ESPRAS Survey on Breast Reconstruction in Europe

Riccardo E. Giunta; Emma Hansson; Carolina Andresen; Elias Athanasopoulos; Giovanni di Benedetto; Aleksandra Bozovic Celebic; Robert Caulfield; Horacio Costa; Cenk Demirdöver; Alexandru Georgescu; Thierry van Hemelryck; Mark Henley; Elisabeth A. Kappos; Reuf Karabeg; Ulla Karhunen-Enckell; Christian Korvald; Stephane de Mortillet; Dylan J. Murray; Drahomír Palenčár; Andrzej Piatkowski; Fabio Santanelli di Pompeo; Georgios Psaras; Hinne Rakhorst; Klemen Rogelj; Lisbet Rosenkrantz Hölmich; Dirk J. Schaefer; Stephan Spendel; Nenad Stepic; Marc Vandevoort; Olavi Vasar; Ruth Waters; Rado Zic; Nicholas Moellhoff; Anna Elander

doi:10.1055/a-1424-1428

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Table of Contents

Handchir Mikrochir Plast Chir 2021; 53(04): 340-348
DOI: 10.1055/a-1424-1428

Originalarbeit

ESPRAS Survey on Breast Reconstruction in Europe

ESPRAS Umfrage zur Brustrekonstruktion in Europa

Riccardo E. Giunta∗

¹Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München

,

Emma Hansson∗

²Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg

,

Carolina Andresen

³Plastic Reconstructive Craniomaxillofacial Hand and Microsurgical Unit, Centro Hospitalar de Vila Nova de Gaia, Portugal

,

Elias Athanasopoulos

⁴Dept. of Plastic Surgery, 424 General Military Training Hospital, Thessaloniki, Greece

,

Giovanni di Benedetto

⁵Department of Plastic and Reconstructive Surgery, Marche Polytechnic University, Ancona, Italy

,

Aleksandra Bozovic Celebic

⁶Surgical Center of Plastic Surgery -A medic, Beogradska 24E, Podgorica, Montenegro

,

Robert Caulfield

⁷Department of Plastic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland

,

Horacio Costa

⁸Aveiro University, Plastic Reconstructive Craniomaxilofacial Hand and Microsurgical Unit, Gaia Hospital Center

,

Cenk Demirdöver

⁹Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Dokuz Eylul University,Izmir, Turkey

,

Alexandru Georgescu

¹⁰University of Medicine Iuliu Hatieganu, Clinic of Plastic Surgery, Cluj-Napoca, Romania

,

Thierry van Hemelryck

¹¹La Clinique Esthétique, les Sables d’Olonne, France

,

Mark Henley

¹²Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals, United Kingdom

,

Elisabeth A. Kappos

¹³Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel and University of Basel, Basel, Switzerland

,

Reuf Karabeg

¹⁴Surgical Clinic “Karabeg”, Sarajevo, Bosnia and Herzegovina

,

Ulla Karhunen-Enckell

¹⁵Head of Breast Surgery Unit, Department of Surgery, Tampere University Hospital, Finland

,

Christian Korvald

¹⁶Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway

,

Stephane de Mortillet

¹⁷Chirurgie Plastique, Reconstructrice et Esthétique, Pôle santé Léonard de Vinci, Chambray les Tours cedex, France

,

Dylan J. Murray

¹⁸National Paediatric Craniofacial Center, Children’s Hospital Ireland, Temple Street, Dublin, Ireland

,

Drahomír Palenčár

¹⁹Department of Plastic Surgery, Medical Faculty of Comenius University Bratislava, Slovakia

,

Andrzej Piatkowski

²⁰Department of Plastic Surgery, MUMC+, Maastricht, The Netherlands

,

Fabio Santanelli di Pompeo

²¹Plastic Surgery Unit, Sant’Andrea Hospital, School of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy

,

Georgios Psaras

²²American Medical Centre, Cyprus

,

Hinne Rakhorst

²³Plastic and reconstructive surgery, ZGT, Hengelo, The Netherlands

,

Klemen Rogelj

²⁴Department of Plastic Surgery and Burns, University Medical Centre Ljubljana, Slovenia

,

Lisbet Rosenkrantz Hölmich

²⁵Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark

,

Dirk J. Schaefer

²⁶Department of Plastic, Reconstructive, Aesthetic & Hand Surgery, University Hospital Basel, Basel, Switzerland

,

Stephan Spendel

²⁷Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria

,

Nenad Stepic

²⁸Clinic for Plastic Surgery and Burns Military Medical Academy, Belgrade, Serbia

,

Marc Vandevoort

²⁹University Hospital Gasthuisberg, Leuven, Belgium

,

Olavi Vasar

³⁰Hospital of Reconstructive Surgery, Tallinn, Estonia

,

Ruth Waters

³¹Department of Burns & Plastic Surgery, Queen Elizabeth Hospital Birmingham, United Kingdom

,

Rado Zic

³²University Hospital Dubrava, Department of Plastic Reconstructive and Aesthetic Surgery, School of Medicine, University of Zagreb

,

Nicholas Moellhoff‡

¹Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München

,

Anna Elander‡

²Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg

› Author Affiliations

Abstract

Background The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access.

Materials and Methods A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country. Suitable participants were identified via the Executive Committee (ExCo) of ESPRAS and national delegates of ESPRAS. The results were evaluated and related to evidence-based literature.

Results A total of 33 participants from 29 European countries participated in this study. Overall, the incidence of breast reconstruction was reported to be relatively low across Europe, comparable to other large geographic regions, such as North America. Equity of provision and access to breast reconstruction was distributed evenly within Europe, with geographic regions potentially affecting the type of reconstruction offered. Standard practices with regard to radiotherapy differed between countries and a clear demand for European guidelines on breast reconstruction was reported.

Conclusion This study identified distinct lack of consistency in international practice patterns across European countries and a strong demand for consistent European guidance. Large-scale and multi-centre European clinical trials are required to further elucidate the presented areas of interest and to define European standard operating procedures.

Zusammenfassung

Hintergrund Im Rahmen des ELF der ESPRAS wurde die Notwendigkeit standardisierter Richtlinien zur Brustrekonstruktion auf europäischer Ebene definiert. Ziel dieser Studie ist es, zunächst einen Überblick über den aktuellen Status, Entwicklungen und mögliche regionale Unterschiede der Brustrekonstruktion in Europa zu geben, wobei ein Schwerpunkt auf dem Angebot, der Verteilung und dem Zugang zur Brustrekonstruktion liegt.

Materialien und Methoden Es erfolgte eine internetbasierte Befragung von in der Brustrekonstruktion spezialisierten Plastischen Chirurgen, welche zusätzlich die nationalen Versorgungsstrukturen ihrer jeweiligen Länder überblicken. Geeignete Teilnehmer wurden über das ExCo der ESPRAS und nationale Delegierte von ESPRAS identifiziert. Die Ergebnisse wurden mit aktueller evidenzbasierter Literatur verglichen.

Ergebnisse 33 Teilnehmer aus 29 europäischen Ländern nahmen an der Studie teil. Im Vergleich zur Gesamtzahl durchgeführter Mastektomien war die Inzidenz der Brustrekonstruktionen in Europa relativ gering, vergleichbar mit anderen großen geografischen Regionen, wie z. B. Nordamerika. Die Verfügbarkeit und der Zugang zur Brustrekonstruktion war innerhalb Europas gleichmäßig verteilt, allerdings kann die geografische Region das Verfahren der Brustrekonstruktion (Eigengewebe vs. Implantat) beeinflussen. Deutliche Differenzen zeigten sich bezüglich Brustrekonstruktionen bei bestrahlten Patientinnen.

Schlussfolgerung Die Studie identifizierte ein ausgeprägtes Maß an Inkohärenz in den internationalen Standards zwischen den europäischen Ländern. Es besteht großer Bedarf für kohärente europäische Leitlinien. Europäische, multizentrische klinische Studien sollten initiiert werden, um eine evidenzbasierte Grundlage zu schaffen.

Schlüsselwörter

ESPRAS - Brustrekonstruktion - freie Lappenplastik - DIEP - Mikrochirurgie - Register Brustrekonstruktion

Key words

ESPRAS - Breast Reconstruction - Free Flap - DIEP - Microsurgery - Breast Reconstruction Registry

Full Text

References

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