We describe what we believe to be the first reported case of intragastric erosion and migration to the jejenum of a laparoscopically inserted gastric band, 3 months after the original bariatric surgery was performed. This had caused ulceration and necrosis of the small bowel as the tension in the port tubing had caused the bowel to become concertinaed over it and resulted in a cheese-wire effect through the jejunal convolutions. As bariatric surgery becomes more common, patients with complications of their procedure may present to the general surgeon as an emergency. We recommend early intervention in patients with gastric erosion.

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Introduction: Long term outcomes for women treated with breast conserving surgery are similar to women having mastectomy. The adoption of modern oncoplastic techniques (e.g. volume displacement) has increased the proportion of women having breast conserving surgery compared with mastectomy. The widespread use of therapeutic reduction mammoplasty (TRM) can further reduce the need for mastectomy in a modern oncoplastic breast unit. We analyse if the introduction of TRM has led to an increase in breast conservation and more choice for women treated at our unit. Methods: Operative logbooks were reviewed. The two-year period April 2007 - April 2009 (before widespread adoption of TRM) was compared to April 2010 - April 2012. Length of stay, re-admission rates, additional operative procedures and cancer recurrences were analysed. Results: During the 2007–2009 time period, a single surgeon undertook 209 primary operations for breast cancer. 64 women underwent mastectomy (30.6%). Of these, 26 (40.6%)had an immediate reconstruction with latissimus dorsi flap (+/− an implant). 4 women in this period had a TRM as their primary surgery for breast cancer (1.9%). During the 2010–2012 period, the same surgeon undertook 201 primary operations for breast cancer. 55 women underwent mastectomy (27.4%): 27 had immediate latissimus dorsi reconstruction; 13 had implant based reconstruction (overall reconstruction rate 72%). 32 patients underwent TRM as their primary breast cancer operation (15.9%), all with simultaneous contralateral breast reduction. Of the immediate reconstruction group in 2007–09, 11 women (42%) have undergone another operative procedure – nipple reconstruction, contralateral breast operations, capsulectomy or “tidying-up” procedures. One patient has had a recurrence of her breast cancer and one patient has died of breast cancer in the 5 year follow-up period. One patient has developed contralateral breast cancer. In the 2010–12 TRM group, 6 patients (18.8%) underwent a second operation – 3 re-excisions of positive margins and 3 axillary clearances (positive sentinel lymph node biopsy at first operation). The median length of stay for women treated with TRM was 1 day compared to a median stay of 6 days for patients undergoing latissimus dorsi reconstruction. Conclusions: Our unit already had high breast conserving surgery rates and a high reconstruction:mastectomy ratio. Introduction of TRM became widespread approximately 2 years ago. Using a TRM technique 25–50% of the breast volume can be removed. This enables some patients who would have been advised mastectomy to be offered a choice of breast conserving surgery; hence the further modest reduction in mastectomy rate seen. TRM enables breast (and nipple) conservation and a quicker recovery period. TRM may appeal to women thinking about breast reduction before a breast cancer diagnosis. It is useful after neoadjuvant treatment, for multifocal tumours and in women where a high tumour volume:breast volume ratio would make good cosmetic results difficult to achieve with traditional breast conservation techniques. A further advantage of TRM is the simultaneous contralateral breast reduction; thus reducing re-operation rates. In conclusion, most importantly, TRM extends breast conserving surgery choices for women with breast cancer. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-11-01.