Factors Associated With Positive Margins in Women Undergoing Breast Conservation Surgery

Objective

To identify factors predicting positive margins at lumpectomy prompting intraoperative reexcision in patients with breast cancer treated at a large referral center.

National Practice Patterns in Preoperative and Postoperative Antibiotic Prophylaxis in Breast Procedures Requiring Drains: Survey of the American Society of Breast Surgeons

Background

To assess national practice patterns regarding use of perioperative antibiotics by surgeons performing breast operations requiring drainage tubes.

Methods

The members of the American Society of Breast Surgeons (ASBrS) were surveyed regarding use of perioperative antibiotics for breast operations requiring drains, with or without immediate tissue expander or implant reconstruction.

Results

Of 2,857 ASBrS members contacted, 917 (32?%) responded; all self-identified as surgeons. Of 905 evaluable respondents, most described themselves as general surgeons (46?%) or breast surgeons (46?%). For cases in which drains are anticipated, most respondents (86?%) reported routine use of preoperative prophylactic antibiotics, with 99?% selecting cephalosporins. Use of antibiotic >24?h postoperatively varied by whether or not reconstruction was performed. In nonreconstruction cases, the majority (76?%) reported ??never/almost never?? prescribing antibiotics beyond the 24-h postoperative period, but 16?% reported ??always/almost always.?? In reconstruction cases, the majority (58?%) reported routine antibiotic use beyond 24?h, and the primary driver of the decision to use antibiotics was reported to be the plastic surgeon (83?%). Among those reporting use at >24?h, the duration recommended for nonreconstruction cases was ??up to 1?week?? in 38?% and ??until drains removed?? in 39?%; this was similar for reconstruction cases.

Conclusions

Cephalosporins are utilized uniformly as preoperative antibiotic prophylaxis in breast operations requiring drains. However, use of postoperative antibiotic prophylaxis is strongly dependent on the presence of immediate breast reconstruction. Consensus is lacking on the role of postoperative antibiotic prophylaxis in breast operations utilizing drains.     

Risk Factors Associated with Breast Lymphedema

Background

The development of breast lymphedema (BLE) after breast/axillary surgery is poorly characterized. We prospectively evaluated clinical and surgical factors associated with development of BLE.

Methods

Patients undergoing unilateral breast-conserving surgery were prospectively enrolled preoperatively and followed for development of BLE. To augment the number of patients with BLE for evaluation of risk factors, postoperative patients identified in the clinic with signs and symptoms of BLE were also enrolled. Logistic regression with Firth’s penalized likelihood bias-reduction method was used for univariate and multivariate analysis.

Results

Of 144 women, 124 were enrolled preoperatively (38 of whom developed BLE), and 20 women with BLE were enrolled postoperatively. Any type of axillary surgery was the strongest factor associated with BLE (odds ratio, 134; 95 % confidence interval, 18 to >1,000). All 58 BLE events occurred in women with axillary surgery as compared with no events in the 46 patients without axillary surgery (p < 0.0001). Among 98 women who underwent axillary surgery, BLE did not occur more often after axillary lymph node dissection versus sentinel lymph node biopsy (p = 0.38) and was not associated with total number of nodes removed (p = 0.52). In multivariate analysis, factors associated with the development of BLE in the axillary surgery subgroup included baseline BMI (p = 0.004), incision location (p = 0.009), and prior surgical biopsy (p = 0.01).

Conclusions

Risk of BLE is primarily related to performance of any axillary surgery but not the extent of axillary surgery or number of lymph nodes removed. Other factors associated with BLE were increased body mass index, incision location, and prior surgical excisional biopsy.     

Intermediate and long‐term outcomes of fibroadenoma excision in adolescent and young adult patients

Fibroadenomas are benign breast masses that often occur in adolescence and young adulthood. Primary management options include observation or surgical excision, but little is known about long‐term outcomes after fibroadenoma excision in adolescents. In the present study, we reviewed the medical records of females aged 13‐35 years who underwent fibroadenoma excision at our institution from 1986 through 2010. Patients were included if they had excision of at least 1 fibroadenoma (confirmed by histopathology) smaller than 5 cm in maximal diameter. We collected information pertaining to clinical presentation, management, and outcomes. In addition, an investigator‐designed long‐term outcome survey was sent to 138 eligible participants to assess patient satisfaction, as well as the recurrence of fibroadenoma, and the need or desire for further surgical intervention. Most patients (126 of 138) underwent 1 operation for fibroadenoma excision. Three women underwent immediate breast reconstruction at fibroadenoma excision. Fifty‐seven patients completed the investigator‐designed survey (response rate, 41.3%) with a median follow‐up time of 13.5 (range, 2.0‐26.7) years. Nine of 55 patients (16.4%) reported postoperative breast asymmetry and the desire to pursue reconstructive surgery. Three survey responders reported breast pain. Fourteen of 56 women (25.0%) reported the diagnosis of 1 or more additional fibroadenomas after the initial excision; another 7 reported recurrence of the mass at the site of excision. Most survey participants were satisfied with the aesthetic outcome of their fibroadenoma excision; however, a small proportion believed that they would benefit from reconstructive breast surgery. The recurrence and development of additional fibroadenomas should be addressed by providers during counseling for treatment options and postoperative follow‐up.