Eleanore Massey

A new level 1 oncoplastic technique for breast conserving surgery: Rotation glandular flap

BACKGROUND When performing conservative surgery for breast cancer, breast reshaping can be a challenging procedure. Level 1 oncoplastic surgery (OPS) techniques, i.e., advancement or rotation of glandular flaps, should be performed when less than 20 per cent breast volume is excised. OBJECTIVE A new Level 1 OPS technique is described. A wide centro-lateral glandular flap is created after extensive undermining of the skin and nipple-areolar complex, and rotated into the cavity. DISCUSSION This rotation glandular flap is a new technique for use following a wide excision, in glandular, not fatty, breasts, and when standard closure of the cavity would not leave a satisfactory cosmetic result.

Choosing breast reconstruction – for richer, for poorer?.

CTRC-AACR San Antonio Breast Cancer Symposium: 2008 Abstracts Abstract #5094 OBJECTIVE To assess whether the age or socio-economic status of patients undergoing mastectomy play any part in influencing their decision to undergo breast reconstruction. METHODS Details were collated from all patients undergoing mastectomy with or without reconstruction under the care of a single surgeon at Cheltenham General Hospital over a 5 year period. All patients having a mastectomy were offered a reconstruction. Zip codes were used to assign government deprivation scores and the corresponding national rank for each patients residential district, according to the 2000 UK national census. Affluent areas have low scores and high rank; deprived areas have high scores and low rank. The Mann-Whitney U test was used to determine whether there was a statistical difference in age or social status between those patients in the mastectomy only group and those who were reconstructed. RESULTS 50 patients underwent mastectomy only (median age 63.5, IQR 52-72), 30 opted for reconstruction (median age 53.5, IQR 44.5-58). There was a statistically significant difference (at the 95% confidence interval) between the average age of the 2 groups (P=0.0002). Median deprivation score for the mastectomy group was 10.4 (6.28-17.84) and for the reconstruction group 9.67 (6.52-17.37). This was not significant (P=0.26). Median ranks were 6224 (4008-7525) and 6511 (2502-7213) respectively (P=0.29). CONCLUSIONS The socio-economic status of patients does not affect their decision on whether or not to undergo post-mastectomy reconstruction. However, younger patients are statistically more likely to opt for a reconstructive procedure. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5094.

Who calls the breast care nurses – the rich, the poor or the poorly?.

Abstract #6094 Introduction: Breast care nurses (BCNs) are valuable members of the team; they provide advice, counselling and act as patients9 advocates. We have previously demonstrated the worth of BCNs in our UK centre1 and the high number of calls they receive from patients and family. In this study, we investigate factors that might influence call rates from individual patients. We have examined the effect of patient age, prognosis and social deprivation on demand for this service.
 Methods: Our BCNs collect prospectively daily call sheets. These sheets include hospital number, age, type of call (phone or face to face), duration of call, purpose of call and outcome. We have examined breast nurse call sheets over a six-month period. The patients9 home zip codes were also collected and allocated to the correct electoral ward (small geographical areas with average population of 5500). Using data from the UK National Census in 2000, information on social status was derived from the patients9 zip codes and given as the Index of Multiple Deprivation (ID2000). The ID2000 has both an ID2000 score and ID2000 ranking for different electoral wards across England. Low ID2000 scores and high ID2000 rankings correspond to areas of affluence. Prognostic information was derived using the Nottingham Prognostic Index (NPI). The data were analysed by Spearman rank correlation using Statview 5.0 (SAS Inc) software comparing call rate to age, NPI and ID2000 scores & rankings.
 Results: During a six-month period, 1188 patients contacted the breast cancer nurse specialists in the NHS and private setting. 204 (17.1%) patients contacted their BCN once; 228 (19.1%) twice; 264 (22.2%) three times and 492 (41.4%) of patients called four times or more.
 Analysis by Spearman rank correlation of number of calls against age (Rho = -0.009, p=0.90), NPI (Rho = 0.068, p=0.40), ID2000 scores (Rho = 0.058, p=0.41) & ID20000 rank (Rho = -0.060, p=0.40) show no evidence of a relationship between age, prognosis or deprivation and the need to access BCNs.
 Conclusions: The BCNs provide a valuable service to patients with breast cancer. This support continues throughout the individual patient9s cancer journey. In Gloucestershire, the need for support appears to be independent of age, prognosis and social status.
 1 Counselling women with breast cancer - whose line is it anyway?
 F G Court, S Scarrott, M Cassidy-Gray, A Thomas, S Vestey, J Bristol, M Ghilchik, H Y Chan
 Abstract 6045 - SABCS 2007. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6094.