P223 Oncologic outcome of areola-sparing mastectomy with immediate reconstruction using free flap...

Friday, 18 March 2011 Poster Session II. Surgery/Sentinels/DCIS S53

autologous tissue (17.4%). There have been no local or distant failures ata mean follow-up of 17 months. The cosmetic results of the contralateralprophylactic NSM were rated as good to excellent, and patients weregenerally very pleased with the result.

Conclusion: NSM should be considered for contralateral prophylacticmastectomy, no matter what type of mastectomy is utilized on the cancerside.Disclosure of Interest: None Declared

P223 Oncologic outcome of areola-sparing mastectomy withimmediate reconstruction using free flap techniquescompared with conventional skin-sparing mastectomy

N. Net1, M. Hubalek2, R. Achleitner2, T. Bauer2, M. Daniaux2, C. Marth2.1Gynecology and Obstretics, 2Medical University Innsbruck, Innsbruck,Austria

Goals: Reconstruction after breast cancer is becoming increasingly im-portant. Immediate reconstruction is an alternative to primary mastectomyand subsequent reconstruction after adjuvant therapy of breast cancer.The originally described technique of Skin sparing mastectomy (SSME)included the removal of gland, nipple areola complex (NAC), and biopsyscar. The purpose of this study is to evaluate the oncological safety andtechnical outcomes of areola-sparing mastectomy (ASME) with immediatefree flap reconstruction compared with conventional SSME and immediatereconstruction with free flap.

Methods: This retrospective analysis includes 167 patients who under-went immediate breast reconstruction using either deep inferior epigastricperforator (DIEP) flap or free transverse musculocutaneous gracilis (TMG)flap between April 2002 and September 2008. 86 patients received a freeDIEP flap and 81 patients free TMG flap for reconstruction, respectively. In45/86 patients with TRAM flap reconstruction and in 36/81 with TMG flapreconstruction the nipple only was removed (48% ASME). We comparedcomplication rate, local recurrence rate (LRR), disease-free survival (DFS),overall survival (OS) and cosmetic results between ASME and SSME withimmediate TRAM reconstruction cases.

Results: Median follow up of patients with ASME or SSME was46 months. Local failure occurred in 6 (7.4%) of 81 patients who underwentASME and in 4 (4.7%) of 86 patients who underwent SSME. Therewere no areola recurrences. Overall survival in the ASME was 99%and in SSME 98%. Disease free survival was in both groups 90%. Nostatistical differences of local failure rate, overall survival und disease freesurvival could be detected between the two surgical approaches. Cosmeticoutcome of ASME was better than that of SSME in the majority of patients.Subsequent adjuvant therapies were not subject for delay due to immediatereconstruction with either free flap. Partial or complete loss of the flap wasa very minor problem and occurred in less than 3% of all patients.

Conclusion: Our study demonstrates that ASME with immediate freeDIEP or TMG reconstruction is as safe as conventional SSME. Surgicalremoval of the areola is not associated with a lower number of localrecurrences. Immediate DIEP or TMG reconstruction and provides a goodcosmetic outcome and high patient satisfaction.Disclosure of Interest: None Declared

P224 Optimizing breast conserving surgery by ex vivo ultrasoundand radiological examination of breast cancer tissue

A. Huschmand Nia1,2, B. Dohmen3,4, M. Hollaender5,6, M. Hofmann7,8,K. Scherer8,9, R. Kubale10,11. 1Breast Cancer Center Pirmasens,Pirmasens, 2German Society for Obstetrics and Gynecology, Berlin,3Institute for Pathology, Kaiserslautern, 4German Society for Senology,Tuebingen, 5Praxis for gynecology and medical tumortherapy, Pirmasens,6German Cancer Society, Berlin, 7Radiology Department, Pirmasens,8German Roentgen Society, Berlin, 9Breast cancer Screening ProgrammPfalz, 10Praxis for radiology and nuclear medicine, Pirmasens, Germany,11European Radiological Society, Vienna, Austria

Goals: We studied the role of ex vivo high resolution ultrasound andradiological examination of breast cancer tissue for the reduction of re-excision rate in breast conserving surgery (BCS).

Methods: We developed a tissue transfer and X-ray system in 2008which reliably ensures precise localization of the tumor within the ex-cised tissue by tissue-radiographs (horizontally and vertically) and tissue-ultrasound. The system is based on a non-opaque tray with radio-opaque

topographic markers. We evaluated the role of ex vivo high resolutionultrasound and tissue-radiographs for the reduction of re-excision rate in200 cases of primary breast cancer undergoing BCS. Additional excisionswere performed during the primary surgery when tissue radiographs andtissue ultrasound indicated a low margin. The margins defined by tissueradiographs were than compared to the histological findings.

Results: Our re-excision rates due to low margins for non palpableinvasive carcinomas (smaller than 15mm) was 2.2% and 10% for DCIS.

Conclusion: Ex vivo high resolution ultrasound and radiological exam-ination of breast cancer tissue can help to reduce the re-excision rate forlow or positive margins significantly. Tissue-radiographs can furthermoreimprove communication between radiologists, breast surgeon and pathol-ogists especially for multifocal disease and lesions smaller than 15mm,provided that a standard tissue transfer and x-ray system is used.Disclosure of Interest: None Declared

P225 Results of combined treatment of breast oncoplasticoperations

V. Ostapenko1, A. Mudenas1, S. Bruzas1, J. Sabonis1, A. Jackevicius1,A. Ostapenko2. 1Institute Oncology Vilnius University, 2Vilnius UniversityMedical Faculty, Vilnius, Lithuania

Goals: The goal of this work to evaluate the results of combined treatmentof breast oncoplastic operations.

Methods: During 1999–2009m. 5908 patient with breast cancer under-went treatment at Lithuanian Oncology center. The data on vital statusof all patients was summarized by Jan 1, 2009. Non-systematic randomsampling (each next or third patient file) was used to evaluate the treatmentresults of operated patients. The surgery treatment − oncoplastic operationwas used as primarily selection criteria. The 429 patient (7.3%) wereselected for the study. Patient at stage I−III were selected for furtheranalysis. The median follow-up time was 79.4 month. 79.8% of patientswere found alive by end of follow-up. All pts underwent breast oncoplasticconserving surgery, irradiation and chemo/hormonotherapy. Evaluating thesize of the tumor, volume of removed tissues, breast and tumour propor-tions, 3 techniques of oncoplastic operations were introduced: Breast on-coplastic operation with local tissues mammoplasty (Crescent Lift, Benellilift), II Breast oncoplastic operation with reduction mammoplasty (supe-rior/inferior pedicle, lateral mammoplasty), III Breast oncoplastic operationwith m. Latissimus dorsi flap or with “Mentor” (190–375 cm3) implants.Distribution of pts according pathological tumor size − “pT” was, pT1 − 192,pT2 − 213, pT3 − 24. Distribution of pts according to nodal status “pN” −PN0 − 276, pN1 − 124, pN2 − 29. Distribution of pts according differen-tiation degree “G” − “G1” − 126, “G2” − 212, “G3” − 91. Estrogen andprogesterone receptors were evaluated in 118 pts.

Results: The five year overall survival for stage I was 94.87% (95% Conf.Interval: 90.01–97.40%). For stage II five year overall survival was 76.5%.(95% Conf. Interval: 69.66–82.00%). For stage III five year overall survivalwas 69.23%. Stage I five year disease free survival was 88.66% (95%Conf. Interval: 82.38%–92.79%), Stage II five year disease free survival −86.49% (95% Conf. Interval 80.15–90.92), Stage III five year disease freesurvival − 69.23% (95% Conf. Interval 47.80−83.26).

Conclusion: The combined treatment of breast cancer stage I patientsafter oncoplastic operations showed 5 years overall survival results 94.87%with good aesthetic results.Disclosure of Interest: None Declared

P226 High resolution ultrasound guided location of non palpablebreast lesions is safe and can significantly reducehook-wire guided surgery

A. Huschmand Nia1,2, B. Dohmen3,4, K. Scherer5,6, M. Hollaender2,7,M. Hofmann6,8, R. Kubale9,10. 1Clinic for Obstetrics and Gynecology,Breast Cancer Center, Pirmasens, 2German Society for Obstetricsand Gynecology, Berlin, 3Westpfalz Klinikum, Institute for Pathology,Kaiserslautern, 4German Society for Senology, Tuebingen,5Mammography Screening Programm Pfalz, Pirmasens, 6GermanRoentgen Society, Berlin, 7Praxis for Gynecology and MedicalTumortherapie, 8Radiology, City Hospital Pirmasens, 9Praxis forRadiology and Nuclearmedicine, Pirmasens, Germany, 10EuropeanRadiological Society, Wien, Austria

Goals: Hook-wire guided surgery was introduced in 1980 by Kopans andDeLuca to help locate occult lesions of the breast. The procedure is