Elective Breast Research Articles

Smartphone thermal imaging for preoperative perforator mapping in DIEP flap breast reconstruction

Perforator-based flaps have become a mainstay of autologous breast reconstruction practice. Despite available radiological investigations ranging from Doppler ultrasound (US) to CT angiography (CTA), finding and quantitatively assessing perforators remains a time-consuming, complex process. Infrared thermographic imaging (IRT) shows promise as a novel modality for preoperative localisation of perforator vessels. Thirteen women undergoing elective breast reconstruction with deep inferior epigastric artery perforator (DIEAP) flaps were recruited between August 2017 and July 2018. All had CTA and Doppler US mapping of arterial perforators preoperatively as standard. Additional abdominal thermal images were taken using a FLIR ONE smartphone compatible camera. Thermal hotspots were compared with Doppler markings and CTA findings. Twenty-six flaps were analysed. Seventy perforators were marked by Doppler US, with a mean of 2.92 perforators per flap (± SEM 0.15, SD 0.72). Forty (57%) had a corresponding hotspot on IRT. Overall, there was a statistically significant positive correlation between the number of perforators detected by Doppler US and IRT (r = 0.573, n = 26, p = 0.003) and kappa index 0.65. Eighty-four perforators were identified by CTA, with a mean of 3.5 perforators per flap (± SEM 0.14, SD 0.66). Fifty-eight (69%) had a corresponding hotspot on IRT. There was a statistically significant positive correlation between the number of perforators detected by CTA and IRT (r = 0.504, n = 26, p = 0.012) and kappa index 0.60. Thermography is an inexpensive, portable, non-invasive imaging technique, which shows statistically significant correlation to CTA and Doppler US in mapping perforators. Level of evidence: Level IV, diagnostic study.

SUN-126 Distinct Molecular Phenotypes of Non-Diseased Breast Adipose Tissue of Pre-Menopausal Obese and Non-Obese Women May Underlie Differing Breast Cancer Risks

Obesity is a major risk factor for many chronic diseases including postmenopausal breast cancer. Paradoxically, breast cancer susceptibility is inversely linked to obesity in pre-menopausal women. Adipose tissues are active endocrine organs that play major roles in tumor development and progression; however, fat depots at different anatomical sites are biologically and functionally distinct and their singular influence on breast epithelial biology remains unclear. To study the early events by which breast adiposity may provide a microenvironment predisposing normal breast epithelial cells to tumorigenesis, we collected breast tissue from pre-menopausal (n=10/group) non-obese (NO, BMI=27.6±0.8) and obese (O, BMI=44.5±2.8) women of comparable ages (NO: 36.1± 3.3; O: 40.0±2.0) with no breast cancer and undergoing elective breast reduction surgery. Breast adipose tissue and corresponding glandular cells were analyzed histologically and evaluated for expression of genes (adipokines, cytokines, steroid hormone signaling) by QPCR and proteins (proliferation, apoptosis, inflammation) by IHC. Adipocyte size distributions from NO and O breasts did not differ (P=0.9). However, adipose mRNA levels for pro-inflammatory cytokines (IL-6, IL-8, CSF-1, MCP-1) and adipokines (LEP, CFD) were higher for O than NO (P<0.05). AdipoQ, ER-α, and ER-β transcript levels were lower for O than NO (P<0.05), while those for CYP19 and PTGS2 showed reverse trends (O>NO, P<0.05). In the corresponding glandular cells, NO had higher mRNA levels for IL-6, IL-8, ER-α, and ER-β than O (P<0.05). Immunostaining with anti-Ki67 antibodies indicated that O glandular cells were 3-fold less proliferative than those for NO, consistent with their lower Cyclin D1 mRNA levels (P<0.05). Galectin-1, a pro-fibrotic protein, showed predominant myo- vs. luminal epithelial localization, with staining intensities for O tending to be higher (P=0.07) than for NO. Perilipin immunostaining was specific for adipocytes and did not differ for O and NO. A non-targeted approach using a Human Cytokine Array (R&D Systems) was employed to further evaluate the inflammation status of O vs. NO adipose. The analyses confirmed the higher expression of IL-8, Leptin and CFD (by QPCR) in O vs. NO and identified C-reactive protein, EMMPRIN, Trefoil Factor-3, Cystatin-3 and Macrophage Migration Inhibitory Factor-1 as greater in O than NO (~2-fold). Our findings demonstrate marked differences in gene and protein expression patterns of O and NO breast adipose tissue, which were accompanied by a suppression of proliferation of O relative to NO breast epithelium. We speculate that early exposure of the breast epithelium to a highly inflammatory environment fueled by breast adiposity may promote a senescent state that confers protection from pre-menopausal breast cancer.

Increased minimum alveolar concentration-awake of Sevoflurane in women of breast surgery with sleep disorders

BackgroundSleep disorders are commonly encountered in clinic. Evidences showed that sleep deprivation may modulate the effectiveness of general anesthetics in rats. However, this phenomenon has not been explored in humans. The study aimed to investigate whether the hypnotic potency of sevoflurane in patients with sleep disorders differ from patients with normal sleep habits.MethodsWe recruited 44 patients scheduled for elective breast surgery and eventually analyzed 38 patients, including 19 subjects with normal sleep habits and 19 subjects with sleep disorders. According to the Dixon ‘up-and-down’ design, patients received sevoflurane at preselected concentrations starting at 1.0 vol%. After a steady-state period, a verbal command for testing awakening was performed. Based on the negative or positive response to the verbal command, we decreased or increased the concentration of sevoflurane by 0.2 vol% in the next patient accordingly. Plasma orexin-A was also measured before observation.ResultsThe MACawake of sevoflurane was 0.80% [95% confidence interval (CI), 0.683–0.926%] in the sleep disordered group vs 0.60% [95% CI, 0.493–0.689%] in the control group. The relative median potency between groups was 0.750 (95% CI, 0.236–0.969). Patients with sleep disorders had significantly higher orexin-A levels than control (72.17 ± 18.24 vs. 36.16 ± 14.18 pg/mL). A significant, positive relationship was detected between orexin-A level and probability of awakening (OR = 1.081, 95% CI is 1.020–1.146, P = 0.008).ConclusionsMACawake of sevoflurane is higher in mild-aged women of breast surgery with sleep disorders compared to those with normal sleep habits. The increased anesthetic requirement may be related to changes of orexin-A levels. These findings suggest that sleep may have a potential impact on clinical anesthesia, including changes of sensitivity to anesthetics or postoperative complications. Further research is needed to confirm this hypothesis.Clinical trial registrationChinese Clinical Trial Registry (ChiCTR1800016022), date of registration 07 May 2018.

A prospective, randomized, double-blind trial to compare body weight-adjusted and fixed doses of palonosetron for preventing postoperative nausea and vomiting in obese female patients.

BackgroundPostoperative nausea and vomiting (PONV) is a common postsurgical complication. Palonosetron is effective for PONV prevention at the usual dose of 75 μg, but the ideal dose for obese patients has not yet been investigated. The aim of this study was to compare body weight-adjusted and fixed doses of palonosetron for preventing PONV in obese female patients.Materials and methodsWe performed a prospective, randomized, double-blind trial involving 80 female patients, aged 18–80 years with an American Society of Anesthesiologists physical status of 2 and 3 and a body mass index (BMI) ≥ 30 kg m-2 who were scheduled to undergo elective breast surgery. Patients received an intravenous body weight-adjusted dose of palonosetron (1 μg kg -1, GI = 40 patients) or a fixed dose of palonosetron (75 μg, GII = 40 patients). All patients received dexamethasone (4 mg). The incidence of PONV, complete response rate (CR), severity of nausea and need for rescue antiemetics and analgesics were assessed at: 0–1 h, 1–6 h, 6–24 h and 24–48 h postoperatively.ResultsThe mean (± SD) BMI was 35.0 (±5.2) kg m-2 for GI and 35.7 (±3.6) kg m-2 for GII. There was no significant difference between groups in PONV incidence, CR, severity of nausea, and need for rescue antiemetics or analgesics. The incidence of PONV for GI and GII was 15% and 27.5%, respectively, during the first 48 h (P = 0.17).ConclusionsA body weight-adjusted dose of palonosetron was as effective as 75 μg for preventing PONV for 48 h in obese female patients who underwent breast surgery. Hence, the fixed dose may be preferable to the body weight-adjusted dose.

Rationalizing blood transfusion in elective breast cancer surgery: Analyzing justification and economy.

BACKGROUND:Transfusion of allogeneic blood in breast cancer surgery is variable, and differences of transfusion incidence have been observed in the literature. Most hospital guidelines including ours dictate group and reserve policy of blood before breast surgery. Here, we aimed to audit the blood utilization in patients undergoing elective breast surgery in our hospital and thereby optimize the blood ordering schedule, economic burden, and loss of clinical resources.MATERIALS AND METHODS:The study included 478 breast cancer surgeries over a period of 6 years. Patient and disease details were obtained from patient file and hospital information system. Blood samples sent to blood bank were subjected to compatibility test and reserved. All transfusions were documented, and statistical analysis was done.RESULTS:Of the total 478 patients, most underwent wide local excision of the breast and modified radical mastectomy. A total of 16 patients received 71 units of blood and blood components in all categories of surgeries. Only 103 were younger women (≤40 years), with a mean age of 31 years. Nontransfused patients were significantly more than transfused ones (P < 0.05). Frequency of blood transfusion was more in young patients (4.9%). Seven (22.6%) of the total 31 Stage IV patients received blood transfusions. Frequency of blood transfusion was more in patients undergoing surgery after chemotherapy (8.8%). A significant loss of time and loss of revenue was observed.CONCLUSION:We conclude that routine compatibility test is not justified for all patients undergoing breast surgery. A more targeted approach is needed to reduce blood demand and associated cost to patient and blood transfusion services.

Analgesic efficacy and spread of local anesthetic in ultrasound-guided paravertebral, pectoralis II, and serratus anterior plane block for breast surgeries: A randomized controlled trial.

Background:Thoracic paravertebral block (TPVB) has become the gold standard to provide postoperative analgesia in breast surgery. Recently, ultrasound-guided (USG) pectoralis (PECS) block and serratus anterior plane (SAP) block have been described as an alternative to TPVB. The objectives were to compare TPVB, PECS, and SAP block in terms of analgesic efficacy and the spread of local anesthetic by ultrasound imaging, correlating it with the sensory blockade.Materials and Methods:Prospective randomized interventional study conducted in 45 ASA grades I–II patients scheduled for the elective breast surgery. Patients were randomly allocated into three groups, i.e., Gr.1 (USG –TPVB) (ropivacaine 0.375% 20 ml), Gr.2 (USG-PECS II) block (ropivacaine 0.375% 30 ml), and Gr.3 (USG-SAP) (ropivacaine 0.375% 30 ml). Spread of the local anesthetics was seen with ultrasound imaging. Onset of sensory blockade, postoperative fentanyl consumption, and pain scores was measured.Results:TPVB and SAP group had comparatively higher spread and sensory block compared to PECS group. Postoperative fentanyl requirement (mean ± SD) was 428.33 ± 243.1 μg, 644.67 ± 260.15 μg, and 415 ± 182.44 μg in the TPVB group, PECS II group, and SAP group, respectively. SAP group had significantly lesser requirement than PECS II group (P = 0.028) but similar requirement as in TPVB group (P = 1.0). Pain scores were not significantly different among the group in the postoperative period.Conclusion:TPVB and SAP group result in a greater spread of the drug and provide equivalent analgesia and are superior to the PECS II block in providing analgesia for breast surgeries. SAP block is easier to perform than TPVB with lesser chances of complications and results in faster onset.

Protocol for a Systematic Review Assessing Surgery versus Primary Endocrine Therapy in Operable Breast Cancer. Prep for Pandemic

IntroductionIn COVID-19 pandemic epicenters cancer care was severely impacted. All elective and semi-elective procedures, as well as select urgent cases, were postponed in order to preserve resources and protect patients and staff from SARS-CoV-2 exposure. Structured decision making for breast cancer treatment resulted in deferment of surgery with initiation of endocrine therapy. Moreover, the waitlist for elective breast cancer procedures after mitigation is a challenge for prioritization. Objective and significanceWe aim to summarize the current body of evidence, comparatively evaluate oncological outcomes of surgery versus primary endocrine therapy (PET), and determine whether PET is a viable long-term alternative to surgery in the context of crisis management strategy for early, operable hormone receptor positive (HRP) breast cancer. PET could potentially be an acceptable bridging or maintenance therapy in select patients during pandemic crisis or for those choosing to forgo surgery in the treatment of breast cancer. Methods and analysisThe database search includes PubMed, EMBASE, and MEDLINE (via Ovid). This systematic review includes women 18 years or older undergoing one of two interventions for HRP breast cancer: surgery (with or without endocrine therapy post-surgery) or solely PET. Studies comparing one of the two interventions of interest to a non-relevant intervention and studies reporting only descriptive data will not be included in the quantitative synthesis of data. After selection of eligible studies based on title and abstract, these studies will be further screened through full text articles by two independent reviewers, with a third as an arbitrator. Eligible studies will be critically appraised at the study level for methodological quality. Cochrane methodology will be utilized for meta-analysis. Ethics and disseminationThis study does not require an institutional review board approval given its summary design nature. Findings of this systematic review will be published in a peer-reviewed journal.

Social Media's Influence on Breast Augmentation.

The purpose of this study is to evaluate if and what social media use influences our patients' decisions to undergo breast augmentation. A single-institution study was designed to evaluate women who underwent elective breast augmentation from 2017 to 2018. Patients were contacted via validated, prompted telephone survey. Data regarding their demographic information and social media utilization pertaining to breast augmentation were collected after obtaining verbal consent. Inclusion criteria were met by 180 patients, of which 69% participated in the survey. Ninety-seven percent of the participants reported utilizing social media in general; the most common platforms were Facebook, Instagram, and the physician's website. Millennials (97%) and Generation X (92%) utilized social media the most and none of the baby boomers. Sixty-four percent of participants reported utilizing some form of social media to research breast augmentation, with the most common resource being Instagram. When analyzing the impact of the social media resources utilized by the participants, Instagram was reported as the most impactful at 54%. Only 18% of participants were utilizing a physician's social media account to research breast augmentation. Among the 50% of patients who utilized social media to compare their surgeon's work with another physician's, the majority (83%) were utilizing the physician's website. Social media influences patients' education and decisions to undergo breast augmentation, with Instagram being the most impactful. This study evaluated the patient population to stay up to date on their social media utilization and resources of education prior to breast augmentation.

Research Related to Capsular Contracture after Breast Augmentation for Cosmetic or Reconstructive Purposes

The upward trend of patients opting for elective breast augmentation, as well as the large number of patients benefiting from alloplastic breast reconstruction, require further studies on the safety profile of these techniques. Without any doubt, the incidence of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has drawn attention to the possible unknown complications characteristic of these procedures, creating the context of further studies devoted to this issue. The present research examines the capsular contracture rate on a group of 253 patients between 2015 and 2019, also proposing a scoring system based on the integration of the main diagnostic criteria related to the capsular contracture. The results of the literature review indicate that a lower incidence of capsular contracture could be achieved by using the newest techniques in the field involving the application of chemical substances on the surface of the latest generation of silicone breast implants.

Optimizing Discharge Opioid Prescribing Practices After Mastectomy With Immediate Reconstruction.

A quality improvement initiative was conducted to provide guidelines for opioid prescribing following mastectomy with immediate reconstruction. Patients undergoing mastectomy with concurrent tissue expander reconstruction were surveyed at their first postoperative visit to determine use of pain medication, satisfaction, and refill rates. Opioid prescriptions were converted to total oral morphine milligram equivalents (MMEs). Guidelines for postdischarge prescriptions were developed. During phase I, 16 patients were surveyed to determine baseline prescribed MMEs and rate of satisfaction. A guideline was subsequently developed to standardize postdischarge prescribing (550 MMEs prescribed average risk vs 900 MMEs high risk), and the survey was repeated (phase II). Median 210 MMEs were used. Of the 23 patients, 1 required a refill, 83% were highly satisfied, and 77% of opioids were unused. Guidelines were further revised to limit prescribed opioids (290 MME average risk vs 450 MME high risk), and the survey was repeated (phase III). A median of 118 MMEs was used. Of the 22 patients, 5 required refills, 73% were highly satisfied, and 53% of opioids were unused. Phase IV included 27 patients. A median of 98 MMEs was used. Two patients required refills, 93% were highly satisfied, and 58% of opioids were unused. Our finding showed that there is significant overprescription of opioids after elective breast surgery. Practice guidelines can reduce the amount of opioids prescribed. Reducing excess opioids available in the community is a noble goal; however, it must be done cautiously, as decreased patient satisfaction can be an unintended consequence.

Abstract P5-15-07: Breast surgery – Is routine 'group &amp; save' required? A quality improvement project

Abstract Introduction Breast surgery, especially for malignant disease, is not associated with significant blood loss and therefore rarely requires blood transfusions. Pre-operative protocols in our hospital and in most other centers routinely require a blood group screening process (group and save) for elective breast cancer surgery. The process of group and save (G&amp;S) in our hospital requires two blood samples to be drawn with at least 30 minute interval in-between. It takes at least 40 minutes for the samples to get processed and the cost for each test is £2.12. The test is valid for a period of 5 days after which time it needs to be repeated. This process in busy hospitals is clearly time consuming, results in delays and is inconvenient for patients and medical staff. The aim of this study was to ascertain the number G&amp;S performed and rate of post-operative blood transfusion for patients undergoing surgery for malignant breast disease. This was to establish if mandatory pre-operative G&amp;S is necessary in all cases, and if the number of tests performed can be reduced. The second part of the study was to analyze the outcome after implementation of changes to reduce the number of G&amp;S tests. Method Retrospective review of patient records who had surgeries for malignant breast disease from December 2015 to November 2016. Exclusion criteria included benign disease, flap reconstruction and breast surgery combined with another major procedure. Following the initial analysis, it was proposed that only the operating surgeon will request the test and that it will not be routinely requested by the pre-op assessment team. A re-audit was done prospectively to study the outcome of change in practice and close the audit loop. Results 151 cases were eligible for review. 97.35% (147 patients) had G&amp;S, and the post-operative transfusion rate was 1.32% (2 patients). Following a change in protocol a significant fall in the testing (97.35% to 35.5%) was seen and there were no post-operative blood transfusions in this period. Conclusion This simple yet important audit showed that routine G&amp;S did not contribute to the patient management, increased cost of treatment, caused patient inconvenience and consumed hospital personal time. The changes we implemented significantly reduced the frequency of this test and was cost effective to the trust. This study has now been converted into a Quality Improvement Project and through this we will continue to improve the results further. This project has also stimulated an interest in the General Surgery department, and other units are now considering changing their practice based on our results. Citation Format: Burrah R, Chicken W, Sathananthan S. Breast surgery – Is routine 'group &amp; save' required? A quality improvement project [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-07.

AB111. 5. An observational study on the effects of propofol-based total intravenous anaesthesia versus vapour-based inhalational anaesthesia on blood pressure and heart rate in women undergoing elective breast cancer surgery

AB111. 5. An observational study on the effects of propofol-based total intravenous anaesthesia versus vapour-based inhalational anaesthesia on blood pressure and heart rate in women undergoing elective breast cancer surgery

Risk factors for severe acute pain and persistent pain after surgery for breast cancer: a prospective observational study

Background and objectivesThere are few prospective studies providing comprehensive assessment of risk factors for acute and persistent pain after breast surgery. This prospective observational study assessed patient-related, perioperative, and genetic...

Feasibility and efficacy of sublingual buprenorphine tablets in managing acute postoperative pain after elective breast cancer surgeries: A series of 10 cases.

Poorly controlled perioperative surgical pain is a consistent risk factor for developing post mastectomy pain syndrome (PMPS).[1] The incidence of chronic pain after mastectomy is as high as 25-60%, which is a range derived from several studies.[2] American Society of Anesthesiologists (ASA) recommends a multimodal approach to postoperative pain management whenever possible which includes use of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, alpha-2 agonists, N-methyl D-aspartate receptor antagonists, gabapentinoids, dexamethasone, anti-depressants and peripheral nerve blocks.[3] Buprenorphine hydrochloride is a partial μ-receptor agonist, OLR-1 (Oxidized Low-density lipoprotein Receptor) agonist, delta and kappa receptor antagonist approved for managing acute surgical pain, cancer pain and non-cancer pain.[4] Sublingual (SL) buprenorphine is available in the form of 200 μg tablets which has been used with good results for managing acute postoperative pain.[5] In the present case series, we have investigated the feasibility and efficacy of SL buprenorphine in managing acute postoperative pain after mastectomy.

Analgesic effect of the bi-level injection erector spinae plane block after breast surgery: A randomized controlled trial.

Due to the complex breast innervation, postoperative analgesia after breast surgery is a challenge for the anesthesiologists. The erector spinae plane block (ESPB) is a newly defined promising technique for this purpose. The main purpose of this study was to evaluate the analgesic efficacy of the ultrasound-guided ESPB in breast surgery, monitoring its effect on the postoperative opioid consumption. Fifty female patients, who were scheduled to undergo elective breast surgery, with the American Society of Anesthesiology physical score I-II, and aged between 25 and 70 years, were included into the study. Patients were randomized into two groups, as the ESPB and the control group. All patients in the ESPB group received a bi-level (T2-T4) ultrasound-guided ESPB with 20 ml 0.25 % bupivacaine (10 ml for each level) preoperatively. An intravenous patient-controlled analgesia device for the postoperative analgesia was given to all patients. The numeric rating scale (NRS) scores for pain and postoperative morphine consumptions were recorded at the 1st, 6th, 12th, and 24th hour postoperatively. Postoperative morphine consumption was significantly lower in the ESPB group compared to the control group at the postoperative 6th, 12th, and 24th hour (p<0.001 for each time interval). The morphine consumption at the 24-hour was reduced by 75%. There was no significant difference in the NRS scores (median NRS values were 2, 1, 0, 0, and 2, 2, 1, 1, respectively). Our study has shown that a significant opioid-sparing analgesic effect in patients undergoing breast surgery could be achieved with a US-guided bi-level ESP block.

Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial.

Background and Aims:Pecs block and its variations provides perioperative analgesia, reduce PONV and other opioid related side effects. We hypothesized that COMIBPES block in addition to general anaesthesia will provide better postoperative analgesia when compared to general anaesthesia alone in breast cancer surgery patients.Methods:After obtaining permission from the institutional review board and registering the trial with Clinical Trials Registry of India (CTRI), we conducted a double blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection. Patients were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, postoperative nausea vomiting (PONV) and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively.Results:Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, compared to nil in group P, P< 0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1.Conclusion:COMBIPECS block is a valuable addition to general anaesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

2122. Can Chlorhexidine Reduce Bacterial Colonization in Surgical Drains and Surgical Site Infections After Breast Cancer Surgery? A Randomized Controlled Trial

BackgroundBreast surgery is considered a clean surgery; however, surgical site infection (SSI) rates are higher than predicted. Postoperative drains remain in situ for several days with an inevitable bacterial colonization and increased risk of SSI.MethodsWe conducted a randomized controlled trial from October 2016 to January 2018 in a Mexican cancer center with high SSI prevalence. We included women with elective breast cancer surgery. Patients were randomized to control (standard drain care) or intervention (occlusive dressing with chlorhexidine 2% at the drain exit site). Perioperative management was standardized for both groups. Patient follow-ups were performed on a weekly basis for at least 30 days. Fluid cultures were performed at the first and second week as standardized in the laboratory. At the time of drain removal, the inner portion was sectioned and cultured by Maki’s semi-quantitative technique. Bacterial quantification was performed using 16 s rRNA-qPCR assay. Culture results of drain fluid and tubing were compared between groups.ResultsWe included 104 patients with 167 surgical drains. Patients’ clinical characteristics (i.e., age, body mass index, comorbidities, clinical stage, preoperative risk, neoadjuvant therapy) were similar in both groups, with no statistical differences. Bulb fluid cultures at the first postoperative week were positive in 42.9% of the control group compared with 27.6% of the antiseptic group (P = 0.04). Cultures from the second week assessment were positive in 79.4% of the control group vs. 53.5% of the antiseptic arm (P = 0.001). Cultures from drain-tubes were positive in 70.2 and 43.8% (P = 0.001) of the control and antiseptic group, respectively (Figure 1). Eleven patients developed an SSI, three (15.4%) from the intervention group, and eight (15.8%) from the control group (P = 0.11). Eighty-four pathogens were isolated from the control group samples at week 1 vs. 52 from the intervention group. Staphylococci spp. were the most common microorganisms in Week 1, 61.9% control and 35% intervention group.ConclusionLocal antiseptics provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization after breast surgery and potentially decrease infectious complications. Our microbiology findings question breast tissue sterility. Disclosures F. Rivera-Buendía, 3M: Donated the dressings used, Research support. D. Vilar-Compte, 3M: Donated the dressings used, Research support.

A retrospective comparison of 3M™ Micropore™ with other common dressings in cosmetic breast surgery

Surgical site infection has considerable cost implications for healthcare providers. Evidence suggests that the use of Micropore™ tape as a dressing for surgical incisions may be associated with reduced/comparable rates of infection in surgical wounds. 3M™ Micropore™ tape is significantly cheaper than conventional wound dressings. The purpose of this study was to compare differences in the rate of wound healing problems including superficial incisional surgical site infection (SSI) and wound healing problems following cosmetic breast procedures between Micropore™ tape and other common wound dressings. A clinical database was utilised to identify all patients undergoing elective breast surgery at a UK private cosmetic surgery group between May and November 2017. The patients were divided into 2 groups: those whose wounds were dressed with 3M™ Micropore™ tape post-operatively and those dressed with other common wound dressings. Data was analysed to assess the prevalence of post-operative wound healing problems (superficial incisional surgical site infection and delayed wound healing) in each group. 1216 patients were identified in our database, 659 patients receiving Micropore™ and 557 patients receiving conventional wound dressings. The overall prevalence of wound healing problems in the Micropore™ tape and conventional wound dressing group were 12% and 10% respectively, with no statistical difference (p = 0.3913). There was no statistical significance between the use of antibiotics and prevalence of wound healing problems in either group. The results of our study suggest that there is no difference between the use of Micropore™ tape and other conventional wound dressings in the prevalence of post-operative wound healing problems in cosmetic breast surgery. Our findings support the routine use of Micropore™ tape in post-operative dressing for clean, non-contaminated, directly closed, elective surgical wounds. We suggest a larger scale, prospective, randomized study should be conducted to confirm these initial findings.

Sub-muscular plane for augmentation mammoplasty patients increases silicone gel implant rupture rate

BackgroundBreast augmentation is one of the most common aesthetic procedures performed worldwide. One of the worst associated complications is implant rupture, a topic that will be addressed in the present study. The risk of developing silicone gel breast implant rupture following breast augmentation is associated with multiple factors, including: older generation implant, increased implant age, implant type, specific manufacturer, severe capsular contracture (Baker grade III or IV), and the presence of local symptoms. We hypothesize that the plane of the implant placement may also play a role in the development of implant rupture due to differences in opposing forces upon the implant between submuscular and subglandular planes. ObjectivesTo assess the effect of potential risk factors on breast prosthesis rupture rate, focusing on implant pocket selection, capsular contracture and implant volume. MethodsA retrospective cohort study was performed on patients with silicone breast implants in either subglandular or submuscular plane, who underwent an elective breast implant exchange, with or without mastopexy, between January 2012 and June 2017. Data collected included patient's age, implant age, implant pocket, implant volume, capsular contracture grade, and implant status (ruptured or intact). ResultsData was collected on 362 women (700 breasts). A total of 284 women (542 breasts) met the inclusion criteria. The average age of the subjects was 43.4 ± 10.4 years. Average implant age during exchange was 10 ± 6.1. There was no difference between the characteristics of the submuscular group and the subglandular group, except from patient age. In a univariant analysis, patient's age (46.4 vs. 41.8, p < 0.001) and implant age (12.2 vs. 8.92 years, p < 0.001) were associated with significantly higher rupture rate. Among ruptured implants, the relative proportion of submuscular to subglandular implants was 64%, compared to 48% among non-ruptured implants (p < 0.0001). When controlling for potential confounders, submuscular pocket (OR = 0.1835, CI95% 1.25–2.69, p = 0.002) as well as implant size (OR = 1.004, CI95% 1.001–1.007, p = 0.005) were found to be a risk factor for implant rupture. ConclusionA sub-muscular implant pocket was identified as a significant risk factor for implant rupture. The prevailing theory that larger size implant carries an increased risk of complications, is also reinforced in this study. Large prospective studies are needed to further clarify risk factors for implant rupture.

The Possible Preventive Role of Pregabalin in Postmastectomy Pain Syndrome: A Double-Blinded Randomized Controlled Trial

ContextChronic postmastectomy pain syndrome (PMPS) has a considerable negative impact on the quality of life of breast cancer patients. ObjectiveThe objective of this study was to assess the possible preventive role of perioperative pregabalin in PMPS. MethodsThis randomized controlled study included 200 patients with breast cancer scheduled for elective breast cancer surgery. They were randomly assigned to one of two treatment groups. The pregabalin group received 75 mg of pregabalin twice daily for seven days and the control group received oral equivalent placebo capsules. The primary outcome was development of neuropathic PMPS. Neuropathic pain was assessed using the Grading System for Neuropathic Pain. Secondary outcome measures were safety and Visual Analogue Scale scores. ResultsNeuropathic pain was significantly less frequent in the pregabalin group compared to the control group at four weeks (P = 0.005), 12 weeks (P = 0.002), and 24 weeks (P < 0.001) postoperatively. PMPS was diagnosed in 11 patients (11%) of the pregabalin group and 29 patients (29%) of the control group (P < 0.001, relative risk: 0.26, 95% CI: 0.12–0.56). At the three follow-up time points, Visual Analogue Scale scores during the first three postoperative weeks were comparable in both groups while they were significantly lower in the pregabalin group at 4, 12, and 24 weeks. These two groups were comparable in the frequency of adverse events (P = 0.552). ConclusionPerioperative oral pregabalin 75 mg twice daily, starting at the morning of surgery and continued for one week, could reduce the frequency of postmastectomy pain syndrome.