title: Process outcomes in breast reconstruction and the impact of a comprehensive breast center.
abstract: BACKGROUND
  Processes outcomes for breast reconstruction (related to access, efficiency, and sustainability) have not been well described. These processes are likely to be impacted by the centralization of breast cancer care into comprehensive breast centers. The authors' study objectives were to define measures for breast reconstruction processes of care and to determine a breast center's effect on these measures.
  
  
  METHODS
  All patients evaluated for postmastectomy breast reconstruction between 2009 and 2013 (2 years before to 2 years after opening of the authors' breast center) were reviewed. Consultation, surgical, and financial data were compared between the two periods.
  
  
  RESULTS
  A total of 614 (45.0 percent) and 750 patients (55.0 percent) were treated before and after, respectively, formation of the authors' breast center. Between the two periods, the internal referral rate for postmastectomy reconstruction increased from 27.1 percent to 46.0 percent (p<0.001). The delay between surgical oncology and plastic surgery consultation decreased from 10.5 days to 3.6 days (p<0.001), as did the delay between plastic surgery consultation and surgery for both autologous (from 45.1 days to 32.6 days; p=0.003) and implant-based reconstruction (from 34.9 days to 25.5 days; p=0.004). The immediate breast reconstruction rate increased from 40.1 percent to 52.7 percent (p<0.001), including autologous reconstruction (from 13.1 percent to 20.8 percent; p<0.001).
  
  
  CONCLUSIONS
  In breast reconstruction, a comprehensive breast center improves processes of care. The authors describe their strategy for integration of reconstructive surgery into a breast center.
authors.affiliation: Columbus, Ohio From the Department of Plastic Surgery and the Department of Surgery, Division of Surgical Oncology, The Ohio State University.
authors.forename: Albert H
authors.initials: AH
authors.lastname: Chao
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Khansa
authors.forename: William B
authors.initials: WB
authors.lastname: Farrar
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002173:Cancer Care Facilities / Q000458:organization & administration*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003191:Comprehensive Health Care / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods*; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States