title: Impact of regional referral centers for microsurgical breast reconstruction: the New England perforator flap program experience.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, MA, USA.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Yueh
authors.forename: Sumner A
authors.initials: SA
authors.lastname: Slavin
authors.forename: Eran D
authors.initials: ED
authors.lastname: Bar-Meir
authors.forename: Hasan S
authors.initials: HS
authors.lastname: Merali
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Houlihan
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Morris
authors.forename: Adam M
authors.initials: AM
authors.lastname: Tobias
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002173:Cancer Care Facilities / Q000458:organization & administration*; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008499:Medical Records; D008866:Microsurgery; D008875:Middle Aged; D009511:New England; D017060:Patient Satisfaction; D011788:Quality of Life; D012017:Referral and Consultation; D012189:Retrospective Studies; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D014656:Vascular Surgical Procedures / Q000379:methods*