Breast Reconstruction Service Research Articles

African Americans have worse in-hospital outcomes in autologous and implant-based breast reconstruction: a population-based study from the National Inpatient Sample from 2015 to 2020.

African Americans have a long history of disparities in healthcare. However, whether their racial disparity exists in breast reconstruction outcomes is less clear. This study compared short-term outcomes of African Americans and Caucasians who underwent autologous (ABR) and implant-based breast reconstruction (IBR). Patients having ABR or IBR were identified in the National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between African Americans and Caucasians, adjusted for demographics, socioeconomic status, comorbidities, and hospital characteristics. In ABR, there were 8296 (63.89%) Caucasians and 1809 (13.93%) African Americans. In IBR, there were 12,258 (68.24%) Caucasians and 1847 (10.28%) African Americans. During the same period, 32,406 (64.87%) Caucasians and 7702 (15.42%) African Americans underwent mastectomy, indicating a lower reconstruction rate in African Americans, particularly in IBR. African Americans presented with significant preoperative differences, including younger age, higher comorbid burden, and pronounced socioeconomic disadvantages. After accounting for preoperative differences, in ABR, African Americans had higher renal complications (aOR = 1.575, 95 CI = 1.024-2.423, p = 0.04) hemorrhage/hematoma (aOR = 1.355, 95 CI = 1.169-1.571, p < 0.01), and transfer rate (aOR = 2.176, 95 CI = 1.257-3.768, p = 0.01). In IBR, African Americans had higher superficial wound complications (aOR = 1.303, 95 CI = 1.01-1.681, p = 0.04), flap revision (aOR = 4.19, 95 CI = 1.229-14.283, p = 0.02), and hemorrhage/hematoma (aOR = 1.791, 95 CI = 1.401-2.291, p < 0.01). In both ABR and IBR, African Americans had longer hospital length of stay (p < 0.01). These results highlight evident racial disparities in breast reconstruction for African Americans. Targeted interventions are needed to guarantee equitable access to breast reconstruction services and to address postoperative complications in African Americans.

Novel single-centre experience - evaluation of outcomes post-implementation of a coordinated combined breast reconstruction service.

Autologous breast reconstruction services are logistically complex and challenging to implement but have better outcomes than implants. This study aimed to evaluate the effect of implementing a coordinated, low-cost combined breast reconstruction service (0.8 FTE nurse liaison, 0.25 FTE plastic surgeon, two dedicated breast surgeons 0.05 FTE each and protected weekly all-day oncoplastic theatre) on unit productivity and efficiency in reducing wait times for immediate autologous breast reconstruction. A retrospective cohort study was conducted on all patients who underwent immediate autologous breast reconstruction at Fiona Stanley Hospital between two study periods, pre-intervention - February 2016 to June 2019 and post-intervention - November 2022. Data were analysed using SPSS v.27. One hundred twenty-seven participants were included, with 49% (n = 62) in the post-intervention group. Most procedures performed were therapeutic (n = 108, 85%). DIEP was the most common flap (84%), and the mean BMI was 26.9 (SD ± 4.2). There was a statistically significant increase in the number of high-risk gene carriers' prophylactic cases and bilateral cases performed post-intervention (5% to 26%, P = 0.001) and (29% to 55%, P = 0.003), respectively. Time to surgery on the waitlist did not significantly change after the intervention (therapeutic group: 3.1 to 3.5 weeks, P = 0.821; prophylactic group: 55.0 to 61.1 weeks, P = 1.000). Overall, there was a marked increase in the overall productivity of the breast service unit in terms of mastectomies, total reconstructions, and autologous reconstructions performed. This single-centre experience showed that implementing a coordinated service significantly increased the unit's productivity. This low-cost intervention can be applied to other healthcare settings.

Loss of breast reconstruction services during the COVID-19 pandemic: Negative impact on patient quality of life and wellbeing

Loss of breast reconstruction services during the COVID-19 pandemic: Negative impact on patient quality of life and wellbeing

Restore C19 national practice survey: The position of UK delayed breast reconstruction services

Restore C19 national practice survey: The position of UK delayed breast reconstruction services

The development of a rural breast reconstruction service: patient reported outcomes and benefits.

In 2021, breast cancer was one of the most commonly diagnosed cancer in Australia. While a mastectomy remains a treatment of choice, only a small percentage of women have access to a breast reconstruction after. Women living in a rural area are less likely to have a breast reconstruction; compared to their metropolitan counterparts. This study analyses the impact of single breast reconstruction service on a Modified Monash 3 (MM3) region and informs consumers and providers of the importance of a breast reconstruction unit embedded in a rural health network. [Corrections added on 2 May 2023, after online publication. Expanded reference citations have been deleted from Abstract section.] METHODS: Following ethics approval, all 64 patients who had undergone a breast reconstruction with this service between 2017 and 2021 were contacted. Patient reported outcomes were recorded through phone interviews, using a standardized questionnaire. For each patient that presented to the rural centre, cost of travel and productivity loss were also calculated, and compared to the closest metropolitan centre. Ninety-seven percent of the 38 participants strongly valued having a breast reconstruction service within their community. Eighty percent of participants were satisfied with their result. Patients were estimated to save on average $8478, by attending the rural breast reconstruction service. Access to a breast reconstruction is significantly impacted by geographical barriers. A rural breast reconstruction service can improve patient access and satisfaction, while also reducing the financial burden on patients.

Quality of breast reconstruction service at a university hospital as assessed by the patients.

To evaluate the quality of breast reconstruction service at a university hospital, as assessed by the patients. This cross-sectional study enrolled adult women who underwent immediate or delayed breast reconstruction by any technique performed at a university hospital between 1 and 24 months before the assessment. The Brazilian version of the Health Service Quality Scale (HSQS) was self-applied to the participants. The HSQS produces percentage scores, which are expressed in values ranging from 0 to 10 for each domain of the scale, and into an overall percentage quality score. The management team was asked to establish a minimum satisfactory score for the breast reconstruction service. Ninety patients were included. The management team considered 8.00 the minimum satisfactory score for the service. The overall percentage score was 93.3%. Only one domain, 'Support,' had an average score lower than that considered satisfactory (7.22 ± 3.0); while the others had higher scores. The domain that scored highest was 'Qualification' (9.94 ± 0.3), followed by 'Result' (9.86 ± 0.4). There was a positive correlation between 'type of oncologic surgery' and 'intentions of loyalty to the service' (ρ = 0.272; p = 0.009) and a negative correlation between 'education' and 'quality of the environment' (ρ = -0.218; p = 0.039). The higher the patient's level of education, the higher the score attributed to 'relationship' (ρ = 0.261; p = 0.013) and the lower the score of 'aesthetics and functionality' (ρ = -0.237; p = 0.024). The quality of the breast reconstruction service was considered satisfactory, but there is a demand for structural improvements, better interpersonal relationships, and a stronger support network for patients.

Access to Breast Reconstruction in Kuwait: Assessing Surgeon-related Factors as a Barrier to Referral.

This is an online questionnaire-based study to investigate the variation in the referring general surgeons' knowledge and perception towards breast reconstructive surgery. A total of 141 general surgeons responded to the questionnaire, and only 63 (44.7%) always discuss the available options for reconstruction with their breast cancer patients. When asked about referral to a plastic surgeon, only 49 (34.8%) responded with always, and the majority (N = 61; 43.3%) responded with sometimes. More than half (N = 73; 51.8%) believe that the general surgeon should determine patient suitability for referral to a plastic surgeon, while only 53 (37.6%) agree that breast cancer patients should always be referred to a plastic surgeon for consideration of reconstruction. The mean knowledge score was 6.6 of 8, while the mean perception score was 8.9 of 12. Responders with a higher total knowledge score were more likely to discuss with patients the availability of reconstruction. Despite the acceptable knowledge scores in our general surgeons, there is a low rate of referral for breast reconstruction in Kuwait. There is a pressing need to generate legislations and a streamlined protocol for referral that facilitate access to breast reconstructive services.

Loss of breast reconstruction services during the COVID-19 pandemic: Negative impact on patient quality of life and wellbeing

Introduction: The COVID-19 pandemic has disrupted many NHS services including breast reconstruction, which was unavailable in Aberdeen Royal Infirmary from March to September 2020. This study aims to determine; how many patients were affected and how did this impact on patients' physical, psychosocial, and sexual wellbeing.

Canadian Expert Opinion on Breast Reconstruction Access: Strategies to Optimize Care during COVID-19.

Background:Breast reconstructive services are medically necessary, time-sensitive procedures with meaningful health-related quality of life benefits for breast cancer survivors. The COVID-19 global pandemic has resulted in unprecedented restrictions in surgical access, including access to breast reconstructive services. A national approach is needed to guide the strategic use of resources during times of fluctuating restrictions on surgical access due to COVID-19 demands on hospital capacity.Methods:A national team of experts were convened for critical review of healthcare needs and development of recommendations and strategies for patients seeking breast reconstruction during the pandemic. Following critical review of literature, expert discussion by teleconference meetings, and evidenced-based consensus, best practice recommendations were developed to guide national provision of breast reconstructive services.Results:Recommendations include strategic use of multidisciplinary teams for patient selection and triage with centralized coordinated use of alternate treatment plans during times of resource restrictions. With shared decision-making, patient-centered shifting and consolidation of resources facilitate efficient allocation. Targeted application of perioperative management strategies and surgical treatment plans maximize the provision of breast reconstructive services.Conclusions:A unified national approach to strategically reorganize healthcare delivery is feasible to uphold standards of patient-centered care for patients interested in breast reconstruction.

Microsurgical autologous breast reconstruction in the midst of a pandemic: A single-unit COVID-19 experience

IntroductionCOVID-19 has disrupted the provision of breast reconstructive services throughout the UK. Autologous free flap breast reconstruction was restarted in our unit on 3 June 2020. We aimed to compare the unit's performance of microsurgical autologous breast reconstruction in the “post-COVID” period compared with the exact time period in the preceding year.MethodsWe retrospectively reviewed prospectively collected data in the “pre-COVID” (from 3 June 2019 to 31 December 2019) and “post-COVID” period (from 3 June 2020 to 31 December 2020). Patient demographics included age, body mass index, co-morbidities, Anaesthesiologists (ASA) grade and smoking status. Surgical factors included neoadjuvant chemotherapy, previous chest wall radiotherapy, unilateral or bilateral reconstruction, reconstruction timing, number of pedicles, contralateral symmetrisation and other procedures.dependant variables were ischaemic time, operative time, mastectomy weight, flap weight, length of stay, return to theatre and complication rates. The number of trainers and trainees present in theatre was recorded and analysed.ResultsFewer DIEP flaps were performed in the “post-COVID” period (45 vs. 29). No significant difference was observed in mastectomy resection weight, but flap weight was significantly increased. No significant difference was found in ischaemic time as well.The postoperative length of stay was significantly reduced. No significant difference was found in rates of return to theatre, unplanned admission, infection, haematoma, seroma or wound dehiscence. No cases of venous thromboembolism or flap failures were recorded.The mean number of trainers and trainees, and the trainee-to-trainer ratio was not found to be significantly different between cohorts.ConclusionAlthough fewer cases were performed, autologous breast reconstruction was safely delivered throughout the COVID-19 pandemic in the first wave without affecting training.

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. Patients and Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.

The Impact of the COVID-19 Pandemic on Breast Reconstruction: A Canadian Perspective.

Background:The COVID-19 pandemic has led to unprecedented challenges and restrictions in surgical access across Canada, including for breast reconstructive services which are an integral component of comprehensive breast cancer care. We sought to determine how breast reconstructive services are being restricted, and what strategies may be employed to optimize the provision of breast reconstruction through a pan-Canadian evaluation from the providers’ perspective.Methods:This was a cross-sectional survey of Canadian plastic and reconstructive surgeons who perform breast reconstruction. The 33-item web-based questionnaire was developed by a pan-Canadian working group of breast reconstruction experts and disseminated via email to members of the Canadian Society of Plastic Surgery. The questionnaire queried respondents on the impact of the COVID-19 pandemic and associated restrictions on surgeons’ breast reconstruction practice patterns and opinions on strategies for resource utilization.Results:Responses were received from 49 surgeons, who reported practicing in 8 of 10 Canadian provinces. Restrictions on the provision of breast reconstructive procedures were most limited during the First Wave of the COVID-19 pandemic, where all respondents reported at least some reduction in capacity and more than a quarter reporting complete cessation. Average reported reduction in capacity ranged from 31% to 78% across all 3 waves. Autologous, delayed, and prophylactic reconstructions were most commonly restricted.Conclusion:This study provides a pan-Canadian impact assessment on breast reconstructive services during the COVID-19 pandemic from the providers’ perspective. To uphold the standards of patient-centred care, a unified approach to strategically reorganize health care delivery now and in the future is needed.

P125. Setting up a new microsurgical breast service in a non-tertiary hospital. Is it safe, and do outcomes compare to centres of excellence?

Aims: Access to autologous reconstruction continues to be limited in some areas of the United Kingdom. This is, in part, due to the perceived difficulty offering this service outside of a large tertiary centre. We present our experience setting up a new microsurgical breast reconstruction service in a district hospital and compare our results to the published outcomes of large volume centres.

Setting up a new microsurgical breast service in a non-tertiary hospital: Is it safe, and do outcomes compare to centres of excellence?

Access to autologous reconstruction continues to be limited in some areas of the United Kingdom. This is, in part, due to the perceived difficulty offering this service outside of a large tertiary centre. We present our experience setting up a new microsurgical breast reconstruction service in a district hospital and compare our results to the published outcomes of large volume centres. Patient data were collected prospectively from the start of the service to date (July 2018- July 2020) with the capture of demographics, management, and outcomes. The BREAST-Q tool was used preoperatively and at a minimum of 3 months. The first 40 patients undergoing DIEP reconstruction were included. Of these, 70% were immediate, mean age was 49 years (27-68) and BMI was 28.1kg/m2 (22-32.5). In all, 50% had one or more co-morbidities other than breast cancer. Median length of stay was 3 days (2-6) with 75% of patients discharged on day 2 or 3. Ten patients' stay exceeded 3 days - mostly due to social reasons. Flap loss occurred in 1 patient (2.5%). Twenty-one patients developed complications (52%) within 90 days: seven Clavien-Dindo Grade I, two Grade II and ten Grade IIIb. Fat necrosis and mastectomy flap necrosis were the most common complications. Surgical intervention was higher in those needing adjuvant therapy. Patient-reported outcomes showed post-operative improvement across all domains except abdominal physical well-being at median 11.3 months. We present the shortest published length of stay for unilateral DIEP reconstructions. We are the first paper to publish patient-reported outcomes following a breast microsurgical enhanced recovery protocol. We demonstrate how a new microsurgical service, utilising an enhanced recovery protocol and careful patient selection can immediately achieve outcomes comparable to well-established centres. There is no reason why all patients should not have access to microsurgical breast reconstruction locally.

Breast Reconstruction Practices and Barriers in West Africa: A Survey of Surgeons.

Surveys were administered to surgeons attending the annual meeting of the West African College of Surgeons in 2018. Surgeons were surveyed regarding their practices and perceptions of breast reconstruction. Information on barriers to breast reconstruction focused on patient- and surgeon-related factors was also obtained. A univariate analysis was performed to assess association of demographic and practice information with perceptions of reconstruction barriers. Thirty-eight surgeons completed the questionnaires; 10 of the respondents were plastic surgeons (27%). The survey response rate was 40%. Factors that a majority of surgeons believed to limit access to reconstruction included limited experience (72.9%), resources (76.3%), and a lack of referrals for reconstruction (75%). In total, 76.5% of surgeons had performed <10 breast reconstruction cases in the past year. Two patient factors highlighted by most surgeons (>80%) were a lack of knowledge and concerns about cost. Perspectives from surgeons in the West African College of Surgeons suggest that barriers in access, patient awareness, surgeon technical expertise, and cost limit the delivery of breast reconstructive services to women in the region. Implementation of interventions focused on these specific metrics may serve as valuable first steps in the movement to increase access to breast reconstruction.

Provision of breast reconstruction services in Australia: the case for change.

Provision of breast reconstruction services in Australia: the case for change.

Abstract P6-11-15: Information gaps and perceived barriers to achieve breast reconstruction among patients with mastectomy in a public breast cancer center in Mexico

Abstract Introduction: Multiple studies have reported that breast reconstruction (BR) after mastectomy is paramount in the global treatment of breast cancer (BC). Despite this, BR rates in Mexico are very low (7-16%), which may be explained by the fact that BR is not completely covered by public institutions in our country. Even though BR rates can increase when pertinent information is offered to patients, little is known about the level of information among Mexican patients. We sought to assess the level of information that patients who underwent mastectomy had about BR in a Mexican referral BC center with public healthcare insurance where BR services are not covered, as well as its relationship with their decision-making and the main reasons why they would or would not want to have BR. Methods: A written questionnaire was applied to 110 women who underwent mastectomy to assess their knowledge and desire for BR, and the reasons for or against it. We then analyzed the differences in information perception between women who did or did not desire BR. Results: Mean age was 51 years (30-78). Most patients had lower education (61%), 29% had a monthly income &amp;lt;300 USD, 73% were responsible for their household income, and 57% had ≥3 children. Most patients had tumors &amp;gt;5 cm (66%), with a high proportion of locally advanced clinical stages (67%). Mean times since diagnosis and since mastectomy were 2.2 and 1.9 years, respectively. Two-thirds of patients wished to have BR. Only 28% looked for information about BR; 65% did not recall ever receiving any information about BR from their doctors; 76% said they were not advised by their providers to undergo BR; 83% never asked their doctors for information regarding BR; and 84% believed they did not have enough information about BR. Notably, 12% of patients received their families’ advice not to have a BR. Seven domains were significantly associated with the desire of having a BR. More patients who did not desire a BR than those who did, reported they did not receive or look for information, advice or counseling about their BR options (see table). The five main reasons to have BR were: 1) It would give me freedom to dress in any kind of clothes; 2) To make my breasts look symmetrical; 3) To look like I used to before the mastectomy); 4) To feel more confident; and 5) To feel more attractive. The five main reasons not to have BR were: 1) I am worried about its cost; 2) I do not know the BR options; 3) I do not have enough information about BR; 4) I am worried the cancer could return; and 5) I am afraid that BR complications can happen. Conclusion: This is the first study to evaluate the association between the information, advise and counseling patients receive about BR and their desire to undergo the procedure in an underserved setting such as the Mexican public healthcare system. The amount of information and counseling about BR significantly correlates with women's interest in this procedure. This lack of information about BR from providers might be mainly due to the lack of BR coverage in public services, which likely play a strong role on the low rates of BR in this country. For this reason, it is of utmost importance to ensure that a specific governmental or civil budget is directed to cover this procedure and, ultimately promote the delivery of BR-related information to all BC patients in a standardized manner. Table. Differences in BR interest according to BR knowledgeQuestionsWould you like to have a breast reconstruction? n(%)No (n=37)Yes (n=73)Total (n=110)PNone of my doctors informed me about breast reconstruction30 (81)41 (56)71 (65)0.01None of my doctors advised me to have a breast reconstruction33 (89)51 (70)84 (76)0.024I never asked my doctor for information about breast reconstruction36 (97)55 (70)91 (83)0.004My doctor did not explain there are many types of reconstruction35 (95)51 (70)85 (77)0.003I do not think I have enough information about breat reconstruction35 (95)57 (78)92 (84)0.027I have never approached an NGO or civil society organizations to get a breast reconstruction37 (100)65 (89)102 (93)0.037I have never discussed with my partner about having a breast reconstruction30 (81)36 (49)66 (60)0.001 Citation Format: Paulina Bajonero-Canonico, Melina Miaja-Avila, José Moral de la Rubia, Jorge A Saldaña-Rodríguez, David E Hinojosa-González, Cristel G De la O-Maldonado, Cynthia M Villarreal-Garza. Information gaps and perceived barriers to achieve breast reconstruction among patients with mastectomy in a public breast cancer center in Mexico [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-15.

Increasing access to breast reconstruction for women living in underserved non-metropolitan areas of Australia.

The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients' informed discussion of BR options and to improve access to BR for women living in underserved locations. Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience sample of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive sample of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas. Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status; locational barriers including limited health services resources and distance; administrative barriers such as hospital policies and inadequate support for women who need to travel; and surgical workforce recruitment barriers. Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities; the creation of designated breast centres with minimum caseload requirements similar to the UK's system; and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals.

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

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.

Principles of patient-centred care and barriers to their implementation: a case study of breast reconstruction in Australia.

"Patient-centred care" is widely promoted as an ideal goal of health care systems, but is often difficult to achieve in practice. This article has three aims: to develop an original set of generalisable patient-centred care principles (PCCPs); to identify barriers to the implementation of these principles in a real-world setting, using breast reconstruction (BR) services in Australia as a case study; and to document examples of successful patient-centred care in relation to BR. Semi-structured interviews (n = 90) were conducted with 31 breast and plastic reconstructive surgeons, 37 breast cancer health professionals and 22 women who underwent mastectomy as part of their breast cancer treatment and were dissatisfied with their BR experiences. Ten broad PCCPs were derived from our participant interviews. These principles comprised the following: maximising patient choice, access to services, patient and family support and appropriateness of information; minimising patient costs and physical and psychosocial morbidity; and facilitating informed decision-making, interdisciplinary patient management and evidence-informed practice. While the major barriers to the implementation of these PCCPs in relation to BR were resource driven, surgeon-related factors were also identified. These PCCPs highlight areas of need but also provide examples of high quality patient-centred care. They may help to guide a national discussion about minimum standards of BR practice, while allowing for some necessary regional and cultural variation. They also have the potential to be applied more widely to the provision of a range of health services within Australia or internationally.