P86. Patient satisfaction following reconstructive and oncoplastic breast surgery

P86. Patient satisfaction following reconstructive and oncoplastic breast surgery

ABSTRACTS P85. Pre-operative anaemia in patients with breast cancer is associated with lymph node metastasis and the systemic inflammatory response bu...

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ABSTRACTS P85. Pre-operative anaemia in patients with breast cancer is associated with lymph node metastasis and the systemic inflammatory response but not survival Victoria Walker2, Roslyn Wallace1, Arfon Powell2, Joanne Edwards1,2 1 Western Infirmary Glasgow, Glasgow, UK 2 University of Glasgow, Glasgow, UK Background: There is a now a growing body of evidence to suggest that patients who develop anaemia during adjuvant chemotherapy for high risk stage II and III disease is associated with poorer outcome. It is possible therefore that pre-operative anaemia may offer a novel prognostic marker for patients undergoing surgery. This study aims to examine the relationships between pre-operative anaemia, tumour proliferation, clinicopathological factors and survival in patients undergoing surgery for breast cancer. Methods: 168 women undergoing surgery for breast cancer between 2001-2002 with full clinicopathological data including haemoglobin (Hb) and Glasgow Prognostic Score (GPS) were studied. Tumour proliferation was assessed through immunohistochemistry using KI67. Analysis of survival included clinical and pathological data in a multivariate (Cox) model. Results: On Chi-squared analysis, pre-operative anaemia was significantly associated with high GPS (P¼0035), Invasive lobular type (P¼0.034), higher Nottingham Prognostic Index (NPI) lymph node metastasis (P¼0.044) and high Ki67 (P¼0.033). Minimum follow up was 52 months and there were 15 cancer deaths. On univariate survival analysis only, ER negative status (P¼0.012), high NPI (P¼0.010), hypoalbuminaemia (P¼0.007) and endocrine therapy (P¼0.012) were associated with survival. On multivariate analysis, high NPI (HR 2.45; 95% CI (1.10-5.44); P¼0.028), hypoalbuminaemia (HR 7.56; 95% CI (1.67-32.22);P¼0.002) and endocrine therapy (HR 3.16; 95%CI (1.04-9.66);P¼0.043) retained independent significance. Conclusion: Pre-operative anaemia was significantly associated with presence of a systemic inflammatory response and higher lymph node metastasis. Further exploring the relationship between anaemia and the systemic inflammatory response may offer evidence for the use of antiinflammatory agents in high risk stage II-III disease. P86. Patient satisfaction following reconstructive and oncoplastic breast surgery Evgenia Theodorakopoulou, Tim Rattay, Jaroslaw Krupa Glenfield Hospital, University Hospitals of Leicester, Leicester, UK Introduction: Breast cancer surgery has historically been associated with significant psychosocial morbidity. The development of reconstructive and oncoplastic techniques allows for more favourable cosmetic outcomes and improvement in post-operative self-perception and quality of life. The validated Breast-Q Questionnaire is a patient-reported outcome tool developed by the Memorial Sloan-Kettering Cancer Centre, determining patient satisfaction following surgery based on cosmetic outcome, body-confidence, psychosocial well-being and peri-operative care. Methods: Seventy-seven patients who underwent reconstructive and oncoplastic surgery at Glenfield Breast Centre (Leicester) under the care of a single surgeon over a two-year period were invited to complete the reconstruction and reduction modules of Breast-Q respectively. Responses were analysed using the Breast-Q scoring software - QScore. Results: Discussion: 54.8% of patients who responded underwent reconstructive surgery using LD flaps and/or implants. The remaining 45.2% had reduction mammoplasty/oncoplastic surgery. 74% of reconstruction patients reported satisfaction with overall outcome Vs 90% of mammoplasty patients. 70.6% of reconstruction patients were happy with the appearance of their breasts vs. 81.5% of mammoplasty patients. Satisfaction with sexual and physical well-being and with care received by surgeon/healthcare professionals was comparable between the 2 groups. Across both groups patients who scored low in their overall satisfaction also down-scored on their satisfaction with breast/nipple appearance,

1129 psychosocial and sexual confidence, and were less content with the information given by their surgeon pre-operatively. Conclusions: This unique study assesses the perceived success of breast cancer surgery using the views of patients themselves. Overall satisfaction with surgical outcome is related to patients’ physical and psychoemotional well-being post-operatively. P87. Does keeping the drains for a longer period after mastectomies lessen seroma formation? Andrea Pisesky Whipps Cross University Hospital, London, UK Background: The incidence of seroma formation is reported between 15.8% - 40% following mastectomy. Although the use of drains post-mastectomy is not essential, but utilization of drains, (24 hours to 7 days post mastectomy) remains standard practice for numerous surgeons across the UK. The optimum time for drainage removal is still under debate. Method: Retrospective study of 12 month period (2010-2011), comparing the incidence and volume of seroma formation between two practices was conducted. One surgeon removes drains 24 hours postmastectomy whilst the second surgeon removes drains at 72 hours or later. Results: A total of 92 mastectomy patients were included. 43 had drain removal within 24 hours and 49 had after 72 hours. There was no significant difference in the rate of seroma formation post drain-removal between the two groups (p¼0.3023, Chi squared test). 57.1% in the 72 hour group (28/49) whilst 44.1% (19/43) in the 24 hour group developed seroma. No difference in the volume of seroma drained between the two groups after removal of the drains (p¼0.2405). 24 hour group was 832.11 ml compared with 554.11 ml in the 72 hour group. The mean number of visits for aspiration was 4.63 in the 24 hour group relative to 3.75 in the 72 hour group. Conclusion: There was no difference in the rate of seroma formation or the total volume of aspirated fluid between the two identified groups (24 verses 72 hours) therefore, taking into account ease of clinical practice and patient preference, we recommend that drains be removed 24 hours post mastectomy. P88. A consecutive series of oncoplastic surgery for breast cancer based on a quadrant-per-quadrant atlas Eleanore Massey, Tarik Ihrai, Stephane Oden, Gabriel Kaufman, Claude Nos, Krishna Clough Paris Breast Centre, Paris, France Introduction: The majority of published techniques for oncoplastic surgery rely on an inverted T mammoplasty irrespective of tumour location. These techniques, although useful, cannot be adapted to all situations. A quadrant-per-quadrant atlas of mammoplasty techniques for large breast cancers was developed in order to offer breast surgeons a technique specific to tumour location, reducing the risk of postoperative complications and delay of adjuvant therapy. Methods: From 2005 to 2010, a series of eligible women with breast cancer were treated by quadrant-specific oncoplastic techniques. All complications and any delay in adjuvant treatment were prospectively recorded, as well as local and distant cancer recurrences. Cosmetic outcome was evaluated using a five-point scale. Results: There were 175 patients. The median tumour size was 22 (range 4 to 90) mm. Twenty three patients (13.1 per cent) had involved margins. Seventeen of these were treated by mastectomy and three had a re-excision. Complications occurred in 13 patients (7.4 per cent) leading to a delay of adjuvant treatment in three patients (1.7 per cent). After a median follow-up of 49 (23 to 96) months, three patients have developed a local recurrence. The mean score after cosmetic evaluation was 4.6 out of 5. Conclusion: A quadrant-per-quadrant approach of oncoplastic techniques for breast cancer was developed which tailors the mammoplasty for each tumour location. This panel of techniques should be a useful guide