Comparative study between Single incision versus two separate incisions in conservative breast surgery and axillary clearance

Background Single incision technique is an oncoplastic surgery aimed to remove both the breast tumor and axillary clearance through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. However this procedure is more difficult, since visualization and the resection space are limited, demanding greater experience from the surgeon. Objective To compere between single incision in excising upper outer breast tumor and axillary clearance versus two separate incisions in conservative breast surgery as regard cosmetic outcome, seroma formation and time needed for drainage for both breast and axilla. Patients and Methods This is a prospective cohort study to compere between single incision in excising upper outer breast tumor and axillary clearance versus two separate incisions in conservative breast surgery as regard cosmetic outcome, seroma formation and time needed for drainage for both breast and axilla. Results Single incision resulted in only one small scar and provided feasible breast cancer treatment with excellent acceptance and satisfaction by the patients. Double incision on breast and axilla is associated with lower rate of long-term postoperative lymphedema and minimizing disruption of axillary lymphatic and vascular channels. Conclusion The single incision technique was shown to be providing better cosmetic result but more seroma formation. With the confirmation of oncologic and surgical efficacy, future areas of study will include long term evaluation of patient oncologic, functional, and cosmetic outcomes following the single incision approach.

231 Breast Lymphedema After Breast Conservative Surgery; An Up-To-Date Systematic Review

Background While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, Aim: We aimed to provide a systematic review to help avoiding or management of breast lymphoedema Method The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits Results A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean BMI was 28.4, most of the studies included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping. Conclusions Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.

P28 Breast Lymphedema after breast conservative surgery; an up-to-date systematic review

Background While arm lymphedema following breast cancer treatment is a common complication; breast lymphedema following treatment is not uncommon. Several risk factors were found to contribute to breast lymphedema, including axillary surgery, high BMI, increased bra cup size, adjuvant chemotherapy, locoregional and radiotherapy boost and upper outer quadrant tumours. Aim We aimed to provide an up to date systematic review to help avoiding or managing breast lymphoedema after Breast conservative surgery for breast cancer. Methods The search term 'breast lymphedema' was combined with 'breast conservative surgery' and was used to conduct a literature research in PubMed and Medline. The term lymphedema was combined with breast, conservative and surgery to search Embase database. All papers published in English were included with no exclusion date limits Results A total of 2155 female patients were included in this review; age ranged from 26 to 90. Mean body mass index was 28.4, most of the studies included patients who underwent conservative breast surgery. Incidence of breast lymphedema ranged from 24.8% to 90.4%. Several risk factors were linked to breast lymphedema after conservative breast surgery, such as body mass index (BMI), breast size, tumour size, tumour site, type of surgery and adjuvant therapy. Treatment options focused on decongestive lymphatic therapy, including Manual lymphatic drainage (MLD), self-massaging, compression bras or Kinesio taping. Conclusion Breast lymphedema is a relatively common complication, yet there is no clear consensus on the definition or treatment options.

Mammographic abnormalities after conservative breast surgery with immediate lipofilling: case control study

Introduction: Conservative breast surgery with immediate autologous fat grafting reconstruction (lipofilling) is emerging as a new technique for breast reconstruction. Concerns have been raised about mammographic abnormalities caused by immediate lipofilling. Lipofilling can lead to mammographic abnormalities, with diffuse microcalcifications as the most frequent, followed by oil cysts. The incidence of radiological abnormalities resulting from fat grafting varies significantly in the literature, ranging from 0 to 86%. However, until now, no study has addressed the mammographic abnormalities found after conservative breast surgery with immediate lipofilling. Methods: This case-control study involved patients submitted to conservative breast surgery with or without immediate lipofilling in our facility between 2010 and 2013. Pathological and clinical characteristics of both groups were compared. The patients included underwent breast imaging tests with digital mammography every six months for two years. In each period, image changes were compared between the two groups. Results: Patients submitted to conservative breast surgery with immediate lipofilling were compared to those without immediate lipofilling. The mean volume grafted was 125±39 cc. Patients who underwent immediate lipofilling were younger than control patients (52.5 vs. 58.9 years, p=0.001). Other pathological and clinical characteristics were not statistically different between the two groups. Mammographic findings revealed no significant differences in the frequency of nodules (0 vs. 8, p=0.2) and calcifications (30 vs. 92, p=0.2) between patients with and without lipofilling. However, patients submitted to immediate lipofilling presented a higher frequency of oil cysts (6 vs. 5, p=0.01) and fat necrosis (3 vs. 1, p=0.03) after 24 months of radiotherapy. No patient was submitted to biopsy during the follow-up. Conclusions: This was the first study to show that lipofilling concomitantly with conservative breast surgery does not seem to induce significant radiological changes. These findings indicate that, from a radiological point of view, immediate lipofilling is safe and can be a new tool in breast oncoplasty.