National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study

Abstract

There has been a substantial increase in the use of immediate implant reconstruction in England. In comparison, there has been an increasing use of autologous free flap reconstruction for delayed procedures. Significant regional variation exists in the type of reconstruction performed, and these patterns need to be examined to determine if variation is related to service provision and/or capacity barriers.

Early multicentre experience of pre-pectoral implant based immediate breast reconstruction using Braxon®

“…The introduction of acellular dermal matrix (ADM) in 2001 by Salzberg et al as an adjunct in subpectoral implant based reconstructions has seen a large increase in its use for IBR following mastectomies in the UK (3,4). Although initial studies reported higher complications, data in the last three years demonstrate decreasing complication rates (5,6 .…”

Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting

“…We recognize that several complex factors are associated with uptake of breast reconstruction following mastectomy (age, ethnicity, income, education, tumor characteristics, healthrelated issues, surgeon/hospital factors, and psychological or other factors). 4,[11][12][13][14][15][16] We are also aware that other factors may have contributed to this increased rate of uptake, including an increased trend in breast reconstruction nationally 9 and possible local logistical aspects (improved process in booking surgery, theater availability, and streamlined referral to plastic team); however, we believe that the introduction of the OP MDT was the key factor in this process and the comparative data in this study (Table 1) supports this assumption.…”

“…These results are in line with recent analysis of National Trends in Immediate and Delayed Post-Mastectomy Reconstruction procedures in England. 9 These showed that the annual number of reconstructions increased from 2182 in 2007 (14.9% immediate reconstruction rate) to 3753 in 2013 (24.7% immediate reconstruction rate). The dominant trend in procedure type was related to implant/expander-based reconstructions, which rose from 30% of all immediate reconstruction in 2007 to 54% in 2013, and the use of free flap procedures increased marginally, the proportion rising from 17% to 21%.…”

“…The dominant trend in procedure type was related to implant/expander-based reconstructions, which rose from 30% of all immediate reconstruction in 2007 to 54% in 2013, and the use of free flap procedures increased marginally, the proportion rising from 17% to 21%. 9 There is still substantial regional variation in IBR rate across the English regions ranging from 13.1% to 36.7%. 10 In our study, there was no significant difference in the cohort of mastectomy patients between 2015 and 2016 apart from the introduction of a dedicated OP MDM.…”

Does the addition of mesh improve outcomes in implant based breast reconstruction after mastectomy for breast cancer?

“…To optimise quality of life and outcomes, the National Institute for Health and Care Excellence (NICE) recommends offering immediate breast reconstruction 3. In the UK4 and US,5 implant based breast reconstruction (IBBR) is the most commonly performed technique.…”