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INTRODUCTION: The 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study. METHODS: A questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines. RESULTS: 81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable. CONCLUSIONS: The iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice.

Original publication

DOI

10.1016/j.ejso.2018.01.098

Type

Journal article

Journal

Eur j surg oncol

Publication Date

05/2018

Volume

44

Pages

708 - 716

Keywords

Acellular dermal matrix, Current practice, Dermal sling, Guidelines, Implant-based reconstruction, Mesh, Survey, Anti-Bacterial Agents, Antibiotic Prophylaxis, Breast Implantation, Breast Implants, Breast Neoplasms, Female, Guideline Adherence, Humans, Mammaplasty, Mass Screening, Mastectomy, Methicillin-Resistant Staphylococcus aureus, Patient Education as Topic, Patient Reported Outcome Measures, Patient Satisfaction, Perioperative Care, Practice Guidelines as Topic, Practice Patterns, Physicians', Prosthesis-Related Infections, Staphylococcal Infections, Staphylococcus aureus, Surgical Wound Infection, Surveys and Questionnaires, United Kingdom