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

INTRODUCTION

Little is known about post-mastectomy reconstruction procedural trends in women diagnosed with breast cancer in England. Our aim was to examine patterns of immediate and delayed reconstruction procedures over time and within regions.

METHODS

Women with breast cancer who underwent unilateral index immediate or delayed post-mastectomy reconstruction between 2007 and 2014 were identified using the National Hospital Episode Statistics database. Women were grouped into categories based on the type of reconstruction procedure. Adjusted rates of implant and free flap reconstructions were then calculated across regional Cancer Networks using a regression model to adjust for age, disease, comorbidities, ethnicity, and deprivation.

RESULTS

Between 2007 and 2014, 21 862 women underwent immediate reconstruction and 8653 delayed reconstruction. Immediate implant reconstruction increased from 30% to 54%, and immediate free flap reconstruction from 17% to 21%. Adjusted immediate implant and free flap proportions ranged from 17 to 68% and 9-63%, respectively, across regions. Free flaps became more common in the delayed setting, rising from 25% to 42%. However, adjusted rates ranged from 23% to 74% across regions. Networks with high/low rates of free flaps for immediate tended to have high/low rates for delayed reconstruction.

CONCLUSION

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.

Interspecialty fellowships in oncoplastic surgery and breast reconstruction – the innovative training scheme in the United Kingdom

Abstract #4141

Improved survival rates for breast cancer have evolved with specialist multidisciplinary care and adjuvant treatment regimes. Surgical options for breast cancer are increasingly complex comprising adequate oncological resection with improved aesthetic outcome, quality of life and psychosexual function for cancer survivors. Such surgery requires oncoplastic skills and innovative techniques and is an integral part of delivering a modern surgical breast service.
 In 2002, an innovative interspecialty training program was established for senior trainees in breast and plastic surgery, initiated by senior breast specialist surgeons and funded by the Department of Health. Nine breast centres in the UK were selected for their high volume high quality specialist care in breast disease with dual training in breast and plastic surgery. Competitive application to the training program selected the highest quality trainees for a year of interspecialty Fellowship training. The demand for these posts has required a highly competitive curriculum vitae and a higher academic degree.
 Since 2004, detailed prospective data has been collected on the qualitative and quantitative experience of the Fellowship scheme. This has been questionnaire based using logbook data for quantitative technical experience and comparative qualitative data for Fellowship satisfaction and outcome in specialty training.
 53 fellows have to 2008 completed interspecialty training. 43 have been in their penultimate or last year in higher surgical training, the majority (42) are breast trainees in general surgery, 11 are trainees in plastic and reconstructive surgery. The Fellowship maximises exposure to operative planning and surgical techniques. 62% of oncology surgery (including breast reconing procedures), 49% of (immediate and delayed) reconstructive procedures, and 49% of breast symmetrization and aesthetic surgery is performed by the trainee under direct supervision. Overall expectations and quality of the Fellowships scored 'high' to 'excellent' and this was reflected in the confidence of fellows to take up NHS Consultant posts and continue to use the skills acquired within a multidisciplinary specialised breast team.
 The interspecialty training program has been successful for both breast and plastics trainees. It has given senior surgical trainees the opportunity to focus and direct their own training requirements into an intense clinical year of surgical oncology and breast reconstruction. Key components to the success of this year include working in high volume, specialist breast and plastic reconstructive units with direct supervision from dedicated trainers, supernumerary training status and an elective surgical practice. It succeeds as a pioneering program designed to increase the number of trained surgeons offering seamless oncoplastic surgery for the benefit of the patients.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4141.