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Establishment of perforator flap programs for breast reconstruction: the New England program experience
Bernard T Lee1, Janet H Yueh, Chen Chen
1Boston, Mass. From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School.
Plastic and Reconstructive Surgery
|December 17, 2009
Summary
Establishing a perforator flap program significantly boosted patient referrals and satisfaction for breast reconstruction. This model can guide other institutions in developing similar successful programs.
Area of Science:
- Plastic Surgery
- Breast Reconstruction
- Surgical Oncology
Background:
- Perforator flap breast reconstruction offers advanced options for patients, but local availability can be a barrier.
- Regional centers centralize cancer care and provide specialized procedures like perforator flap reconstruction.
- The New England perforator flap program was established in 2004 to address these needs.
Purpose of the Study:
- To present a blueprint for establishing a regional perforator flap breast reconstruction program.
- To evaluate the program's impact on patient satisfaction and referral patterns.
- To offer a model for other institutions seeking to develop similar programs.
Main Methods:
- Retrospective chart review of 977 postmastectomy reconstruction patients (1999-2008).
- Analysis of demographics, complications, referral sources, and patient residence.
- Administration of a validated questionnaire to assess satisfaction and quality of life.
Main Results:
- Post-program implementation, out-of-state patient numbers doubled (10.6% to 20.9%).
- Institutional referrals increased significantly (53.8% to 64.4%).
- Perforator flap reconstruction showed higher patient satisfaction (82.7% vs. 65.8%) and increased out-of-base referrals (76.6% vs. 52.0%).
Conclusions:
- Developing a dedicated perforator flap program enhances institutional referrals and patient satisfaction.
- Accreditation standards may encourage more centers to adopt such specialized programs.
- The presented program blueprint serves as a potential model for replication.
