1. Working Together - Breast Reconstruction Karen Bell Clinical Nurse Specialist

2. Working Together HCP’s should work in partnership to support and facilitate integrated working and the development of teams who work together to ensure that patients’ are getting the service that was planned for them with Calman Hine. (NCN 2002)

3. The National Health Service (NHS) Executive (1996a) recommended that the possibility of reconstruction both immediate and delayed should be discussed with all women considering a mastectomy. “Reconstructive surgery can offer positive and rewarding outcomes for some women, but can be upsetting and traumatic for others.” (Harcourt and Rumsey 2001)

4. Background Previous experience in plastic surgery Amount of information provided to patients in breast reconsruction clinics Total patient care

5. Aims To facilitate an understanding of the reconstruction process and to offer comprehensive support to women enabling them to: Become appropriately informed Promote realistic expectations Assist with complex and difficult decision making

6. “Women with high expectations and hopes pinned upon the outcome of reconstructive surgery may be especially vulnerable to severe distress and disappointment if complications occur, thereby compounding the psychological trauma of mastectomy (Harcourt and Rumsey 2001)

7. Reconstructive Meetings Held at Newcastle Nuffield Hospital 6-8 weekly Initially for private patients Referrals from; CNS - Various hospitals GP’s Patients’ Family History Clinic (NHS) Now accessible to private and NHS patients

8. Attended by; Ladies considering reconstruction Ladies who have undergone reconstruction carried out by various plastic surgeons Various reconstructive options Usually prior to seeing plastic surgeon

9. What happens? Reconstruction technique/procedure explained by CNS Diagrams to assist explanation Patients share their experiences and will “show results” good, and not so good. Questions and discussion encouraged Numbers = 4 - 50 Can arrange one to one

10. Feedback from attendees “It’s nice to hear how it really is after surgery and it gave a much better insight into what you can expect.” “It is useful to see that not all procedures work 100% for everyone and I felt that this gave a realistic balance.” “It was informative and very reassuring to see the results. Also the confidence the ladies have regained since the operations. No amount of photographs could have made me feel as informed as I do now.” “It was very heartening and informative to see at first hand some of the results of the alternative approaches adopted for reconstruction by different surgeons and this will enable me to make an informed decision as to which procedure I shall opt for in the very near future.”

11. Feedback from attendees “The meeting gave me a lot to hope for after I complete my treatment. Everybody in the room had gone through similar experiences as I was currently going through and their enthusiasm left me with confidence for the future not only as a breast cancer survivor but as a woman.” “This type of meeting must be very rare but much needed by ladies who have had to go through the trauma of mastectomy. It gives you hope of normality for the future along with information.”