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Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
Published on: May 17, 2024
Targeted Multidisciplinary Continuous Improvement Process Reduces Time to Breast Cancer Surgery with Immediate
Pooja M Varman1, Rahul Rangan2, Amanda Maggiotto3
1Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. varmanp@ccf.org.
Background:
Breast surgery with immediate breast reconstruction (IBR) is associated with delays in definitive surgery and adjuvant therapy. We evaluated a multiphase quality improvement (QI) initiative to reduce time to treatment (TTT) for patients undergoing upfront surgery with IBR.
Methods:
This retrospective cohort study included patients with newly diagnosed breast cancer undergoing upfront surgery at a single institution between January 2022 and June 2025. Patients with metastatic disease, neoadjuvant therapy, or first treatment outside this institution were excluded. The QI initiative comprised three phases: (1) weekly multidisciplinary team huddle; (2) standardized communication protocol; and (3) OR alignment between breast and plastic surgery. Primary outcome was median TTT. Time to treatment for non-IBR patients was tracked concurrently as a balancing metric.
Results:
A total of 3,324 patients met inclusion criteria; 1,100 (33.1%) underwent surgery with IBR and 2,224 (66.9%) without. The cohort was predominantly early-stage (82.8% cTis/T1). Median TTT declined from 56 to 36 days in the IBR group and from 41 to 29 days in the non-IBR group (both P < 0.001). The proportion waiting longer than 45 days declined from 67.4 to 27.3% for IBR and from 40.5 to 22.9% for non-IBR (both P < 0.001). Only the IBR group demonstrated statistically significant improvement through Phase 3 (P < 0.001), while the non-IBR group plateaued after Phase 2.
Conclusions:
A targeted multidisciplinary QI initiative meaningfully reduced TTT for breast cancer patients undergoing upfront surgery with IBR without delaying non-IBR patients. Operating room (OR) alignment was the pivotal intervention, highlighting the importance of system-level coordination between breast and plastic surgery.
