New breast reconstruction guidelines launched

Today new breast reconstruction guidance, which aims to significantly improve the quality and delivery of care for all breast cancer patients in the UK, is launched BAPRAS, the Association of Breast Surgery (ABS) and Breast Cancer Care. It is the first time that plastic and breast surgeons have collaborated on a comprehensive plan for service improvement to drive patient care and standards in the UK, building on original 2007 guidelines

Click here to view the guidelines - For patients  / For healthcare professionals

The guidance has been developed in response to findings from the National Mastectomy and Breast Reconstruction Audit, which involved more than 18,000 women and examined a broad range of clinical and patient-reported outcomes. It highlighted a number of inconsistencies in breast cancer patient care that are currently found across NHS Trusts.

The 2009 Audit  showed variations in pre-operative information given to patients, the ability of patients to access services and patient outcomes. Among the 15,479 women who underwent mastectomy, only 3,216 (21 per cent) underwent immediate breast reconstruction, a procedure which is now recognised as having better patient outcomes. The rate has increased from the 11 per cent estimated for English NHS trusts during the 2005/06 financial year but it varied significantly from 9 per cent to 43 per cent between the 30 English Cancer Networks.

Key findings from the 2010 Audit showed that levels of severe pain in the first 24 hours differed between the types of surgery. Women undergoing mastectomy reported low levels of severe pain in the first 24 hours following surgery. Their rate was 6.2 per cent, which compares well to an 11 per cent rate for other types of major surgery. Women undergoing immediate and delayed reconstruction reported higher rates (respectively,16.5 per cent and 20.1 per cent).

The new guidelines address these inconsistencies in breast cancer patient care by providing members of multidisciplinary healthcare teams with comprehensive best practice information on reconstructive oncoplastic breast surgery at each stage of a patient’s journey. They are expected to radically enhance the treatment, delivery and experience of patients undergoing breast reconstruction. 25 quality indicators have been created including controlling infection rates, improving post operative pain control and ensuring patients have access to plastic surgeons for their treatment. These quality indicators provide a simple checklist against which multidisciplinary teams providing oncoplastic breast reconstruction can measure their own performance.

Joe O’Donoghue, full member of BAPRAS, specialist in oncoplastic breast surgery and consultant plastic surgeon said:

“The National Mastectomy and Breast Reconstruction Audit highlighted a worrying range of inconsistencies in breast reconstruction treatment and care offered to breast cancer patients. Variations in critical areas such as post operative pain management and infection rate control must be addressed to ensure that all patients have equal access to the highest standards of breast reconstruction care and treatment.

“For the first time, this major set of comprehensive guidelines will seek to address these gaps in care, equipping health professionals with key information to be able to deliver consistent and quality treatment to all patients in the UK.”

Dick Rainsbury, President of the Association of Breast Surgery and Editor of the Guidelines, said:

“These ground-breaking guidelines are based around the experience of thousands of women with breast cancer, and hundreds of teams involved in their treatment. They lay down new practice-changing standards of care, so women can now look forward to much better information, easier access and greater choice when facing often difficult decisions about breast reconstruction. They will also enjoy real improvements in hospital care delivered by specialist teams, leading to fewer complications, earlier discharge and a quicker recovery.”

A patient version of the guidelines has also been developed by Breast Cancer Care, with input from patients affected by breast cancer, which aims to help ensure everyone affected is well informed about oncoplastic breast reconstruction and can expect to receive the best possible outcomes, support and care wherever they are treated.

Dr Emma Pennery, Clinical Director at leading support charity Breast Cancer Care said:

“Patients are increasingly being offered a range of breast reconstruction choices and, understandably, often tell us they feel overwhelmed at what can be a very vulnerable time. We hope the patient guidelines, developed in collaboration with breast cancer patients, provide clarity on what people can and should expect from their breast reconstruction team.”