Summary
Objectives
This paper summarises the findings of a national audit of mastectomy and breast reconstruction
surgery carried out in England. It describes patterns of treatment, and the clinical
and patient-reported quality of life outcomes associated with these types of procedure.
Design
Prospective cohort study.
Setting
All 150 National Health Service hospital groups (NHS trusts) in England that provided
mastectomy or breast reconstruction surgery, along with six NHS trusts in Wales and
Scotland and 114 independent hospitals.
Participants
Women aged 16 years and over undergoing mastectomy with or without immediate breast
reconstruction, or primary delayed breast reconstruction, between 1st January 2008
and 31st March 2009.
Main outcome measures
Reconstructive utilisation, post-operative complications and sequelae, and patient-reported
satisfaction and quality of life.
Results
Overall, 21% of the 16,485 women who had mastectomy underwent immediate reconstruction.
However, the proportion varied between regions from 9% to 43% (p < 0.001). Levels of patient satisfaction with information, choice and the quality
of care were high. The proportion of women who experienced local complications was
10.30% (95% CI 9.78–10.84) for mastectomy surgery, ranged from 11.02% (9.31–12.92)
to 18.24% (14.80–22.10) for different immediate reconstructive procedures, and from
5.00% (2.76–8.25) to 19.86% (16.21–23.94) for types of delayed reconstruction. Breast
appearance and overall well-being scores reported 18 months after surgery were higher
among women having immediate breast reconstruction compared to mastectomy only. Postoperative
outcomes were similar across providers..
Conclusions
The Audit found women were highly satisfied with their peri-operative care, with hospital
providers achieving similar outcomes. English providers should examine how to reduce
the variation in rates of immediate reconstruction.
Keywords
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References
- Cancer registration statistics, England, 2011.2013 (Series MB1, no 42.) ONS
- First annual report of the national mastectomy and breast reconstruction audit.The NHS Information Centre, Leeds2008
- Guidance on cancer services. Improving outcomes in breast cancer – manual update.NICE, London2002
- Early and locally advanced breast cancer: diagnosis and treatment.(Clinical Guideline 80.) NICE, London2009
- Development of a new patient reported outcome measure for breast surgery. The BREAST-Q.Plast Reconstr Surg. 2009 Aug; 124: 345-353
- Third annual report of the national mastectomy and breast reconstruction audit.The NHS Information Centre, Leeds2010
- Fourth annual report of the national mastectomy and breast reconstruction audit.The NHS Information Centre, Leeds2011
- The key findings report for the 2008 inpatient survey.Picker Institute Europe, June 2009
- A colorectal perspective on voluntary submission of outcome data to clinical registries.Br J Surg. 2011; 98: 132-139
- Measuring patients' experiences and outcomes.BMJ. 2009; 339: b2495
- Integrating response shift into health-related quality of life research: a theoretical model.Soc Sci Med. 1999; 48: 1507-1515
- Hi! How are you? Response shift, implicit theories and differing epistemologies.Qual Life Res. 2003; 12: 239-249
- Patient reported outcome measures (PROMs) in Elective Surgery Report to the Department of Health.Health Services Research Unit, London School of Hygiene & Tropical Medicine & Clinical Effectiveness Unit, Royal College of Surgeons of England, London2007
- A 10-year retrospective review of 758 DIEP flaps for breast reconstruction.Plast Reconstr Surg. 2004 Apr 1; 113: 1153-1160
- Comparison of donor-site morbidity of SIEA, DIEP, and muscle-sparing TRAM flaps for breast reconstruction.Plast Reconstr Surg. 2008 Sep; 122: 702-709https://doi.org/10.1097/PRS.0b013e3181823c15
- A nationwide analysis of the relationship between hospital volume and outcome for autologous breast reconstruction.Plast Reconstr Surg. 2013 Aug; 132: 192e-200ehttps://doi.org/10.1097/PRS.0b013e31829586c1
- Regional variation in use of immediate breast reconstruction after mastectomy for breast cancer in England.Eur J Surg Oncol. 2010 Aug; 36: 750-755
- An analysis of delayed breast reconstruction outcomes as recorded in the American College of Surgeons National Surgical Quality Improvement Program.J Plast Reconstr Aesthet Surg. 2012 Mar; 65: 289-294
- Morbidity and mortality following breast cancer surgery in women: national benchmarks for standards of care.Ann Surg. 2007; 245: 665-671
- Patient reported outcome measures could help transform healthcare.BMJ. 2013; 346: f167
- Reoperation rates after breast conserving surgery for breast cancer among women in England: retrospective study of hospital episode statistics.BMJ. 2012; 345: e4505
Article info
Publication history
Published online: May 13, 2014
Accepted:
April 29,
2014
Received:
August 27,
2013
Identification
Copyright
© 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
