Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Senthurun Mylvaganam,T Gangamihardja,O.S Olyinka,Christopher Holcombe,M Galea,Ansar Farooq,J Turner,K Ogedegbe,A Allan,J Piper,E.M Teasdale,J.R Dicks,J Winter Beatty,S Hignett,Steven Thrush,Shelley Potter,J Henton,Ramsey I Cutress,F.S Fahmy,I Michalakis,Abhilash Jain,S Mylavaganam,Fiona Macneill ,S Kirk ,Jo Skillman ,Ian King ,Stan Kohlhardt ,Sharat Chopra ,Richard Linforth ,Christina Osborne ,Eisa Nael ,Rachel Brindle ,Velin Voynov ,Dayalan Clarke ,Elizabeth A Baker ,Vummiti Muralikrishnan ,Simon Cawthorn ,Thomas Collin ,Brendan Smith ,Anna Reid ,Antonino Carbone ,Jonathan Massey ,Sandeep Joglekar ,Michelle Mullan ,Lingshan Tang ,Shamaela Waheed ,Ivan Depasquale ,Ruth Waters ,Matthew Gardiner ,Shane George ,Sarah Benyon ,Donna Egbeare ,Chris Holcombe ,Alison Conway Fitzgerald ,Dibyesh Banerjee ,Sue Down ,Jennifer J Hu ,Salim Tayeh ,David Westbroek ,Rosamond Jacklin ,Joanna Seward ,Laila Parvanta ,Lillian Lai ,Philip Turton ,Andrew T Knight ,Nicola Dunne ,Suzanne Gawne ,Mai Rostom ,Amtul R Carmichael ,Rhiannon Foulkes ,Raghavan Vidya ,Musa Barkeji ,Sarah Tang ,Douglas Macmillan ,Anastassi Halka ,Sarah E Clark ,Nikolaos Manoloudakis ,Sa Mcintosh ,Claire V Murphy ,Wail Al Sarakbi ,Serena Ledwidge ,Lisa Whisker ,Habib Tafazal ,Siobhan Laws ,Angela Volleamere ,Isabella Dash ,Eleri Davies ,Julia Henderson ,Elizabeth J Conroy ,Irene Athanasiou ,Kamal Bisarya ,Nicola Barnes ,Matthew Griffiths ,Akinfemi Akingboye ,Tomasz Graja ,Hisham Osman ,Soni Soumian ,Mohamed Fawzy ,Katerina Anesti ,F Soliman ,Raj Achuthan ,Valentina Lefemine ,Amanda Thorne ,Sarah Huf ,Tracey Irvine ,Christopher Hoo ,Paddy Mallon ,Raman Vinayagam ,Douglas Ferguson ,Belinda Pearce ,Janet Smith ,Fayyaz Mazari ,Paula Williamson ,Olivier A Branford ,Rathinasabapathy Rathinaezhil ,Daniel Cocker ,Jane M Blazeby ,Nicola Mills ,Iman Azmy ,Richard James ,Mina Youssef ,Anita Hazari ,Frank Conroy ,M.g Dickson ,Anita Hargreaves ,James Harvey ,Harleen Deol ,Clare E Rogers ,Joanna Skillman ,Katherina Mcevoy ,Duy-Anh Nguyen ,Jorge Leon-Villapalos ,Sunita Saha ,Gareth Irwin ,Alison Waterworth ,Richard K Johnson ,Lucy Mansfield ,Stephanie Robertson ,Katharine Kirkpatrick ,J Roberts

doi:10.1016/j.breast.2017.07.016

Abstract

IntroductionThe introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. MethodsA questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. Results81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. ConclusionsThe iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored.

Highlights

The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking
We report the results of the first phase of the iBRA Study, a National Practice Questionnaire (NPQ) which aimed to survey breast and plastic surgical units across the UK to comprehensively describe the current practice of Implant-based breast reconstruction (IBBR)
Unit demographics are shown in Table 1. 79/81 (98%) units specified the types of breast reconstruction that their unit offered

Summary

Introduction

The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. In the last ten years, the introduction of new techniques using biological or synthetic meshes to augment the subpectoral pocket have revolutionised the practice of IBBR These products allow single-stage direct-to-implant reconstruction [4] avoiding the need for time-consuming and uncomfortable expansions and a second operation [5]. They have broadened the indications for IBBR so that more women are suitable for a mesh-assisted reconstruction than the more traditional tissue-expansion-based techniques. This is because the mesh enlarges the subpectoral pocket improving lower-pole projection and creating a more natural-looking, ptotic result [6e10]. These techniques of IBBR have significant potential benefits for patients and healthcare providers

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Results

Discussion

Conclusion