Women 'denied surgery' after mastectomies

Women who lose a breast to cancer are being denied the chance of a reconstruction which may be critical to their physical, emotional and sexual recovery, a review has found.

Fewer than one in three women undergoing mastectomy for breast cancer has the breast surgically reconstructed, despite guidance first issued by the National Institute for Health and Clinical Excellence (NICE) in 2002, and reiterated in 2009, that all women should be offered it.

Breast cancer is rising sharply with almost 48,000 new cases diagnosed each year. Around four in 10 women diagnosed have a mastectomy. For many of these women, having a reconstruction improves the physical, emotional and sexual outcome, following the trauma of the cancer diagnosis and its treatment. But the proportion of women offered immediate reconstruction is as low as 7 per cent in some areas. Even in the best area of the country – the south east – the proportion only rises to 41 per cent.

Figures from an audit of all 150 NHS hospitals and 114 private hospitals in England that provide mastectomies, published by the NHS Information Centre, show that of 16,485 women who had the operation between January 2008 and March 2009, just one in five (21 per cent) had an immediate reconstruction.

Chris Caddy, consultant plastic and reconstructive surgeon at Sheffield Teaching Hospitals NHS Foundation Trust and an author of the review, said: "In an ideal world, there would be more women having reconstructions.

"Some women take the loss of a breast very hard. The NICE guidelines say we should treat the whole woman and not just the breast cancer."

Despite high levels of satisfaction amongst women having reconstructive surgery, with 90 per cent rating their care excellent or good, the report found 10 hospitals with complication rates and levels of post-operative pain "much higher than expected". Readmission rates and implant loss were also higher.

Complex reconstructions using fat and tissue from the belly, buttocks or thighs gave better cosmetic results and higher levels of satisfaction than simple ones involving the insertion of a silicone implant under a flap of retained skin.

"A reconstructed breast using a patient's own tissue has a warmth and softness and an ability to move with the body that you won't get with an implant. But these are more complex operations and tend to be carried out by plastic surgeons, rather than breast surgeons, and they are in short supply.

"We want to use this report to drive up the quality of reconstructive surgery and tell patients this is what we [plastic surgeons] do and this is what you need to ask for to get a better result," Mr Caddy said.

Dick Rainsbury, of the Association of Breast Surgery and Tim Goodacre, of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, said the shortcomings must be addressed "as a matter of urgency".