WTP5.12 To plicate or not to plicate flat mastectomy flaps - an approach to facilitate day case mastectomy rates: a DGH experience

Aims Breast cancer accounts for 15% of all cancer diagnosis in the United Kingdom, with 40% of patients choosing to undergo mastectomy. Day case mastectomy reduces the chance of complications such as infection and venous thromboembolism, as well as improving patient safety and their overall experience. Plication of flat mastectomy flaps (surgical technique of folding excess skin and fixing to underlying pectorals) avoids the use of drains, reduces seroma rates, supports enhanced recovery and improves day case mastectomy rates, which is the main aim of the study. Methods Intervention cohort of 37 female patients (median age 52; age range 47 to 71) undergoing flat mastectomy flap plication (with 2-0 PDS), discharged on same day; were compared with a control group of 58 female patients (median age 55; age range 49 to 74) undergoing standard care without plication. Results In the intervention cohort there were 0 readmissions within 30 days, seroma formation rates of 22.7% and wound infection rates of 4%. Comparatively, the standard cohort seroma formation rates were 47% and wound infection rates of 7.4% (P <0.05). Other notable features were the improved patient experience and satisfaction (measured with PREMS) with p values of 0.09 between the two groups. Conclusion Flat mastectomy flap plication is a simple time saving technique to reduce seroma rates and improve day case mastectomy rates. It is also cost effective, safe and enhances the patient's positive experience, therefore it should be considered in practice and offered to all patients undergoing mastectomy.