Significant volume loss during breast conserving surgery(BCS)can be anticipated in patients with small breast: tumor ratios, limiting the use of BCS in womenwith smaller breasts or larger tumors. Early experience with autogenous immediate volume replacement(IVR)at the time of BCS led to refinements in the technique, extending its role in clinical practice. The evolution of the technique has been examined, with particular reference to tumor selection, technique and modifications, histopathological findings, and cosmetic, radiological and psychologicalsequelae. Between 1991-1997, 62 patients underwent BCS and IVR using a latissimus dorsi(LD)miniflap. Tumors(diameter 22[ 5-40 ] mm)were located in the upper outer quadrant(29)center(15)upper inner quadrant(17)and lower outer quadrant(1)of the breast. Operations lasted 129(80-245)min, resecting specimens of 144(37-345)g. Margins were positive in 8/62 specimens(13%)and local recurrence was recorded in 5/62(8%), 4 of whom had not received radiotherapy. One local recurrence was treatedby mastectomy(1.8% of whole group)and 4 were treated by re-excision and delayedradiotherapy. The cosmetic, radiological and psychological outcomes of the procedure compared favorably with BCS alone. Breast-conserving volume replacement with LD miniflaps extends the role of BCS without compromising resection, cosmesis or surveillance, and provides a furtheroption in the surgical management of breast carcinoma.

Aim To assess patient recall of intraoperative pain, anxiety, fear, and sensory (visual and auditory) perceptions during second eye clear corneal cataract surgery using assisted topical anaesthesia (ATA), in comparison with first eye cataract surgery using the same technique. Methods This prospective, consecutive, observational study was conducted in a free-standing dedicated ophthalmic day surgery centre. A voluntary questionnaire was distributed to 129 consecutive patients who underwent clear corneal cataract surgery using ATA. Two patients had to be converted to block anaesthesia, and were excluded. Patients were asked to rate intraoperative pain, anxiety, and fear using a visual analogue scale (VAS), and recollection of intraoperative visual and auditory perceptions. Results were analysed using the Mann-Whitney U and Spearman correlation tests. Results There were 70/127 (55%) patients undergoing first eye cataract surgery and 57/127 (45%) undergoing second eye surgery. There was no significant difference in mean pain, anxiety, and fear scores between those undergoing the second eye operation compared with those undergoing their first eye operation. Similarly, there was no significant difference in sensory perceptions between the two cohorts. Overall, there was a small but significant positive correlation between recall of visual and auditory perceptions and combined pain, fear, and anxiety scores (r ¼ 0.33, P ¼ 0.0002). Conclusion There was no significant difference in levels of intraoperative pain, anxiety, fear, and sensory perceptions experienced by patients between the first eye and second eye surgeries. We recommend that preoperative counselling for a patient's second eye be as comprehensive as for the first eye surgery.

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