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Background <p>Breast surgery with immediate breast reconstruction (IBR) is associated with delays in definitive surgery and adjuvant therapy. We evaluated a multiphase quality improvement (QI) initiative to reduce time to treatment (TTT) for patients undergoing upfront surgery with IBR.</p> Methods <p>This retrospective cohort study included patients with newly diagnosed breast cancer undergoing upfront surgery at a single institution between January 2022 and June 2025. Patients with metastatic disease, neoadjuvant therapy, or first treatment outside this institution were excluded. The QI initiative comprised three phases: (1) weekly multidisciplinary team huddle; (2) standardized communication protocol; and (3) OR alignment between breast and plastic surgery. Primary outcome was median TTT. Time to treatment for non-IBR patients was tracked concurrently as a balancing metric.</p> Results <p>A total of 3,324 patients met inclusion criteria; 1,100 (33.1%) underwent surgery with IBR and 2,224 (66.9%) without. The cohort was predominantly early-stage (82.8% cTis/T1). Median TTT declined from 56 to 36 days in the IBR group and from 41 to 29 days in the non-IBR group (both <i>P</i> &lt; 0.001). The proportion waiting longer than 45 days declined from 67.4 to 27.3% for IBR and from 40.5 to 22.9% for non-IBR (both <i>P</i> &lt; 0.001). Only the IBR group demonstrated statistically significant improvement through Phase 3 (<i>P</i> &lt; 0.001), while the non-IBR group plateaued after Phase 2.</p> Conclusions <p>A targeted multidisciplinary QI initiative meaningfully reduced TTT for breast cancer patients undergoing upfront surgery with IBR without delaying non-IBR patients. Operating room (OR) alignment was the pivotal intervention, highlighting the importance of system-level coordination between breast and plastic surgery.</p>

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Targeted Multidisciplinary Continuous Improvement Process Reduces Time to Breast Cancer Surgery with Immediate Reconstruction

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Pooja M. Varman,
  • Rahul Rangan,
  • Amanda Maggiotto,
  • Vincent Wu,
  • Risal Djohan,
  • Zahraa Al-Hilli

摘要

Background

Breast surgery with immediate breast reconstruction (IBR) is associated with delays in definitive surgery and adjuvant therapy. We evaluated a multiphase quality improvement (QI) initiative to reduce time to treatment (TTT) for patients undergoing upfront surgery with IBR.

Methods

This retrospective cohort study included patients with newly diagnosed breast cancer undergoing upfront surgery at a single institution between January 2022 and June 2025. Patients with metastatic disease, neoadjuvant therapy, or first treatment outside this institution were excluded. The QI initiative comprised three phases: (1) weekly multidisciplinary team huddle; (2) standardized communication protocol; and (3) OR alignment between breast and plastic surgery. Primary outcome was median TTT. Time to treatment for non-IBR patients was tracked concurrently as a balancing metric.

Results

A total of 3,324 patients met inclusion criteria; 1,100 (33.1%) underwent surgery with IBR and 2,224 (66.9%) without. The cohort was predominantly early-stage (82.8% cTis/T1). Median TTT declined from 56 to 36 days in the IBR group and from 41 to 29 days in the non-IBR group (both P < 0.001). The proportion waiting longer than 45 days declined from 67.4 to 27.3% for IBR and from 40.5 to 22.9% for non-IBR (both P < 0.001). Only the IBR group demonstrated statistically significant improvement through Phase 3 (P < 0.001), while the non-IBR group plateaued after Phase 2.

Conclusions

A targeted multidisciplinary QI initiative meaningfully reduced TTT for breast cancer patients undergoing upfront surgery with IBR without delaying non-IBR patients. Operating room (OR) alignment was the pivotal intervention, highlighting the importance of system-level coordination between breast and plastic surgery.