1331 An Observational Study Investigating the Role of Therapeutic Mammoplasty in Breast Tumours Greater Than 40mm

Aim For large breast tumours, therapeutic mammoplasty (TM) provides a breast-conserving approach to the conventional mastectomy. The prevalence and outcomes following TM in larger breast tumours is relatively unknown. This study aims to analyse the short-term outcomes and local recurrence rate following TM for breast tumours of varying sizes. Method Single-centre retrospective analysis of data from all patients undergoing a TM between June 2016-October 2019. Variables reviewed included age, imaging, tumour size, pre-operative histology, adjuvant chemotherapy and radiotherapy, post-operative pathology, post-operative complications, and recurrence rates. Results 192 patients undergoing a TM procedure were included, 126 (66%) patients had tumours <40mm and 66 (34%) patients had tumours >40mm. The average age of participants was 61 years with a mean follow-up of 31 months. The mean size of tumours >40mm was 56.8mm, of these patients 15% had positive margins, 2 (3%) patients required a further mastectomy and 8 (12%) underwent margin re-excisions. In lesions >40mm there were six episodes (9%) of T-junction delayed wound healing with two requiring surgical management, two episodes (3%) of wound infections requiring antibiotics and four episodes (6%) of seroma with one requiring surgery for an infected seroma. Two patients were found to have metastatic disease and no patients were found to have local recurrence at the most recent follow-up. Conclusions Our study demonstrated TM offers a surgical option with suitable cosmetic and oncological outcomes for women with early breast tumours above 40mm. These results warrant further study into the long-term outcomes for patients undergoing TM with tumours >40mm.

1573 Can the Technique of Local Perforator Flaps Reduce the Volume of Mastectomies?

Aim National reported mastectomy rate varies from 25% - 45%. Also, when a reduction therapeutic mammoplasty is needed, symmetrisation of the contralateral side will follow. Can the “relative new” technique of local perforator flaps, reduce the volume of mastectomies and contralateral surgery in a District General Hospital? Method Retrospective review of yearly breast cancer treatment operations in Ipswich Hospital. Results 332 surgical operations performed for breast cancer. 79/332 (23,7%) had mastectomy, 54/332 (16,26%) had therapeutic mammoplasty with symmetrisation contralateral surgery, 32/332 (9,63%) had local perforator Flap Surgery. From the perforator flap operations, 23/32 (23/332: 6,92%) would have mastectomy (+/- reconstruction) and 9/32 (11/332: 2,71%) would have therapeutic reduction mammoplasty with contralateral symmetrisation surgery if this surgical option was not available. 0/32 (0,00%) of the local perforator flaps failed. Conclusions Local perforator flaps have resulted in 6,92% reduction in mastectomy rate (also eliminating the possible need for reconstructions). This was in small volume breasts and lower pole carcinomas and 2,71% reduction in symmetrisation surgery. This reduction also reduces the cost of cancer treatment without compromising oncological outcome or patient satisfaction.

THERAPEUTIC MAMMOPLASTY AUDIT FROM A SINGLE INSTITUTIONAL COHORT FROM INDIA

Introduction Therapeutic Mammoplasty (TM) is a Oncoplastic Breast Surgery (OBS) technique suitable for medium-to-large breasts with ptosis with large or multifocal/multicentric (MF/MC) tumors. Several studies have indicated that TM expands the scope, extent, and application of breast conservation surgery. This report describes in detail TM outcomes in Indian breast cancer (BC) patients. Methods From our single institutional cohort (n = 211), we present data related to surgical techniques, clinical management, oncological safety, cosmetic and patient reported outcomes (PROMs, based on Breast-Q questionnaire) from BC patients who underwent TM (categorized as simple, complex, extreme and split-reduction type) Results Mean age at diagnosis was 48.7 years. Majority of these patients had advanced stage (II/III) disease. 178 patients consented and 171 completed 1 year follow-up from 3 main groups (a) simple (n=87) (b) complex (n =39) and (c) extreme TM (n = 49). The post-operative complication rates were low (<10%) without any delay in adjuvant treatment. Cosmetic scores were good-to-excellent (n = 154). Post- 1-year PROMs (n =149) revealed good-to-excellent score for satisfaction with breast, cosmetic outcome and psychosocial well-being for all TM types. Conclusion Our study is a first detailed report describing a multi-factorial audit in TM single institutional cohort in Indian BC patients. We propose that our TM technique/s may be optimally suited for BC scenarios common in India namely (a) advanced stage BC patients with moderate-to-large breasts with mild/severe ptosis (b) multifocal, multicentric tumors (c) LABC at initial presentation.

Cosmetic Outcomes and Symmetry Comparison in Patients Undergoing Bilateral Therapeutic Mammoplasty for Breast Cancer

Background Breast-reduction techniques are increasingly used in oncoplastic breast surgery. Bilateral therapeutic mammoplasty has the benefit of decreasing breast volume, enabling resection of larger tumors, and the potential to assure good postoperative symmetry. The aims of this study were to objectively asses the cosmetic outcomes of therapeutic mammoplasty in patients with breast cancer, using the breast cancer conservative treatment cosmetic results (BCCT.core) software, to compare this score with the surgeon’s score and the patient’s assessment, and to evaluate if other defined parameters have an impact on cosmetic outcomes. The secondary aim was to compare breast symmetry pre- and postoperatively. Materials and Methods We enrolled 146 consecutive patients with primary breast cancer who underwent therapeutic mammoplasty between 2011 and 2018 in Kristianstad Central Hospital, Sweden. We retrospectively collected data from patients’ records. We analyzed the BCCT.core score using postoperative photographs to objectively evaluate cosmetic outcomes on a four-grade scale and compared with preoperative photographs to evaluate symmetry. Cosmetic outcomes were also assessed subjectively by patients and surgeons, using a 10-point Likert scale. Results The majority of patients (89%) had good or excellent BCCT.core scores, which correlated with surgeons’ scores, rs = − 0.22 (p < 0.001). Overall, patients were more satisfied with the cosmetic outcomes than the surgeons (p < 0.001). Evidence supporting an association between the defined clinicopathological variables, for example, tumor size, and cosmetic outcomes, was weak. Conclusion Therapeutic mammoplasty yields a very good cosmetic outcome, evaluated both by subjective and objective measurements. Importantly, symmetry can be improved in patients with asymmetry.