Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction.

BACKGROUND: Implant-based reconstruction accounts for the majority of breast reconstructive procedures performed in Australia. More recently, immediate prepectoral implant reconstruction using the TiLOOP Bra Pocket has gained popularity. This study compares post-surgical complications and patient-reported quality of life outcomes between immediate prepectoral and dual plane implant reconstruction. METHODS: A retrospective study of 80 consecutive patients who underwent nipple-sparing mastectomies and immediate implant reconstruction was conducted. Implants were either completely covered with TiLOOP Bra and/or TiLOOP Bra Pocket (pfm medical, Cologne, Germany) and secured in the prepectoral space (prepectoral group) or placed in the subpectoral plane with inferolateral mesh coverage (dual plane group). Data surrounding patient demographics, clinical details and post-surgical outcomes were compared. Patient-related quality of life outcomes were assessed with the Breast-Q questionnaire. RESULTS: A total of 80 patients (109 breasts) operated on between June 2016 and December 2018 were included. The prepectoral and dual plane groups comprised of 40 patients each, including 50 and 59 operated breasts, respectively. Post-operative complications were comparable with 11 (22%) overall complications in the prepectoral group and eight (14%) in the dual plane group (P = 0.313). Implant loss was uncommon with four (8%) cases in the prepectoral group and five (8.5%) in the dual plane group (P = 0.929). Patient-reported quality of life outcomes were superior after prepectoral reconstruction with patients reporting a significantly higher score in the satisfaction with breasts domain (68.9 versus 57.5; P = 0.036). CONCLUSION: Immediate prepectoral implant reconstruction with the TiLOOP Bra Pocket was associated with improved patient satisfaction and demonstrated no difference in early post-operative outcomes.

Axillary reverse mapping in patients with breast cancer: Is it oncologically safe?

BACKGROUND: Axillary reverse mapping (ARM) is a technique used to identify the lymphatics draining the arm. The aim of this study was to examine the prevalence and predictors of ARM node metastases in breast cancer patients undergoing an axillary lymph node dissection (ALND). METHODS: A total of 87 patients were enrolled in this study. Patent V Blue dye was injected in the upper arm for ARM node localization. All patients had an ALND with the identified ARM node removed and sent separately for histologic analysis. RESULTS: Of 67 (77%) patients in whom an ARM node was identified, 49 (73%) were negative and 18 (27%) were positive for metastases on final histopathology. Positive ARM node status was significantly associated with advanced axillary disease, and larger primary cancers. Patients requiring a completion ALND due to a positive sentinel lymph node biopsy (SLNB) with non-suspicious ARM nodes during surgery did not have ARM node metastases. CONCLUSIONS: There is a high risk of ARM node involvement, approximately a quarter, in patients with preoperatively known lymph node metastases from breast cancer. However, it may be safe to preserve a clinically non-suspicious ARM node in patients with a positive SLNB who require a completion ALND. J. Surg. Oncol. 2016;113:726-731. © 2016 Wiley Periodicals, Inc.

Treatment of inferior pole breast cancer with the oncoplastic 'Crescent' technique: the Westmead experience.

BACKGROUND: Conservative treatment of inferior breast cancers has been a challenge for breast surgeons due to the high incidence of poor cosmetic outcomes. In 2008, Renouvel et al. described an oncoplastic 'Crescent' technique utilizing an advancement flap to fill the defect after cancer excision in the lower pole of the breast. A follow-up study demonstrated no local recurrence at 45 months and excellent or good cosmetic outcomes in over 70% of patients. This study aims to assess the outcomes of applying this 'Crescent' technique in a breast surgical unit. METHODS: Retrospective study carried out at Westmead Breast Cancer Institute on 16 patients treated with the 'Crescent' technique. Data regarding patient and tumour characteristics, operative outcomes and complications were obtained. Patients were invited to complete a modified Breast-Q questionnaire and have their photographs taken to assess patient satisfaction and cosmetic outcome. RESULTS: Over 12 months, 16 women underwent the 'Crescent' technique. Mean tumour size was 11.4 mm (range 2.0-36 mm) and median resected volume was 33.0 g (range 15-117 g). One patient (7.1%) had involved margins. One patient returned to theatre for evacuation of a haematoma. Cosmetic outcome was excellent or good in over 80% of patients. CONCLUSION: The oncoplastic 'Crescent' technique is a safe and reliable technique with good cosmetic outcome that can be implemented in a breast surgical unit.

Relevance of the American College of Surgeons Oncology Group Z0011 Trial to breast cancer in the Australian setting.

BACKGROUND: Conventional wisdom suggests that a patient with a positive sentinel node requires a completion axillary clearance to obtain full staging and durable regional control. However, this dictum has been challenged by the recent American College of Surgeons Oncology Group Z0011 Trial demonstrating that women with node-positive breast cancer who underwent sentinel node biopsy only, and were treated with breast conserving surgery and radiation, had equivalent locoregional recurrence and survival rates to those who had a completion axillary clearance. The aim of our study was to determine what the clinical impact of the Z0011 findings might be if patients were managed according to the Z0011 criteria in an Australian teaching hospital setting. METHODS: We performed a retrospective review, using prospectively collected data, of all female patients with breast cancer assessed at the Westmead Breast Cancer Institute in 2010 and identified the subgroup who would potentially have fulfilled all Z0011 criteria. The characteristics and management of this group were compared with node-positive and to mastectomy patient subgroups. RESULTS: A total of 280 patients with invasive breast cancer were identified. Twenty-six patients satisfied all Z0011 criteria, representing 9.3% of all patients and 21.5% of node-positive patients. Twenty-two (84.6%) patients had a subsequent axillary clearance, with six (27.3%) having additional positive nodes. CONCLUSIONS: The Z0011 study is relevant to 9.3% of all breast cancer patients and 21.5% of node-positive breast cancer patients treated in a major Australian teaching hospital.