Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom.
BACKGROUND
The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions.


METHODS
Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis.


RESULTS
National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R(2) = 0.97) than a linear function (R(2) = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013.


CONCLUSIONS
Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline.
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Daniel R
DR
Leff
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Alex
A
Bottle
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Erik
E
Mayer
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Darren K
DK
Patten
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Christopher
C
Rao
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Paul
P
Aylin
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Dimitri J
DJ
Hadjiminas
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Thanos
T
Athanasiou
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Ara
A
Darzi
Department of BioSurgery and Surgical Technology, Imperial College London, London, United Kingdom; The Breast Unit, Department of Academic Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom; Dr Foster Unit, Imperial College London, London, United Kingdom; and The Breast Unit, Department of Surgery, Imperial Healthcare NHS Trust, London, United Kingdom.
Gerald
G
Gui