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Surgeon warns that hospitals need to face the resource implications of breast reconstruction surgery

March 19, 2002

Roughly three mastectomies can be carried out in the time it takes to do a mastectomy immediately followed by breast reconstruction surgery, a surgeon reported to the 3rd European Breast Cancer Conference in Barcelona today (Thursday 21 March). Stephen Dace (who was a Senior Registrar at the Royal Liverpool University Hospital in Liverpool, UK, at the time of the research) said this had important implications for hospital resources.

He conducted a pilot study that showed that not only did mastectomies with breast reconstruction take longer to do, but they also gave rise to a greater number of early complications after surgery, such as wound infection, and involved more out-patient appointments and more additional surgery.

"This is often overlooked when the performance of a hospital unit is being assessed and this issue needs to be addressed," he said. "The point of carrying out this study was to try to measure the additional time needed to perform breast reconstruction after mastectomy because this has important resource implications. Extra theatre staff are needed, operating sessions are longer, and there needs to be more time allocated to see patients at the clinic after surgery."

Mr Dace, who is now a consultant surgeon in Altnagelvin Hospital, Northern Ireland, looked at three groups of ten women who had had mastectomy alone, mastectomy plus expander reconstruction1 or mastectomy plus TRAM2 reconstruction. He compared the length of time of surgery, the duration of their stay in hospital, complications, follow-up and the need for further surgery.

He found that the length of in-patient stay for mastectomy, mastectomy plus expander and mastectomy plus TRAM was 7.1 days, 5.6 and 9.8 days respectively. It took 14 hours to perform ten mastectomies, 23.3 hours to perform 10 mastectomies with expanders, and 41.4 hours to carry out ten mastectomies with TRAM reconstruction. There were two early complications in each of the mastectomy and mastectomy plus expander groups, and five in the TRAM group. The average number of out-patient appointments was 1.6 (mastectomy), 4.5 (expander) and 3.7 (TRAM). No one in the mastectomy group had further surgery, whereas 70% of the expander group and 50% of the TRAM group did.

There are a number of reasons why patients undergoing breast reconstruction need more out-patient appointments and further surgery. Infection, bleeding or compromise of the blood flow to the newly formed breast are all potential problems. Further surgery might be required to perform nipple reconstruction and to make minor adjustments to the shape of the reconstructed breast.

Mr Dace said: "We have demonstrated that simple cancer surgery such as mastectomy and axillary node clearance is much less time-consuming than when it is followed immediately by a reconstructive operation. Thus, in the time to do a mastectomy and reconstruction, in some cases up to three simple mastectomies without reconstruction could be performed. We are not suggesting that reconstruction should not be done, but extra resources should be made available and the extra requirements should be acknowledged when busy breast units offer a full reconstructive service.

"This is a pilot study and we are aware that the numbers of patients are small and therefore the conclusions reached must be taken in the context of this fact. However, a further audit of larger groups is being performed and this should give a clearer idea of the issues raised."

MW Communications