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Item 177. Prophylactic Absorbable Antibiotic Beads For High Risk Implant-based Reconstruction: A Single Institution Pilot Study(Wolters Kluwer, 2023-05-19) Ahmed, Shahnur; Lee, Jason T. C.; Roth, Dylan D.; Liu, Steven; Fisher, Carla S.; Fan, Betty; Imeokparia, Folasade; Ludwig, Kandice; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of MedicinePURPOSE: Infections are problematic in implant-based reconstruction after mastectomies. Infection rates have been reported to be as high as 31%. Strategies to reduce the risk of infection include various antibiotic irrigation solutions, “no-touch” techniques, optimizing sterility, and empiric antibiotic use for skin flora coverage. Absorbable antibiotic beads have been well described for other indications, including orthopedic and pressure sore reconstruction. The purpose of this study is to evaluate the use of prophylactic biodegradable antibiotic beads during pre-pectoral and sub-pectoral implant-based breast reconstruction following mastectomy. METHODS: A single-center retrospective review of patients who underwent implant-based breast reconstruction post-mastectomy between 2019 to 2022. Patients were divided into two groups: Group I were deemed “high risk” by the senior author and received biodegradable antibiotic beads (1 gram vancomycin, 240 mg gentamicin) during tissue expander or implant reconstruction (pre-pectoral or subpectoral) while Group II (control) had no antibiotic beads. Demographic data, diabetes, body mass index (BMI), implant plane (pre-pectoral or sub-pectoral), smoking and use of mesh were recorded. Outcome variables included postoperative cellulitis or infection requiring oral or intravenous antibiotics and tissue expander loss at 90 days. RESULTS: In our study period, 19 patients (36 total implants/expanders) received biodegradable antibiotic beads during implant-based breast reconstruction (Group I). There were 174 patients (290 total expanders) who did not receive antibiotic beads (Group II). Patients in Group I had a history of previous expander/implant infection in 73.6%. Pre-pectoral placement of implants occurred in 84.2% of patients in Group I and 74.1% in Group II. Diabetes was prevalent in 15.8% of Group I compared to 5.7% seen in Group II patients. The mean BMI in Group I was 30.5 kg/m2 compared to 27.8 kg/m2 in Group II (p-value 0.88). Implant infection rate of Group I at 90 days was 8.3% (3/36 total expanders) compared to 8.6% (25/290 total expanders) in Group II. Implant loss in Group I was 5.5% (2/26 total expanders) compared to 7.6% (22/290) in Group II. CONCLUSION: The incidence of infection in high risk patients who have absorbable antibiotic beads placed during the time of reconstruction appears to be normalized to the control group in this pilot study, suggesting that absorbable antibiotic beads may decrease postoperative infection complications. Future studies may further clarify its benefit in selected groups.Item Adenomyoepithelioma of the Breast in the Setting of Prior Contralateral Breast Malignancy(Springer Nature, 2023-05-18) Dauterman, Leah C.; Lentsch, Kristen; Fan, Betty; Medicine, School of MedicineAn 81-year-old female patient underwent a screening mammogram one year after completing treatment for right-sided estrogen receptor (ER)/progesterone receptor (PR)-negative ductal carcinoma in situ (DCIS). A new 1-cm mass was noted in the contralateral breast. Ultrasound and percutaneous core needle biopsy results were suggestive of an atypical papillary lesion. An excisional biopsy was performed, and the final pathology was consistent with a benign adenomyoepithelioma (AME). Surgical resection was considered her definitive treatment. AME of the breast is a rare clinical entity, with only a handful of case reports and case series available. In this case report, we review common clinical and radiologic presentations, methods of diagnosis, and recommendations for management based on current literature. The presence of an AME in the background of a previous or synchronous breast malignancy occurs in a very small percentage of cases. On review of available literature, we identified other cases with a past or current history of breast malignancy.Item ASO Author Reflections: National Analysis of Breast Surgery Malpractice Cases: A Teachable Moment?(Springer, 2021-12) James, Ted A.; Fan, Betty; Surgery, School of MedicineItem Lymphoepithelial Carcinoma of the Breast Treated With Partial Mastectomy and Sentinel Lymph Node Biopsy(Springer Nature, 2023-05-18) Lentsch, Kristen; Dauterman, Leah C.; Fan, Betty; Surgery, School of MedicineLymphoepithelial carcinoma of the breast (LELC) is a rarely encountered form of breast carcinoma, and there is limited information treatment for this entity. We present a case of a 55-year-old postmenopausal female presenting with a left breast mass on screening mammogram with core needle biopsy showing lymphoepithelial carcinoma. The patient was treated with surgical resection of the mass and sentinel lymph node biopsy, followed by adjuvant chemotherapy and radiation. Given the rarity of this type of breast carcinoma, our case study continues to add to the treatment considerations in the literature, specifically the role of sentinel lymph node.Item Patient Experience Ratings: What Do Breast Surgery Patients Care About?(Springer Nature, 2022-09-06) Fan, Betty; Imeokparia, Folasade; Ludwig, Kandice; Korff, Lisa; Hunter-Squires, Joanna; Chandrasekaran, Bindhupriya; Samra, Sandeep; Manghelli, Joshua; Fisher, Carla; Surgery, School of MedicineIntroduction: Patient experience is essential in the overall care; physicians often receive patient reviews evaluating their consultation encounters. Patient experience surveys can be a helpful tool to identify areas to target for improvement. We sought to evaluate what factors influenced breast surgery patients' reviews of their clinic visits. Methods: Prospective surveys from 2018-2020 were reviewed from a single institution. Surveys were sent to all patients within 48 hours after visiting one of our breast surgery clinics, and patients were asked their preferred mode of contact for the survey. Patients responded to surveys with scores of 0-10, with 0 as "not likely" and 10 "extremely likely" to recommend the provider's office. Scores 0-6 were considered negative, 7-8 neutral, and 9-10 positive. Positive/Negative comments from patients were reviewed and classified according to mention of surgeon, clinic staff/team, clinic processing, and facility amenities. Results: 744 out of 2205 patients contacted responded to the survey, resulting in a 33.7% response rate. Of this cohort, 47.6% (354/744) were new patients, and 52.4% (390/744) were established patients. Interactive voice response (IVR) and email, per patient indicated preferred mode of survey communication, had the highest responses. The average patient score was 9.5. Most ratings were positive (91.3%, 679/744), followed by neutral comments (5.2%, 39/744). There were 3.5% (26/744) which were negative ratings. Of those who responded, 47.7% (355/744) left a comment with their score. Surgeon-specific remarks were often noted in positive comments, followed by clinic staff/team comments. Negative comments most commonly referenced clinic processes. Conclusion: Patient satisfaction surveys provide a window into creating the best patient experience. Further efforts to address these factors affecting patient experiences should be made to continue improving patient care.Item Prophylactic Absorbable Antibiotic Beads for High-risk, Implant-based Prepectoral Reconstruction(Wolters Kluwer, 2023-10-16) Ahmed, Shahnur; Lee, Jason T. C.; Roth, Dylan; Sinha, Mithun; Fisher, Carla; Fan, Betty; Imeokparia, Folasade; Ludwig, Kandice; Lester, Mary E.; Hassanein, Aladdin H.; Surgery, School of MedicineInfections are problematic in postmastectomy implant-based reconstruction with infection rates as high as 30%. Strategies to reduce the risk of infection have demonstrated various efficacies. A prolonged course of systemic, oral antibiotics has not shown evidence-based benefit. Although absorbable antibiotic beads have been described for orthopedic procedures and pressure wounds, their use has not been well studied during breast reconstruction, particularly for prepectoral implant placement. The purpose of this study was to evaluate the selective use of prophylactic absorbable calcium sulfate antibiotic beads during high-risk implant-based, prepectoral breast reconstruction after mastectomy. Patients who underwent implant-based, prepectoral breast reconstruction between 2019 and 2022 were reviewed. Groups were divided into those who received antibiotic beads and those who did not. Outcome variables included postoperative infection at 90 days. A total of 148 patients (256 implants) were included: 15 patients (31 implants) who received biodegradable antibiotic beads and 133 patients (225 implants) in the control group. Patients who received antibiotic beads were more likely to have a history of infection (66.7%) compared with the control group (0%) (P < 0.01). Surgical site infection occurred in 3.2% of implants in the antibiotic bead group compared with 7.6%, but this did not reach statistical significance. The incidence of infection in high-risk patients who have absorbable antibiotic beads placed during the time of reconstruction seems to be normalized to the control group in this pilot study. We present a novel use of prophylactic absorbable antibiotic beads in prepectoral breast implant reconstruction.Item Second Opinions in Breast Cancer Surgery: What Have We Learned?(Springer Nature, 2022-10-11) Beer, Meghan; Allison, Hannah; Fisher, Carla; Fan, Betty; Surgery, School of MedicineIntroduction: Second-opinion consultations (SOCs) provide many benefits. However, duplicate office visits and the logistics of transferring medical records may be concerning for delaying treatment. There is currently no clear understanding regarding the characteristics of patients with breast cancer who desire second surgical opinions or if this contributes to delays in care. Methods: A review of our institutional database from July 1, 2019, to December 31, 2019, identified breast cancer patients who were documented to be SOCs or primary consultations (PC). Neoadjuvant chemotherapy patients were excluded. Comparisons of patient characteristics, tumor characteristics, and surgery factors were performed using chi-square analysis. All analyses were two-tailed and statistical significance was assigned at p <0.05. This study was deemed IRB-exempt. Results: In our review, 158 breast cancer patients were identified, 21 (13.3%) SOCs and 137 (86.7%) PCs. Of the SOCs, 90% (19/21) underwent surgery at our institution. The study revealed an increased incidence of SOCs in those patients who ultimately underwent mastectomy (p=0.039) as well as those with lower pathologic T stage (p=0.021). There were no other differences in demographics, surgery, or tumor characteristics. No delay was seen in time for treatment. Conclusions: Patients who sought second opinions were more likely to undergo mastectomy and had lower pathologic tumor size. The time from biopsy to surgery appointment was longer in patients who sought second opinions but there were no differences in the time from biopsy or surgery appointment. It is encouraging that those who sought second opinions did not face any delay in care once established.