P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop® Bra) for implant based breast reconstruction

S S61 P121. The importance of a chaperone e Ways to improve underuse Katy Rose, Sarah Eshelby, Paul Thiruchelvam, A. Khoo, Katy Hogben West Middlesex University Hospital NHS Trust, London, UK Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK The Royal Marsden NHS Foundation Trust, London, UK Norfolk and Norwich University Hospital, Norfolk, UK Introduction: The importance of chaperones during intimate examination is well recognised. In addition to providing reassurance and support for the patient, chaperones offer protection to the doctor as well. As a result of this, documentation of chaperones in notes is essential. Methods: This 3 stage cross sectional study was completed in a tertiary breast service unit acting as the main referral service for North West London. An initial retrospective analysis was performed and results from this found 0% documentation about chaperone use. Interventions were made: Stage 1: The findings from the initial cycle and chaperone guidelines were presented to the department along with the introduction of a “chaperone stamp” to clinical notes and a “memo pamphlet”. Stage 2: “Chaperone stamp” alone e data collected 1 year after initial data collection. Results: Stage 1: 69.9%; (p < 0.001; CI 59.04% to 80.76%) and Stage 2: 76.6% (p < 0.001; CI 66.7% to 87.13%) both demonstrated increase in documentation of chaperone use compared to initial practice. A 6.7% difference in documentation of chaperone preference was observed between the two post intervention data sets, this was not a significant difference; (p 1⁄4 0.226, CI 15.71% to 2.31%). Conclusions: In modern healthcare environments where patient choice and autonomy are paramount it is essential that clinicians who regularly perform intimate examinations fully comply with chaperone guidance. The authors would suggest that a pro forma approach, such as our chaperone stamp, is an efficacious way to comply and facilitate early identification of any issues with compliance, thus ensuring safeguarding of patients and staff involved in intimate examinations. http://dx.doi.org/10.1016/j.ejso.2015.03.159 P122. An initial experience using a titanium-coated polypropylene mesh (TiLoop Bra) for implant based breast reconstruction Anne Shrestha, Ravi Acharya, Sumohan Chatterjee Hope Hospital, Manchester, UK Introduction: Titanium-coated polypropylene mesh (TCPM) is considered as an alternative to acellular dermal matrix (ADM) in implant based breast reconstruction (IBBR). TCPM is used as a hammock to envelop the lower pole of the implant or expander, as with the ADM. The aim of this study is to examine the limitations and complications of TCPM for IBBR and associated risk factors. Methods: A retrospective analysis of 23 patients who underwent immediate or delayed IBBR using TCPM was carried out. Primary endpoint considered the incidence of removal of implant or expander with or without mesh. Results: 26 procedures IBBR with TCPM was carried out in 23 patients, 3 had bilateral procedures. Time from procedure was a median of 413 days (range 47764). 4 reconstructions failed and implants were removed. 2 patients were smokers, 1 had radiotherapy prior to reconstruction and 1 had recurrent seroma and removal was after 12 months. 3 other patients developed seroma and 2 developed skin necrosis. 16 out of 23 patients had immediate breast reconstruction after have skin sparing mastectomy, only 1 requiring contralateral reduction. 3 underwent delayed reconstruction using expander with TCPM. Conclusion: Careful selection of patients needs to be carried out to ensure possible prevention of failure of reconstruction accounting for factors affecting wound healing. Advantages include remote scar mastectomy, good inframammary fold definition and ptosis, cost reduction, acceptability in patients who prefer not to have animal products. Results seem promising, however, larger sample size and longer follow up is required. http://dx.doi.org/10.1016/j.ejso.2015.03.160 P123. What is the diagnostic value of red blood cells seen in nipple discharge cytology? Sonal Halai, Steven Goh Peterborough City Hospital, Peterborough, UK Introduction: Nipple cytology (NC) is routinely used to assess patients presenting with spontaneous nipple discharge (SND). The presence of red blood cells (RBC) in NC has routinely prompted further intervention. We evaluated the diagnostic value of RBC found in NC. Methods: A retrospective review of all patients who presented with SND between 2009 and 2014 was conducted. Clinical and radiological findings, NC and excised histology were cross-referenced for analysis. Results: A total of 482 NC were included (mean age 45 years, range 15e99). 223 samples were reported normal, 38 insufficient and 221 NC were positive for the following: RBC (164), epithelial cells (25), papillary cells (17) and atypia (15). 173 patients proceeded to have surgery. The following histology were found: 16 carcinoma, 11 DCIS, 3 atypical ductal hyperplasia, 66 papilloma, 1 tubular adenoma, 1 fibroadenoma, 59 duct ectasia and 16 benign breast changes. Defining all malignant pathologies and papilloma in the excised histology as true positive: the presence of RBC in NC has a sensitivity of 67.7%, specificity of 39.0%, positive predictive value (PPV) of 58.0%, and negative predictive value of 49.2%. RBC was present in NC for 18 of the 27 malignancies. Conclusions: 27 out of 482 (5.6%) of our patients with SND were found to have a malignant pathology. Although RBC in NC has a poor PPV in our study, it was the sole abnormality in 6 patients with malignancies. We therefore conclude that the presence of RBC in NC increases the index of suspicion, and should prompt further intervention. http://dx.doi.org/10.1016/j.ejso.2015.03.161 P124. Can increasing Body Mass Index (BMI) affect the accuracy of pre-operative axillary ultrasound scan in breast cancer patients? Habib Tafazal, Veena Vishwanath Queen Elizabeth Hospital, Birmingham, UK Introduction: Accurate pre-operative diagnosis of axillary nodal metastases may avoid further surgery. Obesity may obscure the visualisation of these nodes and can therefore reduce diagnostic accuracy of potential nodal spread. The aim of this study was to assess the relationship between patient body mass index (BMI) and subsequent accuracy of pre-operative axillary ultrasound scan in patients with breast cancer. Methods: Between January 2014 and June 2014, all patients who were diagnosed with breast cancer were retrospectively identified using an electronic patient database. Demographics, BMI, pre-operative imaging and histopathological results were analysed. Logistic regression was performed to explore if patient age, BMI and size of primary tumour may affect correct identification of axillary spread. Results: Of 159 patients identified, mean age (S.D.) was 61.0 (13.1) and median (i.q.r) BMI was 27.6 (24.6e31.6). More patients had a correct US diagnosis than those with an incorrect US diagnosis (98 vs 43 P < 0.001). BMI was similar between these two groups (Correct 27.7 (25.4e32.1) vs incorrect 27.2 (24.2e31.5) P 1⁄4 0.360). When controlling