title: [Breast Reconstruction Post-Mastectomy in the Public Health System of Andalusia, Spain].
abstract: OBJECTIVE
  Breast reconstruction (BR) after mastectomy is widely recommended but there are significant variations in its application. The objective was to know the rate of BR in the Andalusian Public Health System (APHS), timing (immediate or delayed), surgical procedure, frequency of postoperative complications and their characteristics.
  
  
  METHODS
  We used the Minimum Basic Data Set of the APHS with personal data and identification of hospitals encrypted. We selected discharges for breast cancer and mastectomy in 2010-2013 and related readmissions of the same patients in 2010-2014. BR rates were calculated according to patient age and type of mastectomy. Timing of BR (immediate or delayed) and surgical techniques used were described. Postoperative complications were analyzed in the initial episode and in readmissions occurring within a minimum period of 2 years. BR failures were specifically studied.
  
  
  RESULTS
  We analyzed the information of 6,026 women, of which 4,412 met the inclusion criteria (basically, two years follow-up). The BR rate was 29% (22% immediate and 7% delayed) and reached 58% in women younger than 46 years. BR was performed by 27 of the 36 hospitals that practice mastectomies. Global percentage of postoperative complications was 18.6% for immediate BR, 12.1% for delayed BR and 7.9% for patients without BR. Failure occurred in 12.7% of immediate BR and 7.2% of delayed BR.
  
  
  CONCLUSIONS
  In the Andalusian Public Health System the Breast reconstruction rate, is at a similar level to that reported nationally and in other countries.
authors.affiliation: Unidad de Evaluación. Hospital Costa del Sol. Marbella. Málaga and Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC).
authors.forename: Alberto
authors.initials: A
authors.lastname: Jiménez-Puente
authors.affiliation: Área de Obstetricia y Ginecología. Hospital Costa del Sol, Marbella. Málaga.
authors.forename: José Claudio
authors.initials: JC
authors.lastname: Maañón-di Leo
authors.affiliation: Unidad de Documentación Clínica. Hospital Costa del Sol. Marbella. Málaga.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lara-Blanquer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000534:rehabilitation / Q000706:statistics & numerical data*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011634:Public Health; D013030:Spain; D013524:Surgical Flaps
keywords: Breast cancer; Breast prosthesis implantation; Breast reconstruction; Outcome Assessment (Health Care); Postoperative complications; Spain; Surgical flaps; Utilization review; Woman Health Services