Quality assurance in breast reconstruction - Establishment of a prospective national online registry for microsurgical breast reconstructions

Background The loss of a breast, and thus of the female body shape, is often extremely traumatising for women affected. Although free flap grafts have become the gold standard in reconstructive breast surgery, it has not been possible to date to unequivocally document their superiority over conventional alternative techniques. To date, there are no data on the care situation in Germany. Neither the number of reconstructions nor the proportion of the individual techniques is known. A prospective online registry has been set up in order to systematically collect and transparently present the structure and quality of care. The long-term goals are to record the existing quality of care, improve deficits and to certify centres with the appropriate expertise to establish a high level of care nationwide. Methods For this purpose, the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRaC) has set up an internet-based database in which treatment data are recorded anonymously. As part of a certification process, auditors checked structure quality, compliance with specifications, and the stringency of the data entered in comparison with the hospital's internal documentation. If the evaluation is positive, the DGPRaC quality seal is awarded. Results Since its introduction in 2012, the database has provided validated information. Initially, only a few departments were prepared to present their results transparently. However, the number has grown steadily in recent years. As a result, the quality recording assumed a pioneering function nationwide and can now be used as a reliable source of information by patients and doctors. The DGPRaC website features a map of the centres, which are colour-coded according to their respective qualifications. It is thus possible to find a qualified plastic surgeon with comprehensive expertise in acceptable proximity to every oncological breast centre. Conclusion The database provides an overview of the quality of the various surgical techniques and thus the possibility of serious self monitoring and scientific analysis. The systematic collection of data has contributed to strengthening the position of plastic surgery in the field of reconstructive breast surgery. However, the financial and personnel resources required to establish the database were clearly underestimated.