Jenna Morgan

Background: Wire-guided localizations have been the historical standard for breast lesion localization; however, they have logistical constraints and can dislodge in the preoperative period. Radar-guided localization has the potential to uncouple localization from the day of surgery, but the technique needs to be evaluated in a direct comparison with wire-guided localization to ensure efficacy and safety. Methods: The iBRA-NET localization study is a prospective platform IDEAL 2a/2b study comparing wire-guided localization with new generation localization devices. This arm describes SCOUT® radar localization for impalpable breast lesions performed between June 2021 and December 2024, compared with a historical cohort of wire-guided localization performed between August 2018 and August 2020. Primary outcome was identification of the index lesion in the excision specimen. Secondary endpoints included safety (complications), margin re-excision, magnetic resonance imaging bloom size, and specimen weight. Results: Data were accrued from 1297 radar localized patients in 27 units. Index lesion identification was 95.2% in radar-guided excisions versus 99.1% in wire-guided excisions (P = 0.001). In a sensitivity analysis excluding patients receiving neoadjuvant chemotherapy, identification rates were 98.9% versus 99.6% (P = 0.114). For a subset of patients having a simple lumpectomy for a unifocal, unilateral breast lesion with no neoadjuvant treatment (1627), positive margins were seen in the main excision specimen in 1003 (15.0%) wire-guided versus 624 (9.0%) radar-guided excisions (P < 0.001). Re-excision was required in 131 (13.2%) wire-guided versus 91 (14.7%) radar-guided excisions (P = 0.442). There was a significant difference in specimen weight/size2 (0.138 g/mm2 wire-guided localization versus 0.182 g/mm2 radar; P < 0.001). The median start time for surgery was earlier in the day for radar-guided localizations compared with wire-guided (12:27 versus 13:40; P < 0.001). All radar placements in axillary nodes (13) led to successful nodal retrieval. Conclusion: SCOUT® radar localizations are a safe and effective localization technique in both the breast and axilla, with outcomes comparable to wires. There were demonstrable logistical advantages in operative start time when using a radar reflector.

Background: Over 14,000 UK women undergo mastectomy annually, 70% of whom do not undergo breast reconstruction. These women are often left with suboptimal scars. Aims: This study aimed to explore the attitudes of women towards their mastectomy scars, particular the aesthetic outcomes, and to raise awareness of the importance of achieving aesthetic flat closure. Methods: Semi‐structured interviews with women who had undergone mastectomy without reconstruction were recruited from a single UK teaching hospital. Thematic analysis was performed using the Framework Approach. Results: Twenty women aged 47–91 years old were interviewed in 2024. Themes identified: satisfaction with scar cosmesis, physical impacts of scars, attitude towards flat mastectomy scars, body image and confidence, pre‐operative counselling and scar revision surgery. There was widespread patient dissatisfaction with mastectomy scar cosmesis, although attitudes and emotional responses varied. Women viewed their scars as a necessity. Physical symptoms included discomfort from dog ears chafing on bra straps, or scar tightness restricting arm or shoulder mobility. Most women were interested in scar revision surgery, with some requesting more information, or referrals. Those who had scar revision surgery or chose contralateral symmetrising mastectomy displayed more positive attitudes. Conclusions: This study found considerable patient dissatisfaction with mastectomy scar cosmesis and demonstrated the profound impacts of poor cosmetic outcomes, highlighting the importance of optimising aesthetic outcomes and the need for scar revision surgery to help women achieve aesthetic flat closure. These findings demonstrate the importance of careful pre‐operative planning and good surgical technique with more time allocated to manage expectations.

Second victim syndrome (SVS) is characterized by negative psychological and psychosomatic effects on a healthcare provider after an adverse care event. The aim of this systematic review and meta-analysis was to characterize the symptoms of SVS experienced by surgeons and factors affecting their impact, as well as understand common coping strategies that surgeons employ to deal with them. A systematic review of five electronic databases was conducted without restrictions on publication date or language in January 2025. Second victim syndrome, surgeon, and adverse event and their synonyms were used as search terms. Records were screened, quality assessed, and data extracted by two independent researchers. Both qualitative and quantitative studies were included and narratively synthesized. A meta-analysis was performed using a random effects model to calculate the overall prevalence rates of symptoms and coping methods. A total of 36 papers were included in the analysis from 6629 retrieved records. Anxiety (56.3% (95% c.i. 45.8% to 66.3%)), guilt (53.8% (95% c.i. 41.3% to 65.8%)), sadness (48.3% (95% c.i. 34.6% to 62.3%)), and sleep disturbance (50.5% (95% c.i. 38.4% to 62.5%)) were the most commonly reported symptoms. Talking to either colleagues (72.5% (95% c.i. 65.6% to 78.4%)) or family/friends (52.0% (95% c.i. 40.6% to 63.2%)) were the most commonly employed coping strategies. The sex and level of experience of the surgeon and the severity of the event were identified as potential predictors of deleterious impact. SVS significantly impacts surgeons' global well-being, leading to burnout and attrition. Effective interventions require a multifaceted approach, including peer support, resilience training, and institutional changes that normalize emotional responses, encourage disclosure, and address barriers to seeking help. Targeted support for at-risk groups may also be necessary.