And then we have 7 papers and at the end there will be a QR QR code will come up and you can
vote for your favourite paper and there's a prize sponsored by QEed for the best paper
afterwards. So I think we're gonna start.
With Yuko Asana talking about health transfer.
Uh, good afternoon, my name is Yuaano plastic surgeon from Japan.
My practise of fat grafting started, uh, in 2008 with Kotaro
Yoshimura.
So I'm honoured to be, have the opportunity to be here.
I have no disclosure.
Uh, photo grafting is a fundamental technique for plastic surgeon.
However, we often encounter challenges to overcome fat necrosis and unstable viability.
So after fat grafting, the most, uh, sorry, central zone,
so necrotic zone, this zone, uh, both the adipocyte and the stem cells die,
but in the middle zone, so stem cells survive.
So and that adipocyte replaced with new one.
So your similar team closely examine the difference between the aspirated
and excited fat.
So as you can see in the exercise fat is a capillary networks and the
higher number of the vascular associated cells.
This finding led to the development cells assisted lippo transfer the stem cells
added to the poor aspirated fat, significantly enhancing graft viability.
So he began clinical practise using CAL for breast reconstruction in 2007.
In this procedure, we firstly isolate the sal vascular fraction from the extra fat
during the constructive surgery.
This cell processing takes approximately 70 minutes and therefore extends the
overall operation time.
Furthermore, multiple sessions are required to achieve the satisfactory outcome
and also it's difficult to harvest enough fat from underweight patients.
So to address this, we proposed a solution by starting to use cultured the stem cell 82 weeks
before the reconstructive surgery.
Very small amount of fat is dissected for culturing stem cells.
By culturing stem cells through 3 passages, we obtained sufficient quantity of adipose
derived stem cells.
These ACs could be cry preserved to ensuring that their long term viability.
So this stride comparing eachat grafting method in both conventional and cultured
CAL, the concentration of ACs in the graft material is targeted to level
that of in vivo adipose tissue. If the graft volume is 200 millilitres,
the CA contains 1 million cells.
Here I'd like to briefly mention the regulatory framework in Japan.
Under the provision of the Regenerative medicine Promotion Act,
we are granted the flexibility to outsource the self culturing the licenced company.
This unique approach has promoted the application of the generative medicine,
medical institution.
In my practise, the culture says the preserved by the outsourcing company and used
for multiple reconstructive surgery.
With this approach, we can now offer C based reconstruction patients with low body fat.
In conclusion, the novel approach incorporating cell culturing and cryopreservation has shown
this result consistent with conventional CAL.
However, since postoperative period is still relatively short,
for the long term follow-up are necessary to ensure both safety and efficacy.
So next month, we are hosting an international conference in Tokyo,
bringing together experts in basic research and degenerative medicine plastic surgery.
I hope to see many of you again in Tokyo. Thank you very much.
Do you have any questions? Let me just ask you,
so you increase, you have a similar kind of numbers of fat cells.
Do they, what, what, how did the similar number of them stay in the body when you inject it?
Do they behave in the same way grafting.
When you inject the grafted cells, they behave the same way as the long grafted cells,
graft volume detention, yeah.
So to usually to a simple part grafting our data, so for breast augmentation,
healthy breast in the 50, around 50%, but to with stem cells,
70% to 80% but to depend on a patient.
Uh, so for heresy breast, so 3D photography I have data.
Yeah. Thank you.
So we're going to the next presentation by Dorian Hobday.
Uh, lympha surgery to reduce lymphedema following axillary node clearance.
Thanks very much. Um, so today I'm presenting,
um, from our, uh, single centre study from the Royal Free.
It's an ongoing, uh, study, um, so sort of primary results.
We have no disclosures.
The The uh lymphovenous anastomosis approach is, is well known
um and carried out in a number of centres now, um, with blue dye commonly injected into the
medial upper forearm at time of clearance and um.
Dominant vessels, lymphatic vessels being anastomos either end to end or end to side to
veins in the axilla.
The problem of upper limb lymphedema, secondary to axillary lymph node clearance is also very
commonly known with large numbers, um, giving a number of around 20% lymphedema post
axillary lymph node clearance.
Um, in terms of the effects of lymph venous nastomosis, a systematic review and
meta-analysis give figures of between 3 to around 7%,
thus far. However, the majority of the studies included
in these meta-analysis and systematic review are relatively small and don't necessarily have
the longest follow-ups. There are some randomised control trials in
progress of particular note is the initial findings from the Memorial Sloan Kettering
trial. 72 patients in each arm of the trial,
giving results of 9.5% in the lymphovenous anastomosis arm versus 32%
of lymphedema rates in the non-LVA arm.
Safety profile there's a fair amount of evidence.
Cochrane review of 95 patients did not find any increased surgical complications or altered
oncological recurrence.
Uh, in summary, current data is limited by a lack of high quality evidence.
There's loads of data of quality of life on this group.
Um, it's not yet widely available in the UK. It's really centre by centre and there's no
national register on it.
So today, um, I'm just gonna talk about our, our ongoing study.
Um, we're just in our cohort we've just got the patients that we've operated on that we've done
for the lymph venous anastomosis, um, we recruit them via the breast clinic,
we take preoperative measurements, um, assessing limb volume,
uh, carried out by a small team of nurses and doctors.
The bio and penis spectroscopy is on one machine with one operative,
um, and then we also get baseline questionnaires, short form 3636,
and lymphedema life impact scale.
Um, the surgery is performed by a consistent team of breasts and plastic surgeons working
together on a regular basis.
We then follow them up 3 monthly for the first year and 6 monthly for the second year.
We're looking at how many of them get lymphedema, um,
if the bioimpedant spectroscopy fits well with the volumetric measurements and also the
quality of life data.
So in terms of the overall numbers, we've enrolled 38 patients thus far.
3 patients have left the study due to the progression of cancer,
um, leaving at 66 and 4 months.
Um, of the 35 remaining patients, 7 the blue have had at least 24 months,
16 have had between 12 and 24, and 6 have had 6 to 12 months.
6 have had the surgery quite recently.
So just focusing on the 31 patients who have had at least 6 months follow-up,
um, we have a rate of 6.4 for our our lymphedema incidence,
the highest mean limb difference occurring around 3 months post-op.
Um, bio impedances, the same two patients on volumetric measurements,
uh, meet the threshold for lymphedema, um, and linear aggression reveals that more than 1/3 of
the variability in the percentage of limb difference can be accounted for by the by
impedance measurements.
Um, I see the numbers are very small, but of interest, no correlation between either the
short form 36 or the subjective symptoms of lymphedema on LLIS between the patients who
have got lymphedema versus the rest of them.
Um And there is a weak positive correlation between time and the short form 36.
In summary, 6.4% of patients have got post lymphedema thus far.
Um, the, that swelling at 3 months, we speculate it may just be to postoperative
swelling. Um, it's likely that bio impedance represents
an adequate proxy measurement for the limb volume, and we haven't found any correlation
between the uh the objective measurements of lymphedema and the subjective um.
perception of lymphedema and quality of life, I think these patients have had a diagnosis of
cancer, significant surgery, recovery from surgery, and a lot,
you know, ongoing cancer treatment. So that may be something to do with that.
There are limitations. It's a very small study,
but it's ongoing. Thank you.
Thank you for the presentation. Um, are there any questions from the floor?
If not, I have I have two questions for you.
First one, to the best of my knowledge, there, it's not the procedures like for the second,
like actually for the treatment, therapeutic treatment of lymphedema are not covered by the
NHS. What what about the preventive approach?
Do you get any reimbursement, so I don't know the specific funding model,
but I, I think it my understanding is in the centres where it is on offer,
um. I don't think our centre has had to apply for a
new strand of funding for it.
So you get reimbursed for the patients receive it.
It's offered to them. We offer it to all patients who come through
the clinic who are going to have a clearance, and we say you don't have to be involved in the
study. You can have the surgery either way.
All of them have agreed to be in the study, and almost all of them have agreed to have the
lymphovenous anastomosis.
And how do you explain that there's no correlation between quality of life and
reduction I think it's probably just the small numbers, but it's interesting because
lymphedema is obviously such a, you know, awful and debilitating disease,
and I think in broader quality of life studies it certainly does have a big impact,
but I think perhaps.
You know, with all the other things going on in these patients' lives,
um, perhaps the lymphedema.
Isn't having as much of an effect than you might expect otherwise,
and it's interesting as well. The lymphedema life impact scale is something
that's normally only used for patients with lymphoedema to monitor their lymphedema.
We're asking those questions to patients.
A lot of most of them don't have lymphoedema, but interestingly they're scoring
symptomatically as badly as the patients are two patients with lymphedema,
which we thought was interesting.
Yeah, I agree it's probably because it's only 2 years.
Thank you. Next speaker.
He's talking about outcomes for implant-based reconstruction.
Yeah, thank you very much for the opportunity.
Uh, my name is Miko Koyman, and I'm a PhD candidate at the Plastic and Reconstructive
Surgery department at the Netherlands Cancer Institute, and today I'm gonna talk about the
long-term outcomes of the immediate implant-based breast reconstruction and its,
um, risk factors.
We've got nothing to declare.
So it is stated that at least 40% of all women undergoing mastectomy should receive an
immediate breast reconstruction, but unfortunately we're not quite there yet,
so a lot of women are still unaware that they could get an immediate breast reconstruction
and in our centre we tend to reconstruct everyone so we achieve an 83% immediate breast
reconstruction rate, which makes us a unique opportunity to assess our outcomes.
Um, and we know that immediate breast reconstruction is beneficial in a lot of ways
because, for example, for the quality of life, but unfortunately it's not all rainbows and
sunshine. So today we're going to talk about the long
term outcomes and in which revision surgery defined as any surgery to the breast during
follow up. And reconstructive um uh failure we defined as
absence of a breast, uh, so if there is a flat chest without any attempts of reconstructing it
secondarily. And we looked at these outcomes in almost 2000
patients between, uh, breasts between 2012 and 2019, and we both included patients undergoing
the mastectomy prophylactically and therapeutically.
Uh, all implants were inserted sopectly, and most of them in a DTI method.
We defined 19 risk factors, uh, and we both included patient related risk factors as age,
but also treatment related as postmasectomy radiotherapy or nipple preservation.
And our women were on average 44 years old, had a body mass index of 24,
10% smoked, the mastectomy specimen weight was 419 grammes and the implant was a bit smaller.
Nipple sparing mastectomy was performed in 53% and in 20% they received a radiotherapy.
So we looked into all outcomes for the first approximately 5 years and we looked into short
term, long term complications and any other procedures, and if none of the above were
necessary, we labelled the breast as having a final result at once,
and we saw that 40% of all breasts didn't have any revision in follow up.
The latter 60%, of course it is.
And we also looked at all the um the green boxes and uh we saw that those women had a
breast contour and a follow-up, but unfortunately 6.7% didn't.
So 93% had breast contour at end of follow up and this was achieved in 40% in one procedure.
We looked into the uh protective factors and we saw that nipple sparing mastectomy was uh
beneficial as it had a breast contour in 97% almost and no revisions were necessary in
46%.
The DTI reconstruction, we saw that no revisions were necessary in 43%,
so that was also beneficial.
And when looking to the risk factors for the adverse outcomes,
we saw that age, tobacco use, specimen waste, implant volume and radiotherapy were
significant predictors for those.
And age and radiotherapy were predictors for um reconstruction and failure as well.
But one crucial side note, because it cannot be ignored that radiotherapy is a significant risk
factor for both outcomes, but still, if you look at all irradiated women,
90% actually had a breast contour compared to 0% if you don't even offer a reconstruction.
And unfortunately in a lot of hospitals, but also countries,
an immediate breast reconstruction is still advised against or even refused in patients
undergoing radiotherapy.
And we saw that in 33% of all these patients as well, a reconstruction and revision is not
necessary, so only 67% had revisions compared to 100% if there is a sore mastectomy you need
to reconstruct the breast.
So we are advocates for always offering an immediate breast reconstruction if it's
possible, of course, if the women are eligible, while understanding the risks,
because in the majority of all patients, a revision surgery is necessary with these risk
factors, but almost half do not with these protective factors.
And we also saw that reconstruction failure rates actually stayed quite low with these risk
factors. So we would say always offer reconstruction if
possible while understanding and discussing the risk with your patients to enhance shared
decision making. Thank you very much for your attention and if
you want to be notified when it has been published, it's not publisher,
please don't um contact me.
Thank you.
Any questions from the floor?
Can I just ask the, the revision procedures, what do they consist of?
So it's both elective surgeries as like capsulectomies or something else,
but also uh such a procedures, so lipofilling, also the uh complications so long term and
short term complications like infections, but also capsular contracture,
um, and also oncologic procedures. So if there is a residual tumour,
uh, we need to go in again and also those are recorded.
And did you look at patient outcomes for this in terms of pain and things like that,
or? Sorry, you look at patient outcomes,
reported outcomes in terms of we see a lot of patients had radiotherapy with implants.
It's actually quite painful from the contractor.
Yeah. Did you look at that at all?
So only the pain you mean without revision surgery.
So of course when there is a is a b or 3 or 4 with pain,
then we always do a revision surgery if it's if it's necessary,
of course, if the patient wants, but if it's just, if it's just pain,
uh, without a revision surgery, this is not included in the study,
no. And looking back at your results, do you have
do you have any criteria of who can have a reconstruction, say a certain BMI or if they
smoke? Yes, so we don't offer a reconstruction,
an immediate reconstruction if women have large BMI above 25 with big breasts,
so above like 500 grammes, and if they smoke, so the triads,
yeah, BMI is very small, with all three of them, not only if they have it.
Yeah. OK.
Sorry? The BMI just remarked that it's quite a,
yeah, definitely, yeah, so it's not that if women only have a BMI over 25,
we don't reconstruct, it's having all three, so and smoking and a large,
well large BMI and bigger breasts, so they have to, yeah.
And I think if I saw it correctly, um, the percentage of nipple sparing was just 50% or
below 50%, but that's probably because it's quite an old cohort starting,
yeah, so 53% was nipple sparing, but now I think it's definitely larger.
OK, there's no more questions. Uh, thank you.
I'm the go to the next speaker.
That would be, um, John Matthews simplified approach of therapeutic mammoplasty for all
nine zones of the breast.
So simplified approach to therapeutic ma plastic for all 9 stones of the breast.
So in the literature there are a few therapeutic myopplastic approaches to breast
cancer involving tumours involving different zones of the breast.
However, they involve complex pedicles and incisions which do not conform to the classic
breast reduction.
So in this paper, with the help of video presentation, I present therapeutic mammoplasty
approaches to all zones of the breast using pedicles and incisions,
which are commonly used in uh classic breast reduction.
So the choice of procedure was based on two factors, aesthetically acceptable shape of the
breast before surgery, and anticipated volume of dead space after mobilisation of the dermo
glandular pedicle.
So in patients with small to medium sized breasts, and those patients with large breasts,
where the shape of the breast was maintained, uh, my plan is often a vertical scar,
mammoplasty. In those patients where you would like to alter
the shape of the breast for aesthetic reasons, I plan a wise pattern mammoplasty.
And this was also the case in large excisions where the mobilised dermo glandular pedicle was
not enough on its own to fill the defect of the wide local excision cavity and needed
additional tug produced by the horizontal limb of the inverted T.
These were the pedicles used in each zone.
So in short, suprabital pedicle and lateral and lateral pedicle and inferior pedicle were used
to carry the nuclear complex, and inferior pedicle in particular was used to fill the
defect. So this is a short video presentation vertical
scar therapeutic mammoplastic procedures involving different zones of the breast.
This video shows left maxed vertical scar therapeutic mammoplasty for a 42
millimetre cancer involving zone 1A.
In this patient, both vertical scar and we pattern mammoplasty were marked preoperatively.
I would proceed with the vertical scar pattern and will convert to voice pattern only if
displacement of the inferior derma glandular pedicle is not enough on its own to fill the
dead space of the wide local excision cavity.
Converting to voice pattern will provide additional tug produced by pulling down of the
horizontal limb of the inverted T.
Here the cavity is filled by the mobilised inferior pedicle and the plans to proceed with
the uh vertical scar, therapeutic mammoplasty.
Here it shows the pre-op in 5 weeks post-op picture.
Next is a right bracketing wire wise pattern therapeutic mammoplasty for a 44 millimetre
high grade DCIS in zone 1C.
Wide local excision is planned and performed.
Inferi particle is mobilised into the wide local excision defect and medial and lateral
pillars are approximated.
Pre-open 16 weeks post-op picture.
Next is a 60 year old patient with a 44 millimetre cancer involving zone 2A.
She had left two maxi vertical scar therapeutic mammoplasty and centre lymph node biopsy.
Final markings are made on table and scored.
Wide localation is done.
After developing the suprameal pedicle, the inferior pedicle is mobilised into the defect.
X-ray shows two max sees with adequate surrounding margins,
pre-op and 10 week post-op picture.
Next is a right max seedwise pattern, therapeutic mammoplasty for a
50 millimetre locally advanced breast cancer in zone 3C.
W local excision is done.
After developing the smeal particle, the inferior particle is mobilised into the defect.
Pre-op and 3 weeks post-op picture. Next is left central wide local excision,
wise pattern, therapeutic mammoplasty for a 49 millimetre multifocal cancer
involving zone.
2 B. Bothwise pattern and vertical scar markings are
made in this patient.
Cancer is taken out and the X-ray shows adequate margins.
The inferior pedicle is not mobile enough for the vertical scar and it's converted to voice
pattern. Few interrupter switches are inserted to hold
the inferior pedicle in place.
6 weeks post-op picture.
So baseline features 103 3 mammoplastys were performed over a period of 7 years.
Vertical scar mammoplasty was performed in approximately 70% of the cases.
Um, margin re-accession rate was 10%. There were a few early and late complications,
mostly managed conservatively.
After a medium follow-up of 25 months, the local regional recurrence rate was 1%,
and breast cancer specific survival was 96%.
So in conclusion, this paper provides a safe and simple guide to therapeutic mammoplasty
involving different zones of the breast using incisions and pedicles commonly used in breast
reduction. Thank you.
Thank you. Any questions from the audience?
I, I didn't quite understand why do you go ahead with this scar that is kind of on the
side to the to the nipla complex if you cannot mobilise it,
would it not be possible to, to use different flaps to combine different.
Yeah, the other approaches where the expected excision is outside the classic breast
reduction, they use uh N block resection of the cancer, which leads to incisions which do not
confined to the classic breast reduction.
So in my paper what I have shown is that with the pedicles that I use,
um you know I'm able to manage patients and provide the same incisions which is used in
classic breast reduction.
In other um you know end block resections with the skin they put probably
lateral sort of incisions which is quite visible.
And symmetrization may be a problem, especially in those patients.
So we'll move on to the next one.
Thank you, thank you.
So it's nurse Sajit Mursalun Derezan talking about long-term breast shape analysis following
a short scar reduction.
Good afternoon.
So one of the uh most common debates among the plastic surgeons concerns the ideal uh
breast reduction technique in order to maintain a good long-lasting results.
The shortcu supporters focus mainly on the improved breast shape it gives on the low scar
burden and of course on the less wound healing complications as opposed to the older tee scar.
On the other hand, many plastic surgeons still feel that the short scar does not provide a
proper solution in terms of the excess of skin at the lower pole,
and they would rather add the horizontal scar either either in advanced planning or
intraoperatively. There are plenty of shorter scar publications,
but they may focus on the complications and patient satisfaction.
Few of them, however, address the actual technique for removal,
the excess of skin at the lower pole and the implication of the lower on the long term
breast shape. Uh, two studies that are worth mentioning in
that matter are Frank Lister, who showed the stable lower pole in his 250 cases,
uh, following four teachers box suture.
But on the other hand, Hal Findley showed a completely different results.
She showed 80% return to the preoperative nipple to IMF distance in less than 1 year.
So this variant calls for further research.
We asked 129 of our patients to take part in this study.
All of them had a minimum of 1 year follow up, and they were all operated using the whole
thing technique, a sor medial pedicle, uh, with a short scar,
either vertical or J-shaped scar, and they were all invited back to the clinic for measurements
and to fill the rescue questionnaire.
Uh, 40 patients agreed to take part in this study.
Their mean age was 42. Their mean follow-up time was 110 weeks,
that is uh 2.1 year, and the mean BMI was 25, and the mean weight of tissue removed was
377 grammes.
Looking at the measurements, we found that the standard notch to nipple was stable during the
two weeks of two years of follow up. It was 30 centimetres to begin with.
Uh, it was 23 centimetres right after surgery and after 2 years of follow up,
it was 24.9.
The upper border of the breast to the nipple distance remains stable as well.
However, the nipple to IMF distance that was 16 centimetres to begin with was shortened to 7
centimetres right after surgery.
And then after 2 years, it elongated back to 14.45 centimetres.
That is a relative improvement of only 12%.
The breastscu scores were satisfactory and comparable to other er er breast reduction
studies. So the short scars, uh short scar fans,
myself included, uh, we defend our technique quite passionately because we enjoy looking at
the nice narrow shape that the breast gets after this shorter scar.
Uh, we enjoy not having to deal with too many uh breakdowns and of course we take greater
pleasure in the high levels of satisfaction since these are the happiest patients at our
clinic. But as whole friendly mentioned,
although patient satisfaction is a major determinant of surgical success,
we should also be looking at aesthetic improvement from a surgical standpoint.
And from this surgical standpoint, we see that the short scar may address the horizontal
dimension of the breast quite nicely.
However, it does not address as nicely the vertical dimension of the breast.
So this talk is not about offering a solution or a new technique.
It does, however, point a need for modifications that maintain the short car
advantages in terms of shape and projection while providing a more stable lower pole.
These are the study limitations, a relatively small sample size,
a relatively low tissue removed and no uniform time intervals.
I would like to dedicate this talk in memory of Doctor Michael Shefflin,
one of my best teachers and the one who first introduced me to this lovely conference.
Thank you. Thank you.
Are there any questions?
Can I ask the nipple to IMF distance is doubled.
Excuse me. The nipple to IMF distance doubled from 6 to 14.
Is that correct? It was 16 and then 14 after two years of follow
up. So the bottom looks like the bottom.
How does that compare to a pattern, for example?
Excuse me. How does it compare to a pattern?
Do you think it's I didn't check the pattern, but studies show that pattern as well tend to
extend within time.
And, would you, will you change your technique to prevent that?
Will you change your technique to try and prevent the box?
No, actually I'm still a short scar fan. I'm not going to change it because I think that
it does has the advantages that the tee scar does not provide.
I'm thinking more about the g glandularplasty or how you try and maintain it.
OK, I'm thinking more about the gland rather than the skin,
you. Uh, I usually maintain a 5 centimetres gland
pillar, but um when you do the, the short scar, you count on the skin to shrink and apparently
it does not shrink uh as expected.
Yeah, there's a question. Yeah, Andre.
I, I've done a study a long time ago with inferior particle and I found the same,
same kind of findings that over time, over 2 years, there is a significant stretch of the
skin. You the eco or this was a wise pattern inferior
particle which is known to have bottoming out, but the results were similar.
So I think my question, and I think that's what Paul is asking,
Would you consider doing anything to the gland to try to stabilise the gland?
Because clearly we cannot rely on the skin.
That's the first question. The second one is,
did you see a difference on patients who have very nice tight skin in comparison to the ones
who were Postpartum breastfeeding, very loose skin in terms of how much that stretch.
So I haven't checked the skin quality in terms of the elongation,
so I don't have an answer for the second question.
And the first question was, it was similar to what Pauls ask,
is there anything that you think it can be done to retain the position of the breast gland.
So the weight of the glands doesn't really stretch the skin so much over time.
Well, I'm not sure it's a matter of the gland because I tend to maintain a very short peeler.
I think it's a matter of the skin and um while measuring it,
I used it under tension, the, the, the measurements, so I think it's a matter of the
skin and not the peeler.
That's my opinion. Thank you.
Thank you. So the next talk is uh Elena Ribe,
Immediate pre-pectoral implant-based breast reconstruction with Rchromesh,
advantages of the technique and case series report.
Thank you. Hello everybody, thank you for the invitation.
Uh, my name is Elena Uribe.
I'm a plastic surgeon from Bogota, Colombia, and I'm here to,
uh, talk about the use of viral mesh in the perpectorial plane in implant-based
reconstruction. I have no disclosures, uh, as we all know,
um, implant, uh, breast reconstruction can be divided into autologous and implant,
uh, reconstruction. We all know.
That today uh the gold standard is autologous reconstruction and this is supported by higher
um satisfaction rates in um in patients, but it doesn't mean that it doesn't mean that patients
that are reconstructed with implants doesn't get good results in fact we can get very
beautiful results with implants.
Uh, and actually if you see at the, uh, if you, if we see at the numbers we still have a lot,
uh, of patients that are going to be reconstructed by implants in the UK.
70% of the patients are going to be taken to an implant reconstruction and we have similar
numbers in the US. So I think the importance of this subject is to
get the right indication, uh, for implant-based reconstruction, and this,
uh, big study done in the US give us, uh, some clues about what are the indications of implant
reconstruction. And most of them are going to be uh thin
patients we find that patients with body mass index below 25 are going to be good candidates
for implant reconstruction and uh as well patients that are going to bilateral procedures.
So what we propose with this uh study that. It's still ongoing is to use two strategies um
to try to get the best results in in plant-based reconstruction.
The first one is to use the perpectoral plane as we have discussed in this uh meeting we have,
we will have less operative time. We will have less uh pain.
And we will not have animation deformities in our patients and the second strategy is the use
of a mesh with the, uh, the use of a mesh, we will get the advantage of the support of the
thoracic wall, and we will not get tension in our scars.
Uh, we will have better control of the of the envelope and the maintenance of the natural
landmarks. And then, uh, why will we useyquil mesh?yquil
mesh is one of the. Most mostly wide uh available uh materials and
it's also a very non-expensive, um, nonexpensive mesh we try to we um look at
the evidence about the use of iquil mesh and we found that there have been groups that have uh
using this material but most of the studies are using this material to cover the inferior pole
in a subpectoral plane.
Uh, so we try to do this differently and use the perpectoral plane and the addition of the,
of the mesh. So this is our surgical technique.
We use a Vyryl mesh that measures 26 by 30 centimetres.
We completely wrap the implant as you can see in the image.
Uh, we will cut the excess of the mesh, um, once the implant is,
is wrapped, and we will place it in the perpectoral pane as you can see in the image.
We are going to use two stitches to support, uh, the implant to the chest wall,
and we will do the closure.
So this is an ongoing uh uh paper we for the moment we only have 40 patients with I mean age
of 46 years old.
We have very thin patients. You can see the body mass index is 23.1 and 20%
of our patients are are taking two bilateral procedures, so most of our patients are
unilateral. All of the patients are immediate breast
immediate breast reconstruction.
And uh most of the patients are nipple sparing um mastectomies.
Uh, as far as complications we see that only 2 for the for the moment only 2 patients had had
uh failed reconstruction and we define failed reconstruction as the definitive,
uh, removal of the implant. These patients had uh associated infection,
both, both of them. Uh, other minor complications were,
uh, implant change. We have this, uh, this complication in 4
patients and all of this, all of these patients had associated skin necrosis.
Uh, I'm going to show you only two patients that, uh,
that, that are in our study. This is a 50 year old woman.
She has a background of a left ductal invasive carcinoma.
She was taken to an inferior tumorectomy, but unfort unfortunately she had compromised
margins, so she was taken to a completion mastectomy, a left completion mastectomy,
and we use, uh, for the reconstruction, the uh biryl mesh and the implant,
and this is the, the result after the reconstruction.
The other patient is a patient of 48 years old. She had bilateral lobular invasive carcinoma.
She was taken to bilateral skin, uh, nipple sparing mastectomy,
and we use, uh, a prepectoral implant with the vacul mesh,
um, then this is the follow up after uh 60 days of the procedure.
So in conclusions, uh, implant-based reconstruction plays still a very important
role in breast reconstruction.
Uh, it is very important to, uh.
To find a really good indication in our patients, uh,
and we must try to refine our techniques in implant-based reconstruction to try to uh
achieve similar results to autologous reconstruction.
We believe that the perpectorial plane and the addition of a varyl mesh,
it's an option that is worth studying and um.
We think that it might be a good idea just to continue to to follow these patients and to try
to well to see if this is working.
Thank you.
May I ask it, did I understand correctly you always use mesh?
So, do, do you always use the mesh or was it just in this cohort?
Uh, only for the moment, only in this cohort.
And how do you choose if you use it or not?
Uh, no, we are all, we are using always the mesh in the patients that are taken to,
uh, nipple sparing mastectomies.
So always nipple sparing implant, you always use the mesh,
exactly. And, and why?
Sorry, I, I don't understand the question why we are using the why are you always using it.
Uh, well, we try to evaluate the, well, the strategy is to try to
give the sup a support to the implant in, uh, in immediate breast reconstruction.
So if we have a thin patient that is going to, uh, go to uh an implant reconstruction,
we use always the mesh and we we use this technique uh in these patients.
Thank you. Any other questions?
So I think our final talk is Sarah Abraham, she's talking about cryoablation for breast
cancer.
All right, so good afternoon, everyone. I'm a breast surgery registrar at the Royal
Free Hospital in London, and I'm going to be sharing with you our experience with using
cryotherapy in managing patients with breast cancer who are found to be unfit for a general
anaesthesia.
So cryotherapy is a technique of destroying, it's a minimally invasive technique.
Of destroying cells by subjecting them to temperatures below lethal temperatures below
-40 °C, which sets off an instant and delayed destruction of the cellular
ultrastructure, ultimately resulting in coagulative necrosis,
while cryotherapy has found its place in managing many skin lesions as well as
Prostate conditions. What makes it so appealing in managing breast
cancer patients is that it is essentially scarless and it can be done in an outpatient
setting under local anaesthetic.
Um, the aesthetic outcomes are excellent and it can be delivered concurrently with any systemic
treatments that the patients may be receiving.
Uh, also an added advantage is that because it leads to the release of uh tumor-related
antigens, it can work in synergy with, uh, any systemic treatment that the patient may be
receiving. So, cryoablation is delivered via two systems,
which are based one is based on liquid nitrogen, one is based on argon gas.
We use the Boston scientific system, which is, which uses argon gas,
and we did this under ultrasound guidance. So this is the system.
IX system, which is based on argon gas and as you can see here,
this was done under ultrasound guidance. The cryoprobe was placed into the tumour as you
can see here, and it was extended beyond the tumour.
Um, and the regimen followed was uh first freeze, passive throw and second freeze,
each lasting 10, 8, and 10 minutes. And what essentially happens is That there is
formation of an ice ball, uh, which extends to 1 centimetre beyond the tumour,
um, and then we retract the probe. The whole procedure itself lasts for about 45
minutes. Um, for lesions that are too close to the skin,
what we do is we hydrodissect, uh, with a saline to create a little space between the
tumour and the skin to prevent any, uh, skin toxicity.
So our study consisted of enrolling 21 patients between 2021 and 2024.
Uh, 8 patients were excluded because we had incomplete information or we were not able to
follow them up beyond one year of surveillance.
The inclusion criteria consisted of patients with invasive lobular ductal cancer who were
ERPR positive, HER2 negative, uh, with, uh, grade 1 to 2 on the Nottingham scale,
and we did in fact include a patient with multifocal cancer.
Uh, this is again showing you, uh, the case of multifocal cancer in which we use more than one
probe to achieve an adequate margin.
So, um, we followed patients up at 36, and 12 month intervals and at 1 year intervals after
that. No patient, uh, developed any local recurrence.
Uh, one patient develops skin toxicity, which you can see here,
um, it healed with good results.
All patients were put on adjuvant endocrine treatment.
And in terms of the imaging surveillance, we used uh mammograms to uh look at the resolution
of the asymmetry and also contrast, uh, enhanced MRI.
Um, so there are lots of studies happening, lots of studies and trials happening around the
globe that are looking to, uh, study cryoablation in different settings that
patients with metastatic cancer patients.
most exciting, which means the ICSE-3 trial, which is looking to see how cryoablation can be
used to de-escalate management in very young, uh, sorry,
very old women, uh, with very low grade early breast cancers,
um, and that has shown very promising results. So it's emerging as a promising technique,
uh, which is helping us de-escalate the management of breast cancer and move away from,
uh, managing them with surgery.
Thank you.
Any questions? Can I ask, how do you, you vary how big or the
size of the volume that's frozen inside?
I'm sorry. You vary the size of the area which is frozen,
so depending, so depending on how much of an ice ball you want to and depending on the size
of the lesion, you can use a different size cryoprobes and also use multiple cryoprobes at
different angles to achieve that area of ablation.
And how do you know whether you've done it wide enough?
Or you've got all the margins. So um if you.
So the ice ball itself extends to 1 centimetre beyond and it's done under imaging guidance,
and the idea is to insert the probe well beyond the um beyond the lesion to ensure
that the probe itself is quite central and near the marker clip,
which helps, which is a guide to where exactly the lesion is.
OK. Any questions?
Yeah, there's a question at the top, please.
The utility.
No, we did not, uh, give the patients radiotherapy, but they were on endocrine
treatment. Thank you, that was a
very good talk. Um, how many sessions do you need?
So this was uh deliver one session, but this is a procedure that you can repeat if you feel
that you have not achieved adequate ablation or if there are any concerns on surveillance
imaging that there may be a recurrence.
So this, this was one session for each patient.
OK, thank you. OK, I think we'll finish there.
What is it? Yeah, can, can we have the QR code up so now
you can actually vote if it's uh which you, which presentation uh you like most or you
thought most valuable, and then there will be a winner.
Thank you to all the presenters, uh, for your hard work.
Will we know the win and by now, yeah, we'll see it right away.
OK, so, uh, we close the vote now and the winner is uh the last speaker,
which is uh Sarah, so, um, congratulations.
So can you come forward or I'm sorry, To
Sorry. The presentation together, so we've prepared it
together. I'm Tanya.
She's Sara. Sorry.
I couldn't have known that. I'm sorry.
Um yeah, so congratulations. The prize is actually,
you're gonna get the prize. It's not here yet,
but you will get a prize. Thank you so much.
Thank you so much, everyone. Thank you for this opportunity.