BAPRAS Breast Special Interest Group Chair Gary Ross comments on how BAPRAS is helping patients to make informed decisions about breast reconstruction The Angelina Jolie effect (1) has had a long-lasting and global impact, and appears to have increased referrals for genetic testing to centres appropriately since her surgery last May. Although not all patients will be suitable for prophylactic mastectomy there is an increased awareness of the risks and increasingly patients are requesting preventive surgery.
The commonest form of reconstruction following prophylactic mastectomy globally is implant based reconstruction either in combination with autologous flap coverage or with non autologous mesh / matrix coverage over the lower pole of the implant. A national audit of the practice and outcomes of immediate implant based reconstruction currently aims to evaluate the variations in techniques and outcomes. There has been a large uptake amongst plastic surgeons in the iBRA (implant based reconstruction audit) study and BAPRAS remains focused on improving patient safety through validated outcomes. The choice of immediate reconstruction following mastectomy with implants needs to be weighed up against autologous forms of reconstruction such as the deep inferior epigastric perforator flap (DIEP) and allow patients an informed decision as how best to proceed in both the short and long term. Earlier this year BAPRAS produced guidance relating to the very rare (Anaplastic Large Cell Lymphoma) ALCL and its association with breast implants.
We still remain focused on the need for an implant registry that will allow more robust data relating to specific issues such as ALCL and provide valuable information for clinicians and patients alike. Reference 1. The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services. Evans GR et al Breast Cancer Research 2014,16:442