NICE guidelines emphasise the need for breast cancer patients undergoing mastectomy to be offered all appropriate options for immediate reconstruction. In the majority of hospitals this is not happening. Patients are being offered the reconstruction technique for which their surgeon has been trained and many never meet an oncoplastic surgeon to discuss the wide range of options that are available. This means that many have sub-optimal reconstructions often using implants that may need to be subsequently replaced and are incompatible with post-operative radiotherapy. Patients will be better served by a few high throughput, high quality centres specialising in tailoring the right reconstruction for the woman who needs a mastectomy rather than the present system of having reconstruction of variable quality available ubiquitously.
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