title: Establishment of perforator flap programs for breast reconstruction: the New England program experience.
abstract: BACKGROUND
  Patients seeking perforator flap breast reconstruction often face difficult choices if these procedures are not offered locally. To meet this demand, regional referral centers have been created to provide the latest procedures and to centralize cancer care. In 2004, the authors started the New England perforator flap program. The authors present a blueprint of their program and examine its impact on patient satisfaction and referral patterns.
  
  
  METHODS
  A retrospective chart review was performed on all women who underwent postmastectomy reconstruction at Beth Israel Deaconess Medical Center from 1999 to 2008. A total of 977 patients were identified. Demographics, complications, referring patterns, and state of residence were examined. A validated questionnaire (76.4 percent response rate) was administered determining satisfaction, quality of life, and referral patterns.
  
  
  RESULTS
  After program creation, there was an increase in the number of patients undergoing reconstruction from outside the state (10.6 percent versus 20.9 percent, p < 0.0001). There was also an increase in the number of outside referrals to the institution (53.8 percent versus 64.4 percent, p = 0.016). Perforator flap reconstruction had a higher referral rate from outside the referral base compared with nonperforator flap reconstruction (76.6 percent versus 52.0 percent, p < 0.0001). Finally, there was an increase in general patient satisfaction in perforator flap compared with nonperforator flap patients (82.7 percent versus 65.8 percent, p = 0.002).
  
  
  CONCLUSIONS
  The creation of a perforator flap program can increase referrals to an institution and increase general patient satisfaction. With the new National Accreditation Program for Breast Centers, more institutions may consider developing these programs. The authors offer their blueprint as a potential model for program design.
authors.affiliation: Boston, Mass. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Janet H
authors.initials: JH
authors.lastname: Yueh
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
authors.forename: Adam M
authors.initials: AM
authors.lastname: Tobias
authors.forename: Sumner A
authors.initials: SA
authors.lastname: Slavin
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery* / Q000628:therapy; D002173:Cancer Care Facilities / Q000458:organization & administration*; D005260:Female; D006085:Graft Survival; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D015411:Mastectomy, Modified Radical; D008499:Medical Records; D008875:Middle Aged; D009511:New England; D017060:Patient Satisfaction; D016730:Program Development; D012017:Referral and Consultation; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome