Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA National Practice Questionnaire

Senthurun Mylvaganam, Paula R Williamson, Ramsey Cutress, Matthew Gardiner, Steven Thrush, Lisa Whisker, Jane Blazeby, Shelley Potter, the Breast Reconstruction Research Collaborative

Research output: Contribution to journalArticle (Academic Journal)

10 Citations (Scopus)
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Abstract

Introduction: The 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.

Methods: A 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.

Results: 81 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.

Conclusions: The 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.
Original languageEnglish
Pages (from-to)182-190
Number of pages9
JournalBreast
Volume35
Early online date30 Jul 2017
DOIs
Publication statusPublished - Oct 2017

Structured keywords

  • Centre for Surgical Research

Keywords

  • survey
  • implant-based reconstruction
  • acellular dermal matrix
  • dermal sling
  • current practice
  • breast reconstruction

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  • Projects

    ConDuCT-II

    Blazeby, J. M.

    1/04/1431/03/19

    Project: Research

    Cite this

    Mylvaganam, S., Williamson, P. R., Cutress, R., Gardiner, M., Thrush, S., Whisker, L., Blazeby, J., Potter, S., & the Breast Reconstruction Research Collaborative (2017). Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA National Practice Questionnaire. Breast, 35, 182-190. https://doi.org/10.1016/j.breast.2017.07.016