Abstract P2-19-06: Breast conserving surgery using volume replacement with oxidized regenerated cellulose: A cosmetic outcome analysis
Authors: Tanaka S , Iwamoto M , Kimura K , Takahashi Y , Fujioka H , Sato N , Terasawa R , Uchiyama K 
Published: August 2014

Background: Breast conserving surgery (BCS) is a standard procedure for patients with early stage breast cancer. However, as the objective of BCS is to obtain both local control and a cosmetic outcome, it may lead to unsatisfying cosmetic results when the volume of resected tissue is large in order to secure an adequate oncological safety margin. Autologous flaps or artifact implants are commonly used when performing a replacement for a defect in the breast during BCS. Oxidized regenerated cellulose (ORC) is composed primarily of vegetable nitrocellulose and was originally developed as a styptic for surgery. We expected that the ORC would help induce granulation and fibrous tissue with reactive tissue fluid, and finally ORC would prevent adhesion between skin and pectoralis major muscle. In this study, we focused on short-term cosmetic outcomes after volume replacement with ORC after BCS.

Materials and Methods: Inclusion criteria of this study were the patients with early breast cancer indicated BCS that did not required breast reconstruction, or the patients who did not wish to undergo breast reconstruction with autologous flaps after BCS. We evaluated the cosmetic outcome of volume replacement with ORC after BCS, and also examined factors that may have influenced the results. The cosmetic outcomes of these patients were evaluated using scores based on the criteria of the Japan Breast Cancer Society.

Results: Ninety-four patients who underwent this procedure between January 2010 and August 2012 were reviewed. We evaluated cosmetic scores with regards to several clinical factors and the occurrence of complications after this procedure. The mean score of the cosmetic outcome of all patients was 9.5 points out of 12 points. Thirty-seven patients were categorized as “Excellent”, 34 were “Good”, 22 were “Fair”, and 1 was “Poor”. Patient age, body mass index, weight of the specimen, and ORC amount were not significantly different between patients with favorable cosmetic scores and those without.

Table 1. Univariate analyses of clinical factors according to the cosmetic outcome E/G* (n = 71)F/P# (n = 23)P valueAge52.5±12.656.0±10.30.23Body mass index22.0±3.723.3±4.10.15Specimen weight54.0±23.961.4±39.10.27ORC amount$3.2±1.23.2±1.20.95Values are expressed as the mean±SD. *Categorized as “Excellent” and “Good”. #Categorized as “Fair” and “Poor”. $ORC amount used for volume replacement.

However, the weight of the removed specimen was slightly higher in patients with an unfavorable cosmetic score. Although acute dermatitis and eczema was observed in 15% and 3% of patients, all of them were improved with conservative treatment. Cosmetic scores were significantly higher in patients without complications than in patients with complications.

Table 2. Cosmetic scores between patients with and without acute complications Cosmetic scores (mean±SD)P valusWithout9.8±2.00.003With8.0±2.4 

Conclusions: ORC replacement after BCS is a simple and reliable procedure. The selection of indication and prevention of complications are important for obtaining a better cosmetic outcome. To our knowledge, this is the first report to cosmetically evaluate a relatively large number of patients that have undergone ORC replacement after BCS.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-06.