Impact of Regional Referral Centers for Microsurgical Breast Reconstruction: The New England Perforator Flap Program Experience

Yueh, Janet H.; Slavin, Sumner A.; Bar-Meir, Eran D.; Merali, Hasan S.; Houlihan, Mary Jane; Gautam, Shiva; Morris, Donald J.; Tobias, Adam M.; Lee, Bernard T.

doi:10.1016/j.jamcollsurg.2008.10.033

« Previous Next »Journal of the American College of Surgeons
Volume 208, Issue 2 , Pages 246-254, February 2009

Impact of Regional Referral Centers for Microsurgical Breast Reconstruction: The New England Perforator Flap Program Experience

Janet H. Yueh, BA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Sumner A. Slavin, MD, FACS
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Eran D. Bar-Meir, MD
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Hasan S. Merali, BA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Mary Jane Houlihan, MD
- Division of Breast Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Shiva Gautam, PhD
- Biostatistics Program, Harvard-Thorndike General Clinical Research Center, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Donald J. Morris, MD, FACS
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Adam M. Tobias, MD
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
Bernard T. Lee, MD, FACS
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA
- Correspondence address: Bernard T Lee, MD, Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 5A, Boston, MA 02215

Received 14 September 2008; received in revised form 28 October 2008; accepted 29 October 2008.

Background

Development of new, microsurgical techniques for breast reconstruction has led to more natural and durable reconstruction while minimizing morbidity. Despite these advances, institutions are slow to integrate subspecialized programs because of the additional resources required. In February 2004, our institution developed a microsurgery program for perforator flap breast reconstruction. The purpose of this study is to analyze the impact of this program with attention to reconstruction rates, patient satisfaction, and referral patterns.

Study Design

A retrospective chart review was performed on all women who had undergone mastectomy or breast reconstruction at our hospital. A total of 1,172 patients were identified between 1999 and 2006. Patients who had breast reconstruction received a validated questionnaire on satisfaction, health-related quality of life, and sociodemographic data. A 75.4% response rate was obtained.

Results

Since the program's inception, there has been a significant increase in the immediate reconstruction rate from 51.5% to 63.9% (p < 0.001). Between the two time periods, general patient satisfaction after breast reconstruction increased from 58.5% to 74.4% (p < 0.001), and aesthetic satisfaction increased from 58.5% to 69.9% (p = 0.010). In addition, we have seen a 4.1-fold increase in the number of patients per year from outside institutions for delayed breast reconstruction.

Conclusions

The addition of a perforator flap program for breast reconstruction to accredited cancer centers can increase both patient satisfaction and reconstruction rates. The shift in referral patterns emphasizes the role of breast reconstruction within a regional referral center.