Pectoral nerves blocks (PECS) and sedation: A way to avoid general anesthesia in breast surgery - A single institution early experience.

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Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Thoracic Wall Siliconoma after Silicone Leaking from a Defective Breast Implant in Patient with Poland Syndrome

Silicone breast implants are widely used in both aesthetic and reconstructive breast surgery. Within the rare complications that can appear in patients with this type of implant there is the formation of local and peripheral siliconomas, due to the diffusion of the silicone gel contained within the implant, that can appear in case of both damaged and intact implants [1,2]. The use of new generation breast implants (double lumen envelope and content of cohesive gel) has considerably lowered, but not eliminated, the risk of rupture and the possible formation of siliconomas [3]. The reported case regards a patient who, affected by Poland Syndrome, underwent breast augmentation surgery in order to correct the defect at the age of 18. A P.I.P. implant (Poly Implant Prothese, France) was positioned and, after 10 years, at the diagnostic exams revealed a nodular mass of the thoracic wall compatible with siliconoma without evident rupture of the implant

Regional lymphadenopathy following COVID-19 vaccination: considerations for primary care management

Regional lymphadenopathy has been rarely reported following the administration of vaccinations for tuberculosis, influenza, and human papillomavirus (≤1–2/100 000 vaccines).1,2 In the first months of 2021, there seems to have been an increase in the number of women being referred to breast units from primary care and other specialties with clinically enlarged axillary/supraclavicular nodes or with image-detected lymphadenopathy. This has been reported anecdotally across the UK as well as in other European countries and in the US. Recent radiology reports, mainly from the US, have identified a probable link between such lymphadenopathies and COVID-19 vaccination administered up to a few weeks earlier.3–5 As the national vaccine programme progresses, this article considers the implications of this still little-known side effect on vaccine delivery and management of such patients, particularly those with previous history of cancer

Use of tumour bed boost radiotherapy in volume replacement oncoplastic breast surgery: A systematic review.

Tumour bed boost radiotherapy (RT) following breast conserving surgery reduces local recurrence in high-risk disease. There is recent debate over challenges to accurately localise tumour bed for RT boost delivery following volume replacement oncoplastic breast surgery (VR-OBS). This review evaluates the reporting of RT boost following VR-OBS in the literature published between January 2010 and December 2021. This review was in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Nine studies met the inclusion criteria (n = 670 patients), and RT boost was used in eight studies. Boost was administered in total to 384 patients (62.5% of irradiated patients). Only two studies reported boost planned target volumes and only one compared these against surgical specimen volumes. RT boost was not reported in most published studies on VR-OBS. Future prospective research are strongly needed to evaluate long-term outcomes of VR-OBS following RT boost, especially on breast cosmesis and patients' satisfaction