Oncoplastic Breast Conservation Research Articles

Comparison of Oncoplastic Breast Surgery and Breast Conserving Surgery without Reconstruction, A Systematic Review and Meta-Analysis

Abstract Introduction Breast cancer, the second leading cause of cancer-related mortality, poses unique challenges to patients, encompassing physical, emotional, and sexual dimensions. Surgical interventions, such as modified radical mastectomy and breast-conserving surgery (BCS), can exacerbate these challenges. This study explores the integration of oncoplastic breast surgery to address shortcomings associated with traditional approaches. Methods A systematic review of PubMed, Web of Science, and Scopus identified 28 relevant studies, encompassing 28,162 patients. Cosmetic outcomes and patient satisfaction were compared between oncoplastic breast surgery (OBCS) and BCS groups, with a focus on psychological and physical well-being domains. Results The meta-analysis revealed that OBCS demonstrated superior outcomes in satisfaction with breast appearance, psychological well-being, and physical well-being compared to BCS. Patient satisfaction questionnaire results consistently favored the OBCS group. Recurrence Risk: A meta- analysis estimated a significant reduction in the odds of recurrence in OBCS patients with positive margins (odds ratio = 2.44, P < 0.001). This underscores the oncological safety of oncoplastic techniques. Evolution of Breast Cancer Surgery: Oncoplastic breast surgery represents a pivotal advancement in breast cancer surgery. The convergence of surgical oncology and plastic surgery has allowed continual refinement of techniques, ensuring both oncological safety and improved quality of life. Conclusion Accumulating evidence suggests that oncoplastic breast surgery plays a crucial role in achieving wide local resection with enhanced safety margins for malignant breast tumors. By preserving aesthetic and symmetrical breast shapes, oncoplastic procedures contribute to improved patient outcomes, reinforcing the evolving landscape of breast cancer surgery.

ThP1.3 - Oncoplastic Surgery and Magseed Markers: A five-year snapshot of ambition and evolution in breast conserving surgery

Abstract Aim Oncoplastic surgery and localisation markers allow breast conservation in patients who might previously have been treated with mastectomy. We aimed to evaluate breast conservation across a five-year period spanning widening adoption of oncoplastic conservation, and the introduction of Magseed localisation. Method All patients diagnosed with breast cancer or DCIS, screening or symptomatic, in NHS Lanarkshire during the first 6 months of 2017 and 2022 were reviewed. These dates were chosen to eliminate the effects of Covid-19 on practice as much as possible. Results 531 patients (244 in 2017; 287 in 2022) were diagnosed within the study period. Groups were comparable for age (median 62 (32-96) and 61 years (28-94); P=0.4), and tumour size (median 19 (3-150) and 21 mm (4-123); P=0.4). Breast conservation as first operation rose from 69.1% to 85.5%. Use of localisation also increased, from 52.7% of procedures using wires in 2017, to 71.2% using one or more Magseeds in 2022 (P<0.001). Oncoplastic breast conservation rose from 3% to 7% of procedures. Re-excision rates remained in line with national outcomes (20.4% in 2017 and 20.0% in 2022); and ‘failure’ of breast conservation resulting in completion mastectomy also reduced from 8.0% to 4.7%. Overall mastectomy rate (+/- reconstruction) fell from 36% to 18% (P<0.001). A reduction in mastectomy for multifocal or diffuse disease requiring localisation or bracketing was also observed, from 56.2% to 35.5%, though this didn’t reach statistical significance (P=0.13). Conclusion Increasing success in breast conservation has coincided with greater adoption of oncoplastic breast conservation and novel localisation technology. Reassuringly, this has not resulted in an increase in re-excision, nor completion mastectomy rate.

Breast Conservation Project: Clinical Outcomes of Extreme Oncoplastic Breast-Conserving Therapy Versus Mastectomy for Large and Multiple Lesions.

Patients with multiple or large malignant breast lesions are classically considered mastectomy candidates, but extreme oncoplastic breast-conservation surgery (eOBCS) has become an alternative approach. There is a paucity of outcomes data comparing eOBCS with mastectomy. We reviewed our prospectively maintained, single-institution database. We included patients with non-metastatic breast cancer with multiple ipsilateral or single large (≥ 5cm) malignant breast lesions identified preoperatively who underwent either eOBCS or mastectomy. Patient demographics, clinicopathologic features, and surgical, oncologic, and cosmetic outcomes were evaluated. Seventy-six (88%) patients underwent eOBCS and 10 (12%) underwent mastectomy. Median follow-up was 24.8months. Mastectomy patients had larger lesions than eOBCS patients (median 70mm vs. 32.5mm; p = 0.06). Six (60%) index mastectomy patients underwent at least one additional surgery. For eOBCS patients, 34 (44%) required re-excision, 7 of whom underwent more than one subsequent surgery to obtain negative margins, and 6 (7.9%) ultimately underwent mastectomy. For patients undergoing additional surgery (n = 40), median time between index and final operation was 315days for mastectomy versus 21days for eOBCS patients (p < 0.001). Mastectomy patients more frequently experienced complications (p = 0.001) and underwent cosmetic revision (p < 0.001). There was no difference in cosmetic scores, and eOBCS patients reported less pain (p = 0.009). There were two local and three distant recurrences in the eOBCS cohort and one distant recurrence in the mastectomy group. Breast conservation was attainable in over 90% of eOBCS patients. Increased postoperative complications and discomfort and longer duration of surgical treatment in mastectomy patients without oncologic superiority should drive informed patient discussions.

The value of patient-reported experience in oncoplastic breast conservation following standardized assessment and shared-decision making. A qualitative study

IntroductionPatient-reported outcomes (PROs) are emerging as a quality marker for breast cancer care provision. Patient-reported experience (PRE) is equally important, but challenges in qualitative research and documentation have resulted in limited data on oncoplastic breast-conserving surgery (OPBCS). This qualitative study aimed to explore the experiences of patients who underwent OPBCS. Patients and methodsWomen who underwent OPBCS between 2015 and 2021 at the Breast Unit of Uppsala University Hospital were followed up longitudinally using PROs. All participants were invited to share their experiences beyond PROs through a “diary.” Patients’ experiences with care, pre- and postoperatively, and other insights and thoughts that they considered important were documented and analyzed. A narrative research methodology, along with thematic analysis, was employed. ResultsOf the 122 women, 60 (49.2 %) desired to further elaborate on their experiences beyond PROs-related aspects. The most common themes included postoperative side effects, challenges responding to questionnaires, adverse effects of adjuvant treatment, external factors contributing to the preoperative and postoperative overall health status, and satisfaction with the surgery and medical staff. Specifically, 26.7 % of the respondents stated that they felt that PROs were not adequately specific and had further reflections. ConclusionsPatients did not report different experiences depending on the operative technique. Their experience focused on the perception of wholeness and potential ambiguities in the PRO questionnaires. Documenting PRE is crucial, as it enables individualized assessment following breast cancer treatment, thereby strengthening patient-centered care.

Oncoplastic Breast Conservation for Central Tumors: Definition, Classification, and the Analysis of Single Institution Experience.

Tumors in the central part of the breast are usually considered more aggressive and technically difficult, which limits breast conservation. The definition of central tumors from a surgical point of view, classification of the techniques for partial breast reconstruction, and conceptual algorithm of choice based on tumor and breast characteristics are proposed, along with the estimation of surgical and oncological safety. This is a retrospective analysis of the single-institution experience, with a focus on the decision-making process for choosing the oncoplastic breast-conserving surgery technique. To evaluate the safety of breast conservation for central tumors, a comparative analysis of early surgical complications and oncological long-term results of treatment in patients with central breast tumor location and other breast tumor locations was performed. A total of 940 lumpectomies were performed in 926 patients during 15 years. The central breast tumor location group included 128 patients with 130 lumpectomies (13.8%), and the other breast tumor locations group included 798 patients with 810 lumpectomies (86.2%). We did not find any significant differences in the rate of early surgical complications and involved margins, local and systemic recurrence rates, time to progression, or overall survival between the groups. Oncoplastic breast-conserving surgery is a safe procedure for the treatment of central tumors. In our opinion, the proposed classification of partial breast reconstruction techniques and an algorithm of their choice allow for effective restoration of the breast shape and volume according to the parameters of the tumor, breast, surgeon, and patient preferences.

Combining Wise-pattern Volume Displacement and Autologous Volume Replacement to Facilitate Oncoplastic Breast Conservation

Background: Oncoplastic breast conservation has been classically divided into volume displacement (VD) or volume replacement (VR) techniques. There have been few descriptions of merging these two approaches. This report describes our experience combining Wise-pattern VD and autologous VR to repair extensive partial mastectomy defects in patients with ptosis. Methods: A retrospective chart review was performed for patients who underwent combined Wise-pattern VD surgery and autologous VR by the author from June 2017 to June 2023, with at least 6 months follow-up. Patient demographics, oncological and intraoperative details, and complications were recorded. Results: Forty patients underwent Wise-pattern VD surgery combined with a medial intercostal artery perforator flap (five patients), lateral thoracic artery perforator/lateral intercostal artery perforator flap (18 patients), anterior intercostal artery perforator flap (five patients), or muscle-sparing latissimus dorsi flap (12 patients). The average tumor size was 4.0 cm (range, 1.5–9.1 cm), and specimen weight was 152 g (range, 33–415 g). Six patients (15%) required re-operation for positive margins. There was delayed healing of three (7.5%) donor sites. There were no flap failures. Two (5%) patients had clinically apparent fat necrosis without requirement for surgical revision. Conclusions: This report demonstrates the feasibility of combining Wise-pattern VD and autologous VR. We propose that oncoplastic breast-conserving surgery be no longer divided into two mutually exclusive approaches and that surgeons make liberal use of combining these approaches to address challenging cases of breast-conserving surgery.

The Utility of a Novel Bidirectional Lateral Intercostal Artery Perforator Flap for Reconstructing Partial Mastectomy Defects.

Smaller breasts require volume replacement to allow for breast conservation for large tumor to breast size ratios. The lateral intercostal artery perforator (LICAP) flap is one of the most commonly used approaches to replace volume as it readily fills lateral breast defects where most cancers typically arise. The LICAP flap was initially described with the bulk of its tissue volume oriented posteriorly, lateral to the breast footprint. Recently, the "reverse LICAP" flap was described, which uses the same perforators but recruits tissue instead from below the inframammary fold. Here, we combine these two approaches, preserving the same perforators, but harvesting tissue from both below the inframammary fold and lateral to the breast footprint, to create a single, larger, bidirectional LICAP flap. This modified flap replaces more volume than previously described for uni-directional approaches allowing us to potentially avoid mastectomy or more extensive flap reconstructions. Here, we describe 10 consecutive patients where the bidirectional LICAP flap was used to facilitate oncoplastic breast conservation.

Combining a Chest Wall Perforator Flap and Bioabsorbable Implant to Facilitate Oncoplastic Breast-conserving Surgery

Oncoplastic breast conservation is classically divided into two approaches: volume displacement and volume replacement (VR). These approaches are important to use when more than 20% of the breast is removed to avoid deformity. Smaller, nonptotic breasts require VR strategies from flaps based off of local chest wall perforators. When larger volumes are required, a flap based off the thoracodorsal artery can be used. Although this flap can replace larger volumes, it usually requires a position change with increased operative time, patient morbidity, and longer recovery while also exhausting a major reconstructive modality. In an effort to avoid this increased operative complexity, we have found that combining a local chest wall perforator flap and bioabsorbable implant, which has been previously shown to be safe and effective in reconstructing partial mastectomy defects, allows for a simpler VR strategy in patients who might otherwise require a more extensive thoracodorsal artery-based flap surgery or a mastectomy. Here, we present 10 cases where we combined flaps based off the lateral, anterior or medial intercostal artery perforators or lateral thoracic artery perforator with a bioabsorbable implant to successfully perform oncoplastic breast conservation in patients who might otherwise be marginal candidates for VR using a local chest wall perforator flap.

P224 Quality of life and patient outcomes after oncoplastic breast conservation versus nipple sparing mastectomy and immediate breast reconstruction

P224 Quality of life and patient outcomes after oncoplastic breast conservation versus nipple sparing mastectomy and immediate breast reconstruction

Abstract OT1-20-01: SentiNot 2.0: Avoid unnecessary Sentinel Lymph Node Biopsies in women with DCIS

Abstract Background Approximately 15-30% of women with a preoperative diagnosis of ductal carcinoma in situ (DCIS) will be diagnosed with invasive cancer (IBC) on specimen pathology. Risk of upgrade, and impairment of lymphatic outflow after breast surgery, mainly mastectomy, are drivers for upfront sentinel lymph node dissection (SLND). In the SentiNot feasibility study, marking the SLN by superparamagnetic iron oxide nanoparticles (SPIO) injection during primary surgery minimized unnecessary SLNDs, allowing for delayed SLND (d-SLND) only in those with IBC up to 50 days after primary surgery. This policy resulted in that 78.3% study participants avoided upfront SLND. In the d-SLND setting, SPIO detection outperformed the isotope (98.5 vs 60.6%), regardless of type of breast procedure. Incremental healthcare costs were reduced by 8.5% (485 USD per patient) for the entire trial population (ref 1). Prospective Clinical Trial Design SentiNot 2.0 (ClinicalTrials.gov Identifier: NCT04722692), is currently accruing data, powered to examine the detection rate of SPIO over isotope±blue dye during d-SLND. Trial candidates are: patients with a diagnosis of high-risk DCIS/pLCIS (mass-lesions, microinvasion, grade 3, grade 2 &amp;gt;20mm) regardless of type of breast surgery, and patients with planned breast surgery that precludes safe and accurate axillary mapping at a d-SLND (extensive oncoplastic breast conservation, tumors of the axillary tail and mastectomy). In d-SLND, study patients receive isotope±blue dye and within-patient-randomization is performed for which detection method to start with (SPIO-first vs. isotope-first). The trial is stratified for mastectomy and breast conservation. Secondary outcomes are nodal concordance (SPIO vs. isotope) at d-SLND, quality-of-life and health-economy outcomes. Present and Planned Accrual Total target accrual is 500 d-SLNDs. Insofar, 360 women have been included at six different sites in Sweden, Hong Kong, and the USA. Currently, data accrual and institution recruitment is active and expanding. For more information about the trial please refer to ClinicalTrials.gov Identifier: NCT04722692. For discussion regarding potential participation contact dr Andreas Karakatsanis (andreas.karakatsanis@surgsci.uu.se). Citation Format: Eirini Pantiora, Staffan Eriksson, Lida Pistiolis, Roger Olofsson Bagge, Gyula Nagy, Alastair M. Thompson, Vivian Man, Ava Kwong, Andreas Karakatsanis, Fredrik Wärnberg. SentiNot 2.0: Avoid unnecessary Sentinel Lymph Node Biopsies in women with DCIS [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-20-01.

Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study.

The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p=0.656) or the function of the chest wall (Breast-Q 82 vs 82, p=0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p=0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs-1, p=0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.

Oncoplastic Breast Conservation made Possible with Precision Marker for Expansive Disease - A Case Study

Oncoplastic Breast Conservation made Possible with Precision Marker for Expansive Disease - A Case Study

BREAST ONCOPLASTY IN INDIA: FEASIBILITY AND EARLY EXPERIENCE FROM TIER 2 CITY IN NORTH INDIA.

Breast conservation therapy (BCT) is the accepted treatment for early breast cancer. Despite high incidence of carcinoma breast in India, BCTrates are very low as compared to the west. In this article, we wish to share our experience of breast conservation with oncoplasty in Indian women. A retrospective analysis of case records of patients treated with oncoplastic breast conservation from August 2019 to August 2022 at our institution was carried out. Demographic patient data, stage of disease, location of primary tumour, reconstruction method used, post-operative complications and aesthetic score of patients were analysed. There were 39 patients. Most common stage of presentation was T2N0 in 20 patients (51.2%). Tumour arising in upper outer quadrant was most common site, seen in 24 (61.5%). Oncoplastic procedure of volume displacement was done in all patients. Overall surgical complications included wound infection with or without dehiscence and seroma formation. Breast conservation with oncoplasty is oncologically safe for early breast cancer treatment and has good cosmetic outcome with high patient satisfaction rates. Our results show that BCS with oncoplasty is practical outside major cancer centres also.

Determination of Oncologic Outcomes, Satisfaction, and Psychosocial Well-being in Patients with Breast Cancer after Oncoplastic and Conventional Breast Conserving Surgery.

Breast cancer is the most common cancer in women and surgery is necessary for its treatment. We aimed to determine the oncologic outcomes, satisfaction with breasts, and psychosocial well-being in the patients with breast cancer, after oncoplastic and conventional breast conserving surgery (BCS). The patients with breast cancer from Shahid Motahari Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran from December 2020 to December 2021 were allocated to two groups, one who had undergone BCS alone and the patients who had undergone oncoplastic BCS. For all the patients, demographic data, data about surgery, oncologic outcomes, wound complications, and BREAST-Q© questionnaire score were collected and compared between two groups. The mean age of the patients in the oncoplastic BCS and BCS group was 48.13±9.73 (median=48), and 50.01±8.47 (median=50) years, respectively. The mean score of psychosocial well-being was higher in the oncoplastic BCS group in comparison with BCS alone. (P-value< 0.0001). Also, the mean score of satisfaction with breast was higher among the oncoplastic BCS group in comparison with the BCS group (P-value< 0.0001). Replacing traditional BCS with oncoplastic BCS does not adversely affect the oncologic results of surgery but improves the consequent psychosocial well-being and satisfaction in the patients.

The iTOP trial: Comparing immediate techniques of oncoplastic surgery with conventional breast surgery in women with breast cancer - A prospective, controlled, single-center study

IntroductionOncoplastic techniques allow resection of larger tumors, permitting breast conservation in cases otherwise requiring mastectomy. We sought to prospectively compare quality of life (QoL) in patients undergoing oncoplastic surgery as compared to conventional breast conservation (CBC) or mastectomy is lacking. MethodsPatients diagnosed with BIRADS IV-VI lesion were eligible if resection of ≥10% of the breast volume was planned. Patients were allowed to decide whether they wanted to undergo CBC or oncoplastic breast conservation (OBC). Patients who underwent mastectomy and immediate breast reconstruction (IBR) were also included for comparison. The primary endpoint was breast self-esteem using the Breast Image Scale (BIS) at 12 months, secondary endpoints were perioperative morbidity and QoL using the BREAST-Q questionnaire. ResultsFrom 2011 to 2016, 205 patients were included in the study. 116 patients (56.6%) received CBC, 46 (22.4%) OBC and 43 (21%) MIBR. Women in the OBC group were more likely to have tumors ≥ 2 cm than those in the CBC group (34.7% vs. 17.5%, respectively). Women who underwent MIBR were more likely to have tumors > 5 cm than those in the CBC and OBC groups (23% vs 1% and 10%, respectively). The BIS and BREAST-Q improved in each group after 12 months but did not differ significantly between groups at any time point. Surgical complications (seroma, bleeding, infection, necrosis) were numerically more likely in the OBC and MIBR groups. ConclusionOBC and the MIBR allow for resection of larger tumors with a similar quality of life as CBC.

Surgical and oncological outcomes of oncoplastic level 2 procedures versus Immediate Direct to Implant Reconstruction with ADM

Introduction: This study compares the surgical and oncological outcomes of level 2 oncoplastic breast conservation surgery (Therapeutic mammoplasty-TM, Chest wall perforator flaps-CPF) and immediate direct to Implant reconstruction (IDTIR) with ADM.

Abstract P4-11-35: Patient-reported outcome after oncoplastic breast conservation surgery using level I or II techniques without contralateral symmetrization

Abstract INTRODUCTION Oncoplastic breast surgery (OPS), has widened the scope of breast conserving surgery (BCS) enabling larger resections with acceptable oncological safety and cosmetic outcomes. It often involves longer incisions and additional contralateral symmetrization procedures on the normal breast. However, patient’s perceptions on outcome may differ from that of the clinician and it is essential to evaluate feedback from patients undergoing OPS to determine the acceptability of these complex procedures in clinical practice. In this regard Health-related quality of life measures (HR-QoL) are an excellent means of evaluating the outcome of medical care. Further, it is well known that socio-cultural differences may reflect on the attitude of patients to treatment outcome and most of the data on OPS and HR-QoL available reflect western thought processes. Based on the feedback of our patients we designed a simple and practical patient-reported outcome measure (PROM) questionnaire reflecting the important issues as voiced by our patients and validated it using the QQ-10, indicating good face validity and acceptability of our questionnaire. We undertook this study to understand the acceptability of OPS level I and II procedures and to determine the satisfaction with the cosmetic outcome as well as the need for contralateral symmetrization procedures in our patients. PATIENTS AND METHODS Based on patient feedback, a questionnaire (Q-IN) was developed and validated by the QQ-10. It includes 9 questions reflecting three domains of general acceptability of the procedure, satisfaction with cosmetic outcome and degree of functional impairment in terms of altered sensation. 126 patients with breast cancer who underwent OPS level I or II without contralateral symmetrization were included in the study. Q-IN was self-administered during routine follow-up, following surgery, between January 2017 and December 2018. It was validated by 31 patients (24.6%)who also answered the QQ-10, a questionnaire designed to assess patients’ views on their experience of using PROM questionnaires during their medical care. The mean value score of the Q-IN as per the QQ-10 was high (84.79%, SD 11.7%) and mean burden score was low (20.96%, SD 24.6%) indicating that it has good face validity and is relevant and acceptable to our patients.RESULTS Mean age of patients was 51 years (21-77 years) and median follow up was 41 months (2- 156 months) following OPS. Majority of patients 124 (98%) were happy about undergoing BCS and had no doubts about the procedure. Most, 115 (91%) were very happy with the cosmetic appearance (shape, size and overall appearance) of the breast after OPS, 10 (8%) were happy and 1 patient (1%) was unhappy. Although most, 103 (81.7%) women, noticed a difference in size the majority 92 (89.3%) felt it was minimal and only 8 (7.8%) found a major difference in size. Of the 78 (61.9%) women that felt a difference in shape, 63 (80.8%) felt it was minimal and 11 (14.1%) reported a major difference. The quality of life of 23 (18.3%) patients was affected by the change in shape and size of the breast. Of these 17(74 %) only thought about the change in appearance, and in 6 (26%) it made a minor difference. Breast sensation was altered in 76 (63.3%) women and that of the nipple-areola complex (NAC) in 77 (58.7%). Of them, 25 (32.9%) reported no sensation in the breast and 30 (40.5%) felt no sensation in the NAC. When asked about a contralateral symmetrization procedure on the normal breast, only 2 (2%) said they would want to undergo symmetrization surgery. CONCLUSIONS Most patients undergoing level I or II oncoplastic breast surgery are happy and satisfied with the overall cosmetic and functional outcome. Only 2% of patients would like to undergo a contralateral symmetrization procedure to match the operated breast. Citation Format: Vinay Deshmane, Anuja Raniwala, Clotilda Cardoza. Patient-reported outcome after oncoplastic breast conservation surgery using level I or II techniques without contralateral symmetrization [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-35.

Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon's practice in a busy community hospital in Canada.

Background:Oncoplastic breast surgery aims to maintain quality of life by pre-empting and mitigating against breast asymmetry while not compromising oncological effectiveness. This case series demonstrates the implementation of an effective oncoplastic surgical practice in a community hospital within Canada and shows low rates of perioperative complications as well as high levels of patient-reported outcome measures.Methods:A retrospective chart review of patients diagnosed with stage 0–3 breast cancer treated with level I and level II oncoplastic techniques by a single breast surgeon was undertaken. Patient, tumour, procedure, and outcome data were collected. Patient satisfaction was assessed with the Breast-Q questionnaire administered pre- and postoperatively.Results:Oncoplastic breast conservation surgery was performed on 340 patients over a 31-month period. The average size of breast lesions was 1.8 cm, with 96 patients having lesions 2–5 cm in size and 10 patients having tumours larger than 5 cm. Thirty (8.8%) patients experienced a complication requiring intervention. The positive margin rate was 9.4%, and the completion mastectomy rate was 4.7%. Breast Q scores increased across breast satisfaction, process of care, psychosocial, physical, and sexual satisfaction domains postoperatively.Conclusion:This case series demonstrates the feasibility of an oncoplastic breast surgery practice in a busy community hospital in Canada. This adds to the growing body of North American data on the clinical and oncological safety of these techniques and introduces the idea of collecting patient-reported outcome measures within a Canadian population. We hope that this enables these techniques to become the standard of care in North America.

Prospective development of a standardized assessment algorithm for advanced oncoplastic breast conservation. A report from the OncoPRO Value trial

Background: Oncoplastic breast conserving therapy (OPBCT) reduces mastectomy rates while achieving low re-excision rates and good cosmetic outcomes. Several clinical algorithms have been proposed to facilitate decision-making, but there is no consensus and classifications based on excision cut-offs are arbitrary at large. The OncoPRO Value trial aims to develop a standardized oncoplastic assessment for tailored OPBCT, integrating patient preferences and patient reported outcomes in the shared decision-making process.

2021 Canadian Surgery Forum: Virtual, online Sept. 21-24, 2021.

# 01. Design and validation of a unique endoscopy simulator using a commercial video game {#article-title-2} Procedural simulation has been shown to enhance early endoscopy training. In this proof of concept study, we aimed to show that a first-person shooter (FPS) video game with a novel in-house