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thickness nipple-areolar complex (NAC) graft. Prior to securing the graft
after breast reconstruction, all residual retroareolar tissue was excised.
The free NAC graft was secured with a continuous peri-areolar suture.
Results: Since November 2010, sixteen free NAC grafts were per-
formed on fourteen patients. Median age at surgery was 54 (range 44-
66) years. BMI ranged from 20.5e35 (median 25.4). Two patients were di-
abetic, three were smokers. One free NAC graft was placed on the donor
paddle of a latissimus dorsi flap; all other free NAC grafts were placed on
the skin flaps of a dermoglandular reconstruction centred approximately
8cm from the inframammary fold.
Three grafts developed partial necrosis. Two patients had no identifi-
able risk factors, one of whom also developed skin breakdown and implant
extrusion. The third patient was obese and a smoker who also encountered
wound breakdown though no implant loss. No significant pathology was
found on histology of retroareolar tissue.
Conclusion:Utilising a free nipple graft offers oncologically safe imme-
diate NAC reconstruction. This avoids the need for subsequent tattooing of
the NAC and should be considered with immediate breast reconstruction.
http://dx.doi.org/10.1016/j.ejso.2013.01.169
P134. Features of breast cancer in patients with family history
Abdelnasser Salem
Royal Victoria Infirmary Breast Unit, Newcastle upon Tyne, UK
Background and aim: We audited our Family History Breast Clinic
(FHBC) activity to identify pathological and treatment variables of Breast
Cancer (BC) in this group of patients.
Methods: Retrospective review of 5-years activity of FHBC to identify
patients who developed BC, their pathological subtypes and treatment
given.
Results: Out of 698 patients, 54 developed BC (8%) over the 5-year
period (1.6% per year). 29 patients (54%) developed BC at/or before
age of 50, and 25 (46%) above age of 50, median age: 50 (range 29-69).
29% of genetically-tested patients had mutations (18% of all 54 patients).
11% of patients had DCIS, 63% had Invasive BC (IBC) and 26% had
mixed disease (total IBC 89%). 6% had bilateral disease at diagnosis.
50% of DCIS was high grade. 54% of IBC was grade-3, 40% grade-2
and 6% grade-1. 69% of IBC was ER-positive and 19% HER2-positive.
72% of patients opted for mastectomy and 25% opted for contra-lateral
Risk Reducing Mastectomy (RRM). 43% had Breast Reconstruction
(BR) and 50% had Axillary Node Clearance (ANC). 72% of patients
had chemotherapy and 59% had radiotherapy. 11 patients out of the 54
(20%) had either further BC or recurrence.
Conclusion: In screening patients with family history of BC, cancers
occur at young age, are more often invasive and of high-grade. Patients
are more likely to have mastectomy and ANC with a significant fraction
opting for contra-lateral RRM and BR. The relatively high risk cancers de-
tected have impact on the use of adjuvant treatments and survival
expectations.
http://dx.doi.org/10.1016/j.ejso.2013.01.170
P135. Volume of axillary metastases in patients with early breast
cancer and a normal grey-scale axillary ultrasound
Matthew Stephenson, Ali Sever, Jenny Weeks, Pippa Mills, David Fish,
Sue Jones, Haresh Devalia, Peter Jones, Karina Cox
Maidstone and Tunbridge Wells Breast Clinic, Tunbridge Wells, UK
Introduction: In patients with early breast cancer, there is trend to-
wards conservative axillary surgery. Determining which patients are at
risk of high volume axillary metastases may be important for appropriate
surgical planning.
Methods: 381 patients with primary breast cancer and a normal grey-
scale axillary ultrasound were included in the study. All patients had en-
hanced pre-operative axillary staging using contrast enhanced ultrasound
(CEUS) and underwent tumour excision and axillary node clearance
(ANC) or sentinel node biopsy (SNB) +/- ANC. Histopathological analysis
included immunohistochemistry for tumours with a lobular phenotype.
Results: 92 patients were found to have lymph node (LN) metastases.
Of these, 77 had ANC and 15 had a SNB only. The overall prevalence of
LN metastases in patients with invasive disease was 24%. In total, 31% had
ITC or micrometastases and 86% had no more than 4 LN involved. In-
creasing tumour size and grade was associated with an increase in the prev-
alence of LN metastases as was the lobular phenotype. However, the
volume of axillary metastases did not show a positive correlation with in-
creasing tumour size or grade. The lobular phenotype was associated with
a much higher proportion of ITC. The frequency of ITC was also relatively
higher in T2 and G2 tumours.
Conclusions: The majority of patients with early breast cancer and
a normal grey-scale axillary ultrasound do not have axillary LN metasta-
ses. In those patients with axillary LN metastases, our data suggests that
the volume of disease within the axilla remains constant despite advancing
tumour size and grade.
http://dx.doi.org/10.1016/j.ejso.2013.01.171
P136. Breast Screening and repatriation in North West London:
A patient’s choice
Jennifer Stevens, Anika Kaura, Katy Hogben
Charing Cross Hospital, Imperial College Healthcare NHS Trust, London,
UK
Introduction: Patients in North West London with a screen detected
cancer receive their results centrally at Charing Cross Hospital (CXH).
At this clinic patients can chose to receive treatment at their local hospital
or CXH. We aimed to investigate the factors that influence hospital
selection.
Methods: Patients who requested treatment at CXH were asked to
complete a questionnaire on the day of surgery. Local hospital was deter-
mined using postcode. Patients were asked to rate the factors influencing
their choice of hospital. We asked if patients had prior experience of
CXH or their local hospital.
Results: 24 patients completed the questionnaire (11 local to CXH,
13 not local to CXH). In the non-local group, meeting the CXH team
(11), efficiency of the CXH clinic (7) and reputation or previous expe-
rience at their local hospital (7) most commonly influenced decision
making. 6 of the non-local group would have initially preferred to re-
ceive their results locally, but changed their decision following the
CXH clinic. Only 4 had met their local breast team. Travel (10) and
proximity to local hospital (10) were the strongest influences in the
group local to CXH.
Conclusion: Over 50% of patients treated at CXH were not from the
area local to CXH. Those not local were impressed by their experience
in the clinic. Few had met their local breast team suggesting that if results
were given locally patients may feel more comfortable choosing to be
treated there.
http://dx.doi.org/10.1016/j.ejso.2013.01.172
P137. Neoadjuvant chemoradiotherapy and immediate free breast
reconstruction - a new treatment sequence for managing locally
advanced breast cancer
Patrick Tansley, Kelvin Ramsey, Meron Pitcher, Damien Grinsell
Western Hospital, Melbourne, Australia
