in OPS. More complex procedures, such as Level-2 OPS, have higher wound complication rates and longer operative times. BMI ≥ 30 and diabetes increase risk, while smoking appears less impactful. VR OPS may be advantageous in high-BMI patients. These findings support surgical planning, patient counseling, and shared decision-making.

It has been 131 years since Halsted reported radical mastectomy to treat breast cancer in 1894. The concept of "R0 resection" as the most important treatment strategy has significantly contributed to improving the survival rate of patients with breast cancer. With deep understanding of the mechanism of tumorigenesis and advancements in systematic treatment since the 20th century,modified radical mastectomy proposed by Patey and Auchincloss,aimed to improve quality of life,replaced radical mastectomy and became the mainstream surgery for breast cancer. Based on NSABP-B06 trial,the 2025 St. Gallen consensus persisted in the principle of preserving breast-conserving surgery whenever possible. Additionally,the guidelines recommend axillary lymph node dissection can be omitted in patients with negative sentinel lymph nodes,supported by high-level evidence. The AJCC Cancer Staging System (8th Edition) showed the evaluation of breast cancer burden has transcended TNM stage,leading to the level of detecting microscopic tumor burden. Pathological test is no longer limited to pathomorphology, instead,immunohistochemistry,molecular pathology testing,and next-generation sequencing technologies have laid a scientific foundation for categorized treatment of breast cancer. The evolution of breast cancer surgery is undergoing a shift from "maximal resection" to "minimal effective treatment" de-escalation. On this basis,promoting the standardization and homogenization of breast surgery suited to China's national conditions is the common goal of breast surgeons at this stage.

Limited data is available on patients diagnosed with breast cancer at age 85 and older, and there is no consensus on mammographic screening guidelines for older women, including those with a history of breast cancer. We sought to describe characteristics of presentation in this patient population and to determine whether differences exist between older women with a history of breast cancer and those without. A retrospective review was conducted of all female patients aged 85 and older who consulted a breast surgeon for a diagnosis of new or recurrent breast cancer. From January 1, 2009 to September 30, 2024, 132 patients with newly diagnosed or recurrent breast cancer were identified. Mean age was 88.3years (range 85-99). Ninety patients (68.2%) were diagnosed with breast cancer for the first time and the remainder (42; 31.8%) had a history of breast cancer. 57.1% of patients with a history of breast cancer were diagnosed on screening imaging compared to 31.1% with no prior history, who more commonly were diagnosed based on symptoms. In patients with a history of breast cancer, there was a mean time of 14.6years from index cancer to ipsilateral breast tumor recurrence and 19.2years from index cancer to contralateral cancer event. Roughly one-third of patients had a prior breast cancer and were significantly more likely to be diagnosed on screening studies compared to women who did not have a history of breast cancer. Women without a history of breast cancer were more likely to be symptomatic at the time of diagnosis and more likely to be diagnosed at a later disease stage. In patients with a prior breast cancer, second breast cancer events tended to happen late, which raises the question of how long screening should continue after a breast cancer diagnosis in older patients and whether guidelines should distinguish between those with a prior history of breast cancer and those without.

ABSTRACT The American Society of Breast Surgeons urges surgeons to advocate for breast conservation and discourage contralateral prophylactic mastectomy (CPM) when consulting with early-stage breast cancer patients who are not at high risk for developing contralateral cancer. At the same time, surgeons are advised to respect the preferences and values of such early-stage patients, many of whom have been shown to exhibit a preference for CPM, choosing it over less-extensive surgical options. How are these different imperatives balanced during actual consultations? We use Conversation Analysis (CA) to examine recorded consultations for early-stage breast cancer and show how a surgeon manages this interactional challenge via a multi-component narrative that she positions at the beginning of the treatment phase of the consultation. Two illustrative cases are presented and contrasted: In the first, the surgeon is able to produce the entire narrative up front, before the patient expresses a surgical treatment preference, while in the second, the patient makes an early request for CPM. We analyze how, in this second case, the surgeon creates interactional space to table the request for now, and expand the request-response sequence in order to complete the narrative before the treatment decision is finalized. We consider the implications of our findings for the concepts of informed decision making and shared decision making for preference-sensitive treatment decisions.

BackgroundThe reverse-sequence endoscopic nipple-sparing mastectomy with immediate prepectoral implant reconstruction (RSEM-IPI) has been described as a safe and feasible procedure for early-stage breast cancer. The aim of this study was to evaluate the learning curve for RSEM-IPI.MethodsBetween January 2023 and February 2024, we collected data on 104 consecutive patients who underwent RSEM-IPI at our hospital (53 for group 1 and 51 for group 2). The surgeons in group 1 completed the endoscopic training and assistance, whereas the surgeons in group 2 did not. The learning curve was analyzed using the cumulative sum (CUSUM) method to assess changes in the operative times across the case sequence.ResultsAmong the 281 patients who received breast reconstruction surgeries, a total of 104 consecutive data were recorded and eligible. Both groups had higher rates of postoperative complications including bleeding, nipple-areolar complex (NAC) ischemia, skin ischemia, infection and longer drainage duration during the phrase 1 compared to the phrase 2. Notably, in terms of the most severe postoperative complications, implant expose and loss, both groups exhibited higher rates during the phrase 1. Breast-Q scores for group 1 in phases 1 and 2 were 66 and 84, respectively, while for group 2, they were 67 and 80. As compared with surgeons in group 2, well-trained surgeons in group 1 were more accessible for stable learning curve with fewer training patients (18 patients) and relatively lower rate of postoperative complications (p > 0.05).ConclusionThe estimated learning curve for RSEM-IPI was achieved after 18 cases in the well-trained surgeon group. The endoscopic training and assistance were critical to master the breast endoscopic surgeries for breast surgeons.

Hospital systems must document adherence to strict quality standards to achieve specialty accreditation. Requirements often include completion of quality improvement (QI) projects. Because breast surgeons are often the leaders of the multidisciplinary teams, they are tasked with initiating these QI projects. Although they are comfortable interpreting data in their practices, most breast surgeons lack formal training in quality. This report aims to provide guidance for breast surgeons to initiate and navigate QI projects. The Patient Safety and Quality Committee of the American Society of Breast Surgeons reviewed the literature for relevant resources of surgical quality to establish a framework for surgeons to use when performing QI projects. Review of the literature and online sources showed nine key principles breast surgeons should use when performing QI studies. Emerging data, a change in process, or patient/provider feedback can provide potential ideas for study. After creating a problem statement, the stakeholder team defines the current state by obtaining local data and comparing it with established benchmarks. Once a gap is identified, a root cause analysis is performed to determine potential interventions for improvement. Assessment of results after implementation can be used to measure success. Quality improvement in breast surgery involves a combined effort between health care staff and stakeholders to improve the care provided to patients. Breast surgeons are well positioned to direct these projects as leaders of the care teams. This report provides a framework for common understanding of the key principles of QI in breast surgery.

ASO Author Reflections: Precision in Practice: Breast Surgeons as Catalysts for Quality Improvement.

The long-standing practice of prohibiting ipsilateral arm use for intravenous access, blood draws, or blood pressure monitoring after breast cancer surgery has persisted in many countries and remains common in some Japanese institutions, often based on routine signage and overly simplified education. While historically justified in the era of Halsted's radical mastectomy owing to high postoperative lymphedema rates, today's surgical landscape, with the increasing use of breast-conserving surgery and sentinel lymph node biopsy (SLNB), has seen a marked decline in clinically significant arm swelling. Recent large retrospective studies and society statements (Society for Ambulatory Anesthesia, American Society of Breast Surgeons, and Australian and New Zealand College of Anaesthetists) support risk-based, individualized assessments rather than blanket exclusion. This article examines the cultural, educational, and systemic factors that maintain outdated restrictions and presents a symptom-guided risk stratification framework. Asymptomatic patients 1year after SLNB or 3years after axillary lymph node dissection/regional lymph node radiation are at low risk for access-related complications. This article explores the unintended harm of rigid policies, including compromised access, delay in care, and patient distress, and proposes strategies for institution-level policy revision and patient education. Shifting from prohibition to personalization aligns clinical practice with modern evidence, promotes patient autonomy, and prevents the perpetuation of outdated norms.

IntroductionSeroma formation is a frequent complication after simple mastectomy due to the creation of a large dead space. Multiple aspirations are required to manage patients' symptoms. At present, breast surgeons lack consensus on effective preventative strategies. To address this issue, we have implemented a technique called quilting, which involves suturing the mastectomy flap to the chest wall muscle to convert the dead space into smaller compartments, thereby reducing the possibility of seroma. MethodAn audit was carried out from April 2020 to June 2021 to establish postoperative seroma rates for patients undergoing simple mastectomy without reconstruction. A subsequent evaluation was completed between October 2023 and December 2024 following the adoption of quilting as standard practice. After each stage, results were shared with UK breast surgeons along with a survey to assess perceptions of quilting and other preventive strategies. An analysis was then done to examine the relationship between sharing audit data and the decision to quilt. This study seeks to outline the effectiveness of quilting in the prevention of seroma formation while also assessing current and alternative practices of UK surgeons in managing seromas. The insights gained from the quilting audit were shared in a follow-up survey to challenge the perception surgeons held of quilting and to consider incorporating this technique into their future practices. ResultsA total of 66 simple mastectomies were performed, with 32 patients receiving quilting and 34 undergoing conventional closure. On average, each patient in the quilting group received 13 sutures, taking an average of nine minutes for suturing. Among the 32 patients in the quilting group, there were no failed day cases due to postoperative haematomas or complications such as pain, wound breakdown, or long-term disfigurement of the flap. Only one case developed a seroma, but the volume was not clinically significant enough to require drainage. The non-quilting group showed a 70% seroma rate, with patients averaging three aspirations each, averaging 230 ml of fluid.Sixty UK-based surgeons responded to the first survey and 48 to the second. The first survey revealed that only 11.6% of surgeons offered quilting, 48% relied on drains, and 35% took no measures to prevent seroma formation. After sharing the quilting audit results, 79% of respondents indicated they would consider implementing quilting, while 20% remained resistant to the idea. The changes to response were statistically significant (p<0.00001).ConclusionThe feedback from the surveys indicates a lack of consensus among UK surgeons regarding the prevention of seromas post-mastectomy. Nonetheless, there is a significant willingness to explore quilting. Our findings demonstrate that quilting is both safe and effective in reducing seroma formation, leading to improved patient outcomes. We recommend that future research focus on establishing comprehensive national evidence and guidelines aimed at decreasing seroma rates, thus addressing the current variability in approach across the country.

ABSTRACT Background: Despite being considered routine, breast surgery is associated with a high incidence of acute and chronic postoperative pain, which can significantly impact recovery and quality of life. Regional anesthesia techniques have become increasingly relevant within multimodal analgesic strategies, yet clinical practice remains heterogeneous and lacks clear guidance. To address this, we aimed to develop a multidisciplinary, evidence-based consensus on the role of regional anesthesia in breast surgery. Methods: An expert panel was appointed by the Italian Chapter of the European Society of Regional Anaesthesia, including anesthesiologists and breast surgeons (in partnership with the Italian National Association of Breast Surgeons). A four-round Delphi method was applied to refine an initial set of 24 PICO-formulated questions. Each question was evaluated for relevance and clarity using a 9-point Likert scale (1 = not relevant/clear, 9 = extremely relevant/clear). Finalized questions underwent systematic review or network meta-analysis depending on data availability. Results: Eleven clinically relevant and clearly formulated PICO questions were identified after four Delphi rounds. These questions encompass acute and chronic pain control, block safety in anticoagulated patients, awake surgery, and the comparative efficacy of single-shot versus continuous blocks, among others. Each question will guide a systematic review and support the development of graded consensus statements. Conclusion: This consensus project establishes a transparent, multidisciplinary framework for guiding the use of regional anesthesia in breast surgery. The ultimate objective is to formulate a set of consensus statements, graded according to evidence strength, which will serve as a foundation for future guidelines and standardized clinical decision-making.

A positive margin following tumor resection (i.e., surgical removal of a cancerous tumor) indicates that cancer may remain in the body and can require a re-operation. This study is part of a larger project designing a technology to support the intraoperative evaluation of margins. This study explores the goals, decisions, information needs, and system requirements of a surgeon performing breast cancer surgery. We conducted semi-structured interviews with 11 breast surgeons to understand how they currently perform resections and then performed a qualitative thematic analysis. We identified three main goals and 13 subgoals. The three main goals are: treating cancer, meeting patient needs, and meeting institutional needs. Surgeons made multiple decisions to accomplish each sub goal and required multiple information elements to make these decisions. Our results will inform the design of the new technology and a sociotechnical systems-based analysis to ensure the technology fits in surgeon workflow.

Open excisional biopsy is currently the mainstay of management of a variety of benign and indeterminant (B3) breast lesions in Australasia. Vacuum assisted biopsy (VAB) and vacuum assisted excision (VAE) are being increasingly adopted into the management algorithm of such breast lesions internationally and are beginning to gain interest in Australasia. This study aims to review the experience and outcomes of a series of surgeon-performed ultrasound (US) guided VAB/VAEs undertaken by specialist breast surgeons in Australasian including its application and clinical deployment. An Australian multicenter trial of US-guided surgeon-performed VAB and VAE of benign or indeterminant breast lesions was conducted by three experienced breast surgeons from major breast services. The study involved prospectively collected data on 462 US-guided VAB/VAEs in 397 patients, in both outpatient and day case settings from 2015 to 2024. Malignant lesions proven on previous biopsies were excluded. A total of 462 surgeon-performed US-guided vacuum-assisted procedures were undertaken in 397 patients. 137 procedures (29%) were performed as diagnostic VABs and 325 (71%) were undertaken as VAEs. Successful complete excision was achieved in 308 (95%) of cases where the intent of the procedure was complete excision, defined as absence of any lesion seen on US following the procedure and on subsequent interval US examination. Duration of follow-up ranged from 6months to 9years. The average size of lesions was 20mm in the diagnostic VAB group and 11mm in the VAE excision group. The average time for either procedure was approximately 15min. No infection was reported and hematomas requiring surgical evacuation were <1%. VAB/VAE are minimally invasive techniques well suited for management of variety of benign and B3 breast lesions. US guided VAB/VAE interventions are reliable, safe, and quick to perform in both day procedure or outpatient settings and can be readily learned by breast surgeons, especially those who already possess experience in breast interventional US. We have demonstrated its utility and viable deployment in contemporary Australian breast surgical practice and would advocate for its adoption in the Australasian surgical management algorithm, especially for small B3 lesions.

Background: Virtual consultations (VCs) have been utilized across various clinical specialties and have the potential to reduce outpatient clinic costs and improve patient satisfaction. In breast surgery, we aimed to assess the utility and feasibility of VC in new-patient clinics for women under 30, who are considered a low-risk subgroup.Methods: Between December 2020 and April 2021, data were consecutively collected from 118 women aged under 30 who were referred from primary care to the breast clinic. Participants were offered VCs, followed by ultrasound (USS) if clinically indicated and/or face-to-face review. Clinicopathological data were collected on referrals, imaging, and follow-up, with descriptive statistics used for analysis.Results: An outpatient USS was performed by a sonographer trained in palpation for 80.3% (n = 94) of patients after a review in the VC clinic. In comparison, 15.4% (n = 18) of patients were reassured and discharged directly after the VC consultation. The USS was normal in 64.9% (n = 61) of patients, with the remainder showing benign pathology. Six biopsies were performed, all of which were benign. Only 14.4% (n = 17) of patients required a face-to-face appointment with a breast surgeon, and 64.1% (n = 75) of patients were discharged after VC + USS alone. Routine follow-up of benign disease was organized for 6.0% (n = 7) of patients, with one patient booked for elective surgery for benign disease. No adverse events were reported.Conclusion: Utilizing VC, the majority of new referrals did not require face-to-face appointments, and the diagnosis rate is low in this younger age subgroup. VCs have the potential to reduce the burden on new-patient clinics and reduce costs while improving patient convenience. Larger studies with longer follow-up are needed to assess the long-term safety of this approach.