American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Standard 2.18: Reconstructive Surgery

All appropriate patients undergoing mastectomy are offered a preoperative referral to a reconstructive/plastic surgeon. Reconstructive surgery is provided by or referred to reconstructive/ plastic surgeons who are board certified or in the process of board certification.

Definition and Requirements

As part of an informed decision-making process, every effort should be made to ensure patients undergoing mastectomy are offered a preoperative discussion with a reconstructive/plastic surgeon who is board certified or in the process of board certification by the American Board of Plastic Surgery (ABPS). Board certification should be obtained as applicable.

The Breast Program Leadership Committee (BPLC) is required to evaluate and report the referral offer compliance rate annually for all appropriate referral candidates.

The type of breast reconstructive surgery is dependent on the nature of the defect and the overall health of the patient. While there is an increasing trend in immediate breast reconstruction utilizing tissue expanders, implants, or autologous tissue transfer, patients should be made aware of all of their options, including delayed reconstruction. Patients need to be aware that breast reconstruction does not interfere with surveillance or detection of local recurrence. Consideration needs to be given to the timing of reconstruction with respect to systemic adjuvant chemotherapy or radiation therapy.

The American Society of Plastic Surgeons (ASPS) developed a quality improvement program, Tracking Operations and Outcomes for Plastic Surgeons (TOPS). This program is designed to provide plastic surgeons with a mechanism to submit clinical and demographic information into multiple, confidential databases, minimize redundant data entry, and provide clinical/practice information to plastic surgeons and their specialty to measure outcomes.

Process Requirements

Accession List and Data Review Requirements for the Site Visit

The center is required to provide a de-identified accession (case) list of breast cancer cases diagnosed and/or treated at the center (class of case 10–22) prior to the site visit date. Class of case is defined in the Facility Oncology Registry Data Standards (FORDS) manual.

Breast reconstruction referrals are documented in the patient medical record. If the patient is deemed inappropriate and/or the patient declines the referral offer, it must be documented in the patient medical record.

Reconstructive surgery is provided by or referred to reconstructive/plastic surgeons who are board certified or in the process of board certification.

The BPLC evaluates and reports the referral offer compliance rate annually for all appropriate referral candidates.

Compliance is reviewed annually by the BPLC.

Documentation

Complete all required standard fields in the Survey Application Record (SAR).

Provide documentation of board certification for all reconstructive/plastic surgeons on the Breast Care Team (BCT).

Document the annual referral offer compliance rate and annual audit by the BPLC in the meeting minutes.

Evaluation

The surveyor will review board certification, annual compliance audit, and patient medical records during the medical records review portion of the site visit, to evaluate compliance.

Rating Compliance

Compliance

  1. All appropriate patients undergoing mastectomy are offered a preoperative referral to a reconstructive/plastic surgeon, and the referral is documented in the patient medical record.
  2. Reconstructive surgery is provided by or referred to reconstructive surgeons who are board certified or in the process of board certification.
  3. Compliance is reviewed annually by the BPLC and documented in the meeting minutes.

Noncompliance

The center does not fulfill one or more of the compliance criteria.

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