E69: Outcomes for Modified Oncoplastic Lift and Lymphatic Excision and Reconstruction with Radiation

Introduction: The Modified Oncoplastic Lift and Lymphatic Excision and Reconstruction technique is a simplified procedure that employs standard incisions, multi-layered internal stitching, and subsequent advancement flaps and facilitates lymph node extraction through the initial incision. This technique is easily learned and minimizes large incisions. We present patient-reported satisfaction and clinical outcomes associated with this oncoplastic technique combined with radiation therapy.

Methods: Patients who underwent this technique with and without sentinel lymph node biopsy (SLNB) and with and without radiation were included. Demographics, tumor type, and treatment outcomes along with a BREAST-Q v2.0 [Breast Conservation Therapy (postoperative)] survey were collected. We evaluated the satisfaction with breast appearance (higher score indicates higher satisfaction) and adverse effects of radiation breasts (higher score indicates lower satisfaction).

Results: Of 152 patients who met the inclusion criteria, 105(59%) patients answered the BREAST Q. The mean age was 58.6 years [SD 10.7], and mean BMI was 32.68 kg/m2 [SD 10.42]. We had 2.63%(n=4) Asian, 10.52% (n=16) African American, 15.13 %(n=23) Non-Hispanic White and 71% (n=108) Hispanic patients. We had 33.5% (n=51) carcinoma in situ, 53.2% (n=81) Stage 1, 18.4% (n=28) Stage 2, 5.92% (n= 9) cases, 1.31% (n=2) Stage 4 (oligometastatic) and 34.9% (n=53) benign cases. Out of 56 patients who underwent SLNB more than half (55.4%) had it through the same incision as the lumpectomy. A total of 53.3% (n=81) patients received radiation. The mean BREAST Q score was 79.49 for patients who got radiation vs 87.91 for patients who did not receive radiation. A total of 55 patients had documented extent of reconstruction from the patients who had radiation, including the following three cohorts: < 10 cm2 (65.45%, n=36), 10-30 cm3 (16.36 % ,n= 9), and >30 cm3 (18.18%, n=10). The mean BREAST Q score for adverse effects of post-reconstruction radiation was 7.63 (range 6-16) with distribution in the three cohorts. The seroma formation was 0%, re-excision 5% (n=8), and local recurrence 3.23% (n=5).

Conclusions: This technique proves to be feasible in the setting of radiation by showing high patient-reported outcomes for all patients including those with a greater extent of reconstruction. It had recurrence rates lower than standard for lumpectomies without increasing re-excision needs while having a significant impact in decreasing seroma formation.