title: National trends in immediate and delayed post-mastectomy reconstruction procedures in England: A seven-year population-based cohort study.
abstract: BACKGROUND
  Little is known about post-mastectomy reconstruction procedural trends in women diagnosed with breast cancer in England. Our aim was to examine patterns of immediate and delayed reconstruction procedures over time and within regions.
  
  
  METHODS
  Women with breast cancer who underwent unilateral index immediate or delayed post-mastectomy reconstruction between 2007 and 2014 were identified using the National Hospital Episode Statistics database. Women were grouped into categories based on the type of reconstruction procedure. Adjusted rates of implant and free flap reconstructions were then calculated across regional Cancer Networks using a regression model to adjust for age, disease, comorbidities, ethnicity, and deprivation.
  
  
  RESULTS
  Between 2007 and 2014, 21 862 women underwent immediate reconstruction and 8653 delayed reconstruction. Immediate implant reconstruction increased from 30% to 54%, and immediate free flap reconstruction from 17% to 21%. Adjusted immediate implant and free flap proportions ranged from 17 to 68% and 9-63%, respectively, across regions. Free flaps became more common in the delayed setting, rising from 25% to 42%. However, adjusted rates ranged from 23% to 74% across regions. Networks with high/low rates of free flaps for immediate tended to have high/low rates for delayed reconstruction.
  
  
  CONCLUSIONS
  There has been a substantial increase in the use of immediate implant reconstruction in England. In comparison, there has been an increasing use of autologous free flap reconstruction for delayed procedures. Significant regional variation exists in the type of reconstruction performed, and these patterns need to be examined to determine if variation is related to service provision and/or capacity barriers.
authors: Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK; Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK. Electronic address: jomennie@doctors.org.uk.
authors: J C
authors: JC
authors: Mennie
authors: Department of Plastic and Reconstructive Surgery, St Thomas Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
authors: P-N
authors: PN
authors: Mohanna
authors: Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Queen Victoria Road, Newcastle-upon-Tyne, NE1 4LP, UK.
authors: J M
authors: JM
authors: O'Donoghue
authors: Department of Breast Surgery, Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust, Romsey Road, Winchester, SO22 5DG, UK.
authors: R
authors: R
authors: Rainsbury
authors: Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
authors: D A
authors: DA
authors: Cromwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000601:surgery*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D016462:Mammaplasty / Q000639:trends*; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications; D013524:Surgical Flaps; D015626:Tissue Expansion; D016896:Treatment Outcome
keywords: Breast cancer; Breast reconstruction; Expander; Free flap; Implant; Practice variation