Only one in ten women with breast cancer are getting access to reconstruction surgery at the time of their mastectomy a recent audit shows. This is despite recommendations from the National Institute for health and Clinical Excellence (NICE) in 2002 that it should be available to all.

These are the early findings of the National Mastectomy and Breast Reconstruction Audit, published by the Royal College of Surgeons of England and the NHS Information Centre on behalf of the Healthcare Commission.

The number of patients needing surgery for breast cancer is rising every year. There was a 37% increase in the total number of operations performed for breast cancer in the NHS in England between 1997 (24,684) and 2006 (33,814). While this expansion in capacity shows a remarkable flexibility on the part of the NHS there are a number of problems with breast cancer surgery services that remain to be addressed.

Experts say having the mastectomy and reconstruction in one operation reduces the number of operations a woman has to go through and also minimises the psychological impact of losing a breast.

John Browne, senior lecturer in health services research at the Royal College of Surgeons Clinical Effectiveness Unit said: “This audit of breast cancer surgery shows that a good service is available in England, despite the health services being under pressure. However, over the last ten years we have seen little improvement in access to immediate reconstruction after mastectomy."

Chris Caddy, consultant plastic surgeon and member of the British Association of Plastic Reconstructive and Aesthetic Surgeons, said: “For many patients, reconstruction is felt to be the final step in their recovery. Currently, most women have reconstructive surgery some time after their mastectomy. Whilst immediate breast reconstruction has a longer anaesthetic and recovery time, it tends to achieve better cosmetic results, smaller breast scars and only one hospital stay."

The National Audit, the first of its kind in the world, describes the initial findings of a four year comprehensive study of mastectomy and breast reconstruction practices and outcomes in England and is due for completion in December in 2010. Future annual reports will gather new data on patient experience and outcome to gain a full picture of how NHS services for breast cancer are working.