Free flap breast reconstruction in the UK: are we meeting demand?

Abstract

INTRODUCTIONThe demand for free flap breast reconstruction appears to be increasing. The aim of this study was to evaluate the capacity for microsurgical breast reconstruction across the UK and compare this with the apparent demand to inform future workforce planning.METHODSA questionnaire was sent to all 56 plastic surgery units in the UK to establish whether they performed reconstructive breast surgery, the number of free flaps they performed each year and what issues they were encountering in meeting the demand. The unit response rate was 93%.RESULTSCurrent workforce planning figures show that there are 161 consultant plastic surgeons who perform free tissue breast reconstruction. Across the UK, the total number of extra breast reconstructive surgeons felt to be needed was 78. The mean number of free flaps performed per surgeon each year was 20. Respondents suggested that they felt that 20 free flaps was a suitable number to maintain their skills. Two-thirds (66%) of the respondents reported issues impairing delivery of their free flap service with access to theatre (41%) and inability to meet the demand (18%) as the two key reasons.CONCLUSIONSOur results show that there is a demand for microsurgical breast reconstruction that is not being fully met. It is hoped that this survey will add to the evidence base that plastic surgeons remain an integral part of the care of many breast cancer patients and that it will encourage trainees to consider breast microsurgery as their subspecialty of choice.