The reconstructive journey: Description of the breast reconstruction pathway in a high-volume UK-based microsurgical centre

Abstract

Autologous breast reconstruction, on its own, is a complex microsurgical procedure. However, this operation is usually just one of a series of steps along a patient's reconstructive journey. This includes not only a primary major surgical event but also the consequent recovery, potential complications and secondary surgeries required to optimise the final outcome. Unfortunately, there is limited information of what patients can expect from this reconstructive journey in the literature. The aim of this study was to characterise the journey of a consecutive cohort of patients through their whole reconstructive pathway in a high-volume UK-based breast reconstruction service. A retrospective case analysis was undertaken including all the patients who had an autologous breast reconstruction at the Queen Victoria Hospital in East Grinstead between January 2012 and December 2014. Their case notes were reviewed from their initial referral to their final discharge. Number of operations, complication rates and time required to complete their journey were recorded, as well as differences between different flap options, immediate versus delayed and unilateral versus bilateral breast reconstructions. A total of 409 autologous breast reconstruction cases were performed in the 3-year study period. The vast majority of breast reconstructions used a deep inferior epigastric perforator flap (81.5%), with muscle-sparing transverse abdominal flaps (14.6%) and transverse upper gracilis flaps (3.9%) being the other options utilised. Free flap success was observed in 99.5% cases. Almost all patients opted for subsequent surgery (94%) of any kind. Only 75% opted for the reconstruction of their nipples. On average, 3.20 procedures were required per patient on this cohort, and these procedures were performed in 1.5 surgical episodes on average. Bilateral reconstructions reached the discharge point sooner than unilateral reconstructions and required a smaller number of operations. The average time to complete the reconstructive journey was 20.8 months. Patient-centred decision-making is fundamental to select the correct intervention for each patient and empower her in her healing journey. Standard measuring of patient satisfaction is still an unaccomplished goal in our unit.