Breast Awareness Month - Reducing complications and improving patient outcomes in breast surgery.
Join us for the special Breast Awareness Month podcast which discusses the use of sNPWT in reducing surgical site complications following breast surgery.
Welcome to Smith and Nephews Closer to Zero podcast bimonthly podcast with leading experts in wound care, hosted by Smith and Nephew. Helping healthcare professionals in reducing the human and economic cost of wounds.
Hello, I'm Ruth Timmins from Smith and Nephew, and welcome to this special Breast Awareness Month podcast with Professor Sanjay Warrier, who will be discussing with us about reducing complications and improving patient outcomes in breast surgery. We're delighted to have Sanjay with us today, who is a dedicated and compassionate consultant breast oncology and oncoplastic surgeon at Chris O'Brien Lifehouse and Royal Prince Alfred Hospital in Sydney. He's also a visiting medical officer at Breast Screen New South Wales. Sanjay is the immediate past President of Breast Surgeons of Australia, New Zealand, and an Associate Professor at the University of Sydney with the Royal Prince Alfred Academic Institute. He's the lead researcher at the institute with goals of developing and creating a culture of academia within the breast department. So, welcome Sanjay. It's great to have you with us today.
Thanks Ruth for having me.
So, perhaps you could just describe a little bit about your clinical setting and the patients that you see in your area of expertise.
Yeah, definitely. So Ruth, I'm a breast cancer surgeon and over time what's happened is the type of operations we do have become more complex. I think the expectations from us towards the patients has increased and the expectations of the patients towards the surgeon and the type of results they would like to have aesthetically following cancer surgery has also increased. And it puts an imperative to try and get a really good result after performing surgery. The type of surgeries that we perform include breast conserving surgery, where we preserve the breast. And the way that we do that includes, using plastic surgical techniques, where we use breast reduction patterns. And I also do volume replacement techniques where if we take a large volume of the breast tissue away, I'll replace the tissue with fat from another area of the body, often at a close site, into that space. And that's just in the breast conserving space. On top of that, I also do a lot of reconstructive work, where there is real importance to get the wound healed well and the scars looking good.
Thanks for explaining your expertise there. And I guess, you know, it is Breast Awareness Month, so perhaps, you know, what are your thoughts on the relevance of that and why it's important?
From my perspective, I think it's an incredibly important month, I think over time, it's easy to become complacent because there is a lot of, generally, breast awareness. But when you actually look at what we're talking about and why we've got this month, a female is, often in a family, is the nucleus of the family and breast cancer impacts one in eight Australian females. So if you have yourself and seven friends in a room, one of you potentially in your lifetime could develop breast cancer. So, having awareness that this is something that's going to impact basically every family in some way, it is important that there is awareness about what to do. And primarily the goal of Breast Awareness Month is to make people aware that, you know, how do we check? How do we check the breasts? How often do we check? Not to be complacent. And that's probably the goal of it. But then on top of that, it's also important from our perspective to raise awareness about the techniques that we're doing. So, that patients that are having breast cancers are also aware of how to get a good result at the end of their breast cancer treatments.
Yeah. It's really important, isn't it, to raise the awareness. So, just moving onto, sort of, the surgical complications, what can be the impact of surgical site complications in your experience, both from the patient perspective and from your perspective?
Yeah. So when we're talking about surgical complications, it's important and it's something that I've thought about a lot over a long period of time is, I really don't like getting complications, as do other surgeons. And there are variables that we can control and there are things that we can't control. And a lot of people can be good technically, but just the operation itself is not enough to ensure a good result. It includes the operation and utilising technologies to get good results from an operative perspective. But then on top of that, it's also important to think about the preoperative which is before the operation and also the postoperative which is critical, what do we do after the operation? And that all comes into how a wound will heal. When we talk about wound healing in general, we talk about reducing tension on the wound, that will improve the quality of the wound healing and also, improving the blood flow that's going to a wound. And if a wound has blood going towards it, there's a good chance that the body will heal with time. And that's really been the premise for us using negative pressure which has become a standard for me, for my high risk patients.
So, from the patient perspective, if they get a surgical site infection or complication, what's the impact, in your experience, that has on the patient?
These are patients that already have a cancer diagnosis and they're already going through a stressful time. So, to potentially have a surgical site infection, that can be very devastating for the patient. That includes requiring hospital admission and intravenous antibiotics. If there is a breakdown in the wound, that is, may require a small revisional procedure but still involves an extra operation. And in really severe cases, it may be loss of the reconstruction or requiring major revisional surgery and breast conserving surgery. So for the patient, that's a massive deal. That's a huge deal. So, it really is important that we do everything we can to try and reduce the likelihood of this happening.
So, you mentioned before about the use of single use negative pressure wound therapy. So, what is your experience in the past in using something like PICO 7 and what have you found as a result?
Yeah, coming back to the principles of wound healing, it just sort of made sense that if we don't need tension on the wound and you're going to get a wound to heal better if we do that, and we've used negative pressure in a lot of other scenarios previously. So it just made a lot of sense that if we use something that's reducing the tension on the wound which negative pressure does, that we would end up with better results. And my personal experience, I started using a very clunky machine many years ago with the premise that this would be important for high risk patients and then, as the technologies developed, and particularly with Smith and Nephew and the PICO device, and I've trialled multiple devices, I've found personally that the results that I've got with it have been fantastic. The thing about the PICO 7 dressing that I like is the fact it's providing an appropriate amount of pressure for the patient cohort that I have. I think it has about 75mm of mercury pressure and that allows enough support without being overly aggressive. On top of that, I like the interface with the skin. So even just as a dressing, it's a lot easier to remove off than a lot of standard dressings. And, if I just digress slightly, you look at a lot of people and how they approach their surgical techniques, surgical techniques have developed over the 20 years and in the same way, so have dressings. And it's interesting to see people who are potentially using the same dressings they did 20 years ago, compared to what is available in 2020. So, for me I've no doubt that this particular dressing has reduced my complications. It has accommodated for, potentially, patients that otherwise would have had breakdowns in their wounds and I'm a big believer in it.
Okay, well thank you Sanjay. So, how has PICO improved your clinical outcomes for your patients? What sort of influence on your data has it had?
Thanks, Ruth. So with regards to, we've sort of spoken about the mechanics of it and in terms of my data we have captured over 200 cases of high-risk patients who have had breast conserving and reconstructive surgery and with the patients that have had the PICO 7 dressing, there's been an incredibly low rate of infection and associated wound breakdown in those patients. And these are complex patients. These are patients that potentially have had chemotherapy prior to surgery. Some of them have been smokers. There has been a cohort of patients that are diabetics as well which puts you at an increased risk of having a wound breakdown, and our results have been pretty amazing. I think it really is removing a variable from the equation in terms of healing. So we've talked about, when we talk about reducing tension and improving blood flow which is the mechanics of the dressing but it takes the variable of the patient out of the equation as well. So we have a patient that could be a lovely person but they've got three kids at home they have to lift. They try their best to try and adhere to what we want in the post-operative setting but it's just sometimes very, very hard because of life. And I just have that reassurance that the patient, even if they lift their hands up, they're getting negative pressure to the area that doesn't need tension on it in that critical period of time. And that's been shown by the results that we've been able to get with our post-operative patients. And the important thing to also take into consideration is when we've looked at our data, I've gone to my team and said we have to be very hard about our definitions. So, we've included, in terms of infection, patients that have required extended oral antibiotics. And so, I'm very comfortable that the data that we've captured is very accurate.
Okay, thank you. So, I know you've had experience with PICO 7Y. Can you give us a bit of insights into what advantages, perhaps, that has in breast surgery?
Yeah, Ruth, with the PICO 7Y it was a natural evolution that, particularly when you're talking about the shape of the breast, to have the negative pressure covering the entire breast, that's what the PICO 7Y is doing. And it acts as a proper bra support of negative pressure to the entire breast. So, rather than just being around the incision line it's providing that extra support which I've been alluding to. I think that's been probably one of the best things I've noted with dressings is the fact that now, rather than just being at the incision site, the silicone interface is across the entire breast. And even with the patients that we've interviewed they have found that it's been fantastic in terms of how they have noted the support, personally, for them. So, both me, I'm comfortable and the patient's comfortable with the dressing.
Thanks, Sanjay. and, I guess, what would be your take home messages today for our audience or thoughts to leave us with today?
I have to say, and this is not...when I started using this dressing it wasn't because I had a particular person selling it to me and really pushing it on me. It was the quality of the actual product and it has sort of sold itself, and I think that is an important point, that Smith and Nephew do have a good product. And varying surgeons will have varying experiences but my experience utilising this dressing, I know it's reduced the likelihood of me having complications. And I think the take home message is the fact that it is important to try and continue to improve your practice whether it's in the operation, before the operation but we can't forget after the operation. And in the operation and after the operation, that's where this dressing is doing a good job. And it's important because of the patients, and end of the day, that's what it's about. It's about the lady who's in front of you and she's diagnosed with breast cancer, she's already frightened, she's expecting a good result. Can you improve your results to ensure that they get the best possible outcome and this has definitely done that for me. Thanks Ruth.
Thank you so much for your time today Sanjay, for your insights and helping us to focus on Breast Awareness Month. So, thank you to our audience for joining us today and again thank you to Sanjay. Don't forget to tune in to our next podcast.
Breast surgery and patient profiles are increasingly complex, raising the risk of complications. This can have a negative impact on patient outcomes. Preventing and treating wound complications is vital to help reduce infection rates, prevent readmissions and improve outcomes. PICO 7Y Single Use Negative Pressure Wound Therapy, with our innovative AIRLOCK™ technology provides simultaneous treatment of two wounds. Compared to standard dressings, PICO significantly reduced wound complications including 75% reduction in wound dehiscence (1), 58% reduction in surgical site infections(2) and 38% reduction in post-surgical dehiscence (3). For more information on how PICO 7Y helps to reduce post-op complications and improve scar outcomes(4) , contact your local Smith and Nephew representative or email us at email@example.com
The information presented in this podcast is for educational purposes only. It is not intended to serve as medical advice. Products listed, and outline of care are examples only. Product selection and management should always be based on comprehensive clinical assessment. For detailed product information, including indications for use, contraindications, precautions and warnings, please consult the products applicable instructions for use, prior to use. Helping you get closer to zero surgical site complications.
1.Harvey J, Henderson J, Patel L, Murphy J, Johnson R. Therapeutic mammaplasty - impact on the delivery of chemotherapy. Int J Surg 2014;12:51-55
2. Strugala V, Martin R. Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system for the prevention of surgical site complications Surgical Infections. 2017;18:810–819
3. Galiano R et al. A prospective, randomized, intra-patient, comparative, open, multi-center study to evaluate the efficacy of a singleuse negative pressure wound therapy (NPWT) system on the prevention of post-surgical incision healing complications in patients undergoing bilateral breast reduction surgery. Plast Reconstr Surg Glob Open 2018;6:e1560;
4. Tanaydin V, Beugels J, Andriessen A, Sawor JH, van der Hulst RRWJ. Randomized controlled study comparing disposable negative-pressure wound therapy with standard care in bilateral breast reduction mammoplasty evaluating surgical site complications and scar quality. Aesthetic Plast Surg. 2018; 42:927-935
BSc (Med) MBBS FRACS MS
Chris O'Brien Lifehouse
Immediate Past President BreastSurgANZ
Sanjay is a dedicated and compassionate Consultant Breast surgeon who specialises in Oncoplastic Surgery at Chris O’Brien Lifehouse and Royal Prince Alfred Hospitals. He is also a Visiting Medical Officer at BreastScreen NSW. Sanjay is the immediate past President of Breast Surgeons of Australia New Zealand (BreastSurgANZ) and an Associate Professor of the University of Sydney with the Royal Prince Alfred Academic Institute. He is lead researcher at the Institute with goals of developing and creating a culture of academia within the Breast Department.