A clinical practice review on process efficiency in autologous breast reconstruction

Autologous breast reconstruction is considered the gold standard technique for breast reconstruction following mastectomy. Thanks to recent refinements the main focus of surgery has shifted from flaps survival and donor site morbidity to optimal aesthetic outcomes and patients' satisfaction. However, prolonged operative time remains a limiting aspect for many patients and surgeons who aim in improving access to care and outcomes. Process mapping is a quality improvement strategy consisting of the creation of a visual representation of a process to recognize errors, minimize waste and optimize outcomes. It has been effectively applied in abdominal based autologous breast reconstruction in nine papers. The process segments and analysis varied between published papers, but all authors focused on intraoperative process mapping and reported reduced operative times. Additional preoperative and postoperative factors have been studied and are commonly applied to further optimize efficiency (such as preoperative CTA, co-surgery model, flap perfusion evaluation, postoperative monitoring, and ERAS protocol). Although shorter operative times are related to decrease surgical morbidity and faster recovery time, and safety, the aesthetic outcome should remain the main focus in autologous breast reconstruction. In fact, the true ultimate aim should be the achievement of high patient satisfaction.