279 Reconstruction as Part of Breast Care Service: Are We Doing It Right?

Abstract

Abstract Aim Breast cancer is the most common cancer in the United Kingdom. About one-third of our breast cancer patients underwent mastectomy. The Association of Breast Surgery (ABS) and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) guidelines state that all patients who undergo mastectomy should be offered immediate breast reconstruction (IBR) and delayed breast reconstruction (DBR) unless contraindicated. This audit aimed to evaluate our service compliance to the guidelines and identify factors affecting the number of patients offered breast reconstruction (BR). Method Our audit evaluated all mastectomy cases (n = 137) done between March 2018 and February 2021. Patients with previous breast cancers were excluded. Data were collected from clinical notes and letters. Results 20.4% and 32.1% of patients were offered IBR and DBR respectively. Only 14.7% of patients not offered IBR had contraindications recorded whereas the remaining had no discussions recorded. Of those not offered IBR, 57.8% were expected to have adjuvant radiotherapy. All male patients (n = 3) and those with American Society of Anesthesiologists (ASA) grade 4 (n = 5) were not offered any BR. The average age of patients not offered IBR was 63.9 whereas that of DBR was 66.7. The average estimated size of tumour of patients not offered IBR and DBR were 42.3mm and 45.7mm respectively. Only <10% of patients not offered BR were smokers. Conclusions There is room for improvement in terms of our service compliance. Breast care services should aim to provide all-inclusive care to patients. A consultation checklist can be used to ensure BR is discussed alongside mastectomy.