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. 2017 Oct:35:182-190.
doi: 10.1016/j.breast.2017.07.016. Epub 2017 Jul 30.

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

Senthurun Mylvaganam  1 , Elizabeth Conroy  2 , Paula R Williamson  2 , Nicola L P Barnes  3 , Ramsey I Cutress  4 , Matthew D Gardiner  5 , Abhilash Jain  5 , Joanna M Skillman  6 , Steven Thrush  7 , Lisa J Whisker  8 , Jane M Blazeby  9 , Shelley Potter  10 , Christopher Holcombe  11 ; iBRA Steering Group; Breast Reconstruction Research Collaborative
Collaborators, Affiliations

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

Senthurun Mylvaganam et al. Breast. 2017 Oct.

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.

Keywords: Acellular dermal matrix; Breast reconstruction; Current practice; Dermal sling; Implant-based reconstruction; Survey.

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Figures

Fig. 1
Fig. 1
Number of immediate implant-based breast reconstructions performed per year by participating unit.
Fig. 2
Fig. 2
Patient selection for dermal sling procedures (n = 66).
Fig. 3
Fig. 3
Patient selection for biological mesh-assisted procedures (N = 62).
Fig. 4
Fig. 4
Patient selection for synthetic mesh-assisted procedures (N = 25).
See this image and copyright information in PMC

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