Breast reconstruction in the United Kingdom and Ireland

Background: Although it is becoming more common, previous surveys have identified concerns regarding the safety of immediate reconstruction following mastectomy. The aims of this study were to define current practice of breast reconstruction in the UK and Ireland, and to identify the characteristics of surgeons who use immediate breast reconstruction. Methods: A postal questionnaire survey of 498 consultant breast surgeons in the UK and Ireland was performed in January 2000. Results: There were 376 responses (response rate 76 per cent). Eighty-eight per cent of surgeons ‘always’ or ‘usually’ discuss reconstruction with patients due to undergo mastectomy; clinicians with a heavy caseload were significantly more likely to discuss it (odds ratio (OR) 18·45 (95 per cent confidence interval 1·99 to 171·07)). The majority of respondents (57 per cent) preferred delayed to immediate breast reconstruction; 70 per cent believed that immediate reconstruction has disadvantages, most commonly that it interferes with adjuvant therapy (56 per cent). Older surgeons were significantly less likely to perform immediate reconstruction (OR 5·18 (2·21 to 12·11)), and were significantly more likely to believe that immediate breast reconstruction has disadvantages (OR 2·02 (1·01 to 4·05)). Surgeons from Ireland were less likely to discuss and perform breast reconstruction (OR 0·20 (0·10 to 0·43) and 0·27 (0·12 to 0·60) respectively), or to have access to a plastic surgeon (OR 0·22 (0·11 to 0·44)). Conclusion: Significant variation exists in the delivery of breast reconstruction after mastectomy in the UK and Ireland. The age, workload and personal characteristics of the surgeon are important in determining reconstructive practice. © 2002 British Journal of Surgery Society Ltd