1. The National Mastectomy and Breast Reconstruction Audit Key findings of the Fourth Annual Report
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

2. Audit aims
To describe provision of mastectomy and breast reconstruction services in England
To investigate determinants and outcomes of care for women with breast cancer having a mastectomy with or without breast reconstruction
Help in the development of future standards and guidelines in this area.
All work is being done on a comparable basis, but at Unit level only.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

3. Audit methodology The Audit prospectively enrolled:
women with breast cancer
who underwent mastectomy or breast reconstruction surgery
in the NHS and independent sector in England
between 1 January 2008 and 31 March 2009
Data collected from:
clinicians on clinical practice and inpatient outcomes
patients on treatment options, patient-reported outcomes and experience of care
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2010

4. Audit participation – clinical study
18,216 women with complete information:
16,558 treated at English NHS trusts
1,249 treated at independent hospitals
409 treated at non-English NHS trusts that also chose to participate
Overall NHS case ascertainment of 81.4%
More than two thirds of NHS trusts achieved over 75% case ascertainment
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

5. Audit participation – PROMs study
10,623 women asked to participate
8,725 (82%) gave their consent
8,159 women sent 3 month questionnaires
6,882 (84%) returned a completed questionnaire
8,536 women sent 18 month questionnaires
7,110 (83%) returned a completed questionnaire
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

6. Fourth Annual Report Provides data on:
Patient characteristics and patterns of care
Patient-reported experience, information provision and reconstructive choices
Patient quality of life 18 months after surgery
Help in the development of future standards and guidelines in this area.
All work is being done on a comparable basis, but at Unit level only.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

7. High levels of patient satisfaction
Over 90% of women were very satisfied with the competence of their consultant surgeon
92% of mastectomy only patients
96% of immediate reconstruction patients
96% of delayed reconstruction patients
85% of women were very satisfied with the professionalism of the clinical team
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

8. Recommendation 1
NHS trusts and independent hospitals should act to maintain the current high levels of satisfaction with both consultant surgeons and breast cancer teams.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

9. Patient decision making and concerns
Very satisfied that their consultant surgeon involved them in the decision making process
- 75% of mastectomy only patients
- 81% of immediate reconstruction patients
- 87% of delayed reconstruction patients
Very satisfied that their consultant surgeon was available when they had concerns
- 69% of mastectomy only patients
- 75% in the immediate reconstruction patients
- 76% in the delayed reconstruction patients
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

10. Recommendation 2
NHS trusts and independent hospitals should ensure that women are able to be involved in decision making to the degree that they wish, and that staff are available to address the concerns of women undergoing cancer treatments and complex reconstructive procedures.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

11. Informing patients of what to expect
A few examples:
Around one fifth of reconstruction patients were not satisfied with the size of their reconstructed breast in comparison to their unaffected breast
Three quarters of IR and four fifths of DR patients were satisfied or very satisfied with how their abdomen looked following TRAM/DIEP flap reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

12. Recommendation 3
Clinicians should use the summary of the experiences of women undergoing breast reconstruction collected during the Audit to augment information about outcomes obtained from volunteers whose background, cancer treatments and age may differ significantly from the woman making reconstructive decisions.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

13. Levels of emotional and sexual wellbeing
Feel confident in a social setting most or all of the time 18 months after surgery
77% of mastectomy only patients
85% of immediate reconstruction patients
92% of delayed reconstruction patients
Feel sexually attractive when clothed most or all of the time 18 months after surgery
37% of mastectomy only patients
57% of immediate reconstruction patients
68% of delayed reconstruction patients
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

14. Recommendation 4
Clinicians should inform women undergoing mastectomy that those who underwent breast reconstruction reported higher levels of emotional and sexual well being than those who underwent mastectomy alone.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

15. Sufficient reconstructive information and choices
In those having delayed reconstruction, higher levels of satisfaction with breast area appearance and sexual wellbeing were attained following free flap reconstruction compared to pedicle flap reconstruction with or without an implant.
Both groups reported greater satisfaction than the group that had delayed implant-only reconstruction
In those having immediate reconstruction, levels of satisfaction with breast area appearance and emotional and sexual wellbeing following pedicle or free flap reconstruction were greater than those following implant only reconstruction
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

16. Recommendation 5
NHS trusts and independent hospitals should act to ensure that women in both the immediate and delayed reconstruction settings are provided with sufficient information and choices about the full range of reconstructive options.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

17. Overall results of surgery at 18 months
Proportion that rated the overall results as excellent or very good:
73% of mastectomy only patients
67% of immediate reconstruction patients
78% of delayed reconstruction patients
Proportion that were satisfied or very satisfied with how they looked in the mirror clothed:
83% of mastectomy only patients
90% of immediate reconstruction patients
93% of delayed reconstruction patients
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

18. Recommendation 6
NHS trusts and independent hospitals should ensure that they continue to attain the excellent results of mastectomy and breast reconstruction surgery reported by patients.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

19. Benchmarking using national results
The Audit has established local and national baselines for patient satisfaction and quality of life outcomes following mastectomy and breast reconstruction surgery
Hospital organisations should refer to their own results, the national average, and the outcomes of high performing organisations in evaluating the care they deliver in future
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

20. Recommendation 7
The Audit findings represent the first national data of their type, and should be used by NHS trusts and hospital organisations to define a performance benchmark against which their future outcomes may be compared.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

21. High achieving organisations in the Audit
A number of organisations were found to have results that were significantly better than the national average for particular aspects of care quality and outcomes
The results attained at these organisations demonstrate what is achievable, and should be used to help set future targets for care quality and outcomes

22. Recommendation 8
Those involved in the development of future guidelines on mastectomy and breast reconstruction should refer to the results of high achieving organisations when setting benchmarks for future audit.
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011

23. Thank you for your support and participation
Thank you for your support and participation! The four annual reports are available for download at Please or call for any general queries or for copies of the Audit reports Please if you have any methodological queries or would like to use the RCS patient questionnaires for audit or research
Slides produced by the MBR Project Team. © The National Mastectomy and Breast Reconstruction Audit 2011