P48 Surgical treatment of early breast cancer — Moving towards breast conservation and immediate breast reconstruction

Introduction: Breast cancer is a hypercoagulable state and predisposes patients to venous thromboembolism (VTE). We sought to determine independent risk factors for VTE post-surgical treatment for breast cancer using a national risk adjusted database. Methods: Participant Use Data Files in the National Surgical Quality Improvement Program database from 2012 to 2016 were studied. Female patients with invasive and in situ breast cancer that underwent either mastectomy with immediate breast reconstruction, autologous or implant-based, or lumpectomy were identified with current procedural terminology and International Classification of Diseases-9 codes. Venous thromboembolism was defined as occurrence of deep vein thrombosis or pulmonary embolism. Non-VTE and VTE groups were compared and statistical differences were addressed through propensity score weighting. The balance of the model was checked with comparing standardized differences before and after weighting. Multivariate logistic regression was used to determine independent predictors of VTE. Results: A total of 137 449 procedures were identified. After applying exclusion criteria, 40 986 lumpectomies and 35 909 mastectomies remained for the analysis (n = 76 895). Venous thromboembolism was found in 172/76 895 patients (0.2%). In the weighted data set, mastectomy, BMI> 35 and length of stay >3 days were predictors of VTE. The greatest odds ratio (OR) was observed with mastectomy with immediate autologous breast reconstruction (OR = 8.792, P < .001; 95% CI: 3.618-21.367). Conclusion: Autologous breast reconstruction was associated with highest risk of VTE. Hospital LOS >3 days, BMI >35, and general anesthesia also increase odds of developing VTE. These variables are predisposing factors that need to be considered in patients undergoing surgical treatment for breast cancer.

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Outcomes of skin sparing mastectomy with immediate breast reconstruction with Latissimus dorsi (LD) flap in surgical treatment of breast cancer

QJM ◽

10.1093/qjmed/hcaa050.060 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S M Othman ◽

A K Elfekky ◽

M E Elshinawi ◽

A G Othman

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Breast Reconstruction ◽

Latissimus Dorsi ◽

Breast Conservation ◽

Immediate Breast Reconstruction ◽

Breast Conservation Surgery ◽

Autologous Reconstruction ◽

Immediate Reconstruction ◽

Aesthetic Result

Abstract Introduction Breast cancer is a devastating disease affecting women of all ages worldwide with the age incidence in Egypt being one decade younger than the mean age incidence, the latissimus dorsi (LD) flap is an important volume-replacement option due to its stability and versatility as an autologous flap. LD flap could be used for total breast reconstruction after mastectomy in selective cases or to fill a large quadrantectomy defect. Aim The aim of this study is to estimate the oncologic and aesthetic outcomes and the procedure-related complications of latissimus dorsi (LD) flap with skin sparing mastectomy in management of breast cancer. Patients On 25 patients breast cancer underwent skin-sparing mastectomy with immediate reconstruction using LD flap, Methods All patients were subjected to : (Complete history taken, General examination, Local examination and routine investigations) Surgical procedures 25 patients with breast cancer underwent skin-sparing mastectomy with immediate reconstruction with LD flap. Results Mean age of included patients was 41.12 years with mean BMI 29.17 kg/m2, regarding tumor classification DCIS represented 8% LCIS represented 20% IDC represented 32% ILC represented 40% of all patients, Positive lymph node 1-3 in 40% of patients and more than 3 in 20% of patients and 40% of patients had negative lymph node,96% of patients had no recurrence on the other hand only 4% shows locoregoinal recurrence, Regarding postoperative immediate complications 72% of patients showed no complications. Discussion In the current study we aimed to estimate the oncologic and aesthetic outcomes and the procedure-related complications of latissimus dorsi (LD) flap with skin sparing mastectomy in management of breast cancer. Conclusion Skin sparing mastectomy with immediate breast reconstruction using latissimus dorsi muscular flap allows single-stage, totally autologous reconstruction with a satisfactory aesthetic result, low morbidity, and good quality of life. Recommendations Breast cancer patients are best managed by a multidisciplinary team, Breast conservation surgery does often leave a significant deformity which can best be corrected by an immediate LD flap reconstruction, this method is simple and effective, our concept should be further analyzed in larger comparative studies.

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