Background:
Te Whatu Ora Hutt Hospital Plastic Surgery Department provides the breast reconstruction service for patients from Te Ikaroa (Central) and Te Tauihu (Top of the South Island) regions. Audit of our mastectomy reconstruction outcomes has not been carried out for longer than a decade. Reviews of this nature monitor surgical performance standards, provide quality assurance, and allow for reflection and service improvement. Our intention is for this audit is to demonstrate local adherence to international standards, reveal areas for improvement, and be a living document for ongoing reference.
Methods:
This audit reviewed all delayed, immediate, and prophylactic breast reconstruction patients. Reconstruction methods from 2019 to 2024 include: a range of autologous (free and pedicled) flaps, breast implants (single and 2-stage), and combined autologous with implant reconstruction. Data, inclusive of demographics, operative specifics, complications, number of operations and surgeons, was collected retrospectively from all hospitals in the catchment area in an effort to reliably demonstrate outcomes. Exclusion criteria: patients who did not have follow-up for a minimum of 1 year.
Results:
266 reconstructions (244 women) included: 76 free flaps (9 bilateral), 31 pedicled flaps, 67 expanders, 94 implants, 29 flap plus implant. Outcomes reviewed include: intraoperative complications, total or partial flap/implant loss, haematoma, seroma, necrosis of skin, arterial occlusion, venous congestion, ischaemic time, infections, hernias, complications at 1 year, unexpected ED presentations, and complications post radiation.
Conclusion:
There is great value in maintaining an audit of service provision. At this stage of data collection, our free flap failure, hernia, and complicated seroma rate conforms to international standards. Number of total free flap reconstructions has fallen compared to previous audit, which may reflect the impact of COVID-19 over this audit period. Further analysis including implant based outcomes currently in progress.