A RARE CASE REPORT OF PRIMARY NEUROENDOCRINE CARCINOMA OF BREAST

we report a case of 51 year old lady, presented with complaints of hard lump in the right breast.On clinical examination lump of size 4x3cms in outer lower quadrant was noted. Ultrasonographic imaging showed evidence of 3x2cms ill dened hypoechoic lesion with spiculated margins and microcalcications. Trucut biopsy was done and histopathological report was given as Suspicious for malignancy which was followed by modied radical mastectomy with axillary clearance. Histopathological examination and Immunohistochemistry(IHC) was done.

TP8.1.6 Why do people remain in hospital after mastectomy?

Aims Mastectomy is established as a safe day-case procedure. Amidst the ongoing COVID-19 pandemic it is essential to find ways to continue elective surgery with greater efficiency. The aim of this study is to establish factors associated with overnight admission after simple mastectomy, enabling more effective pre-operative planning. Methods All patients undergoing simple mastectomy in our unit between January and October 2020 were included. Those undergoing immediate reconstruction were excluded. The electronic case notes were reviewed to include procedure performed and patient characteristics. Basic statistical analysis was performed. Results 95 patients underwent simple mastectomy (28 with axillary clearance and 58 with sentinel node biopsy). 56% of procedures were day-case. Axillary clearance was more common in the inpatient compared to the day-case surgery group (24% vs 45%). Both average age and ASA were significantly lower in the day-case compared to the inpatient group (p < 0.05). There was no significant difference in BMI or specimen weight between groups. 16 patients underwent simple mastectomy without drain insertion, none required admission. Of the patients admitted overnight following surgery, 50% were pre-planned admissions. 57% of these were for patients identified as high surgical or anaesthetic risk at pre-operative assessment. Overall 5 patients stayed in hospital due to patient preference. Conclusions In addition to axillary surgery performed, age, ASA and perceived pre-operative risk are associated with overnight admission following simple mastectomy. Knowledge of these factors can better inform pre-operative planning. Providing enhanced post-operative support at home may enable more patients to be discharged on day of surgery.

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.

Ultrasound to the Rescue: Axillary Clearance under Complete Regional Blockade

No single regional anaesthetic technique is capable of complete anaesthesia of the axillary region. Regional or interfascial nerve blockade could be an effective alternative where administering general anaesthesia is not feasible, with superior analgesia, favourable haemodynamics, and reduced opiate related adverse effects. Ultrasound guidance improves effectiveness and safety profile. We report a case of a successful axillary clearance conducted under combined regional blocks for an axillary nodal recurrence following mastectomy for a breast carcinoma, in a patient who was not fit for general anaesthesia due to a persistent lobar pneumonia and recurrent asthma exacerbations. Our experience and current evidence supersede the initial conceptions of difficult ultrasonic intercostobrachial nerve (ICBN) visualization.

Risk factors for implant failure following revision surgery in breast cancer patients with a previous immediate implant-based breast reconstruction

Purpose The aim of the current study was to evaluate risk factors and timing of revision surgery following immediate implant-based breast reconstruction (IBR). Methods This retrospective cohort included women with a previous therapeutic mastectomy and implant-based IBR who had undergone implant revision surgery between 2005 and 2015. Data were collected by medical chart review and registered in the Stockholm Breast Reconstruction Database. The primary endpoint was implant removal due to surgical complications, i.e. implant failure. Results The cohort consisted of 475 women with 707 revisions in 542 breasts. Overall, 33 implants were removed due to complications. The implant failure rate (4.7%) was lower without RT (2.4%) compared to RT administered after mastectomy (7.5%) and prior to IBR (6.5%) (p = 0.007). While post-mastectomy RT (OR 3.39, 95% CI 1.53–7.53), smoking (OR 3.90, 95% CI 1.76–8.65) and diabetes (OR 5.40, 95% CI 1.05–27.85) were confirmed as risk factors, time from completion of RT (> 9 months, 6–9 months, < 6 months) was not (OR 3.17, 95% CI 0.78–12.80, and OR 0.74, 95% CI 0.20–2.71). Additional risk factors were a previous axillary clearance (OR 4.91, 95% CI 2.09–11.53) and a history of a post-IBR infection (OR 15.52, 95% CI 4.15–58.01, and OR 12.93, 95% CI 3.04–55.12, for oral and intravenous antibiotics, respectively). Conclusions Previous axillary clearance and a history of post-IBR infection emerged as novel risk factors for implant failure after revision surgery. While known risk factors were confirmed, time elapsed from RT completion to revision surgery did not influence the outcome in this analysis.