Center of Excellence in Breast Reconstruction
In partnership with key opinion leaders and industry professionals, SRC developed the Center of Excellence in Breast Reconstruction (COEBR) program. The COEBR program identifies surgeons and facilities that provide excellent breast surgical care and are dedicated to continuously improving healthcare quality and patient safety.
The COEBR program addresses issues facing the specialty, including:
- Difficulty in identifying excellence for patients and referring physicians
- The need to control care provider costs and outcomes (including reimbursement and malpractice rates)
- Use of outdated procedures
- The need to establish universal standards to measure program performance
- Lack of a central outcomes database
Ready to Apply?
1: Institutional Commitment to Excellence
The applicant facility demonstrates a commitment to excellence in breast reconstruction from the highest levels of its medical staff and administration.
This commitment includes having specialty-specific credentialing and privileging guidelines in plastic surgery and surgical oncology.
2: Surgical Experience
The applicant facility performs at least 200 breast reconstruction procedures annually.
Each applicant surgeon has served as the primary surgeon for at least 200 breast reconstruction procedures in their lifetime, and performs at least 100 procedures annually.
For surgeons, procedures performed at any facility may be used toward volume. Surgeons must have served as the primary surgeon for a procedure to qualify. If the surgeon’s role as primary surgeon has been properly documented, procedures performed during fellowship or residency may qualify. Cases in which the surgeon served as co-surgeon or assisting surgeon do not qualify.
Each procedure used for volume must be thoroughly documented to enable a medical chart review.
Volume waivers may be approved in some circumstances.
3: Physician Program Director
The applicant facility must appoint a Physician Program Director (or Co-Directors) for the Center of Excellence in Breast Reconstruction (COEBR) program. The Physician Program Director(s) must:
- Participate in the relevant decision-making administrative meetings of the facility.
- Be accredited, or in the process of becoming accredited as a Center of Excellence in Breast Reconstruction (COEBR) surgeon.
- Be primarily responsible for coordinating the multidisciplinary services and systems for breast reconstruction.
- Participate in multidisciplinary team meetings.
Multidisciplinary team meetings should be held at least quarterly to ensure that decisions related to breast reconstruction are addressed in a comprehensive manner.
4: Consultative Services
The applicant facility must have a full complement of consultative services required for the routine and intensive care of breast reconstruction patients and their potential complications.
- During surgery and until discharge from the post-anesthesia care unit (PACU):
- Anesthesiologist or certified registered nurse anesthetist (CRNA) who supervises anesthesia delivery on all breast reconstruction patients and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA must be available onsite within 30 minutes if needed.
- Available on site 24/7 (or at all times when patients are present):
- Physician certified in Advanced Cardiovascular Life Support (ACLS) or equivalent, or an acute response team, at least one of which is ACLS-certified, trained with an established protocol to follow in the event of a sudden respiratory or cardiac event.
- Available on site within 30 minutes:
- Critical care specialist (if a critical care specialist is not available, a written transfer protocol that details the transfer plan of breast reconstruction patients to other emergency or critical care facilities can be provided)
- Intensivist or equivalent (hospital only)
- Surgical Oncologist
- Vascular Surgeon
- Available on site within 24 hours:
- Infectious disease specialist
- Medical Oncologist
- Psychiatrist /Mental Health Professional
- Wound care specialist
- The facility is also able to identify the following consultative staff:
- Nursing program manager
- Physical Therapist
5: Equipment and Instruments
The applicant facility must maintain a full line of equipment and surgical instruments to provide appropriate perioperative care for breast reconstruction patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.
If the facility does not have an emergency department or intensive care unit, it must have equipment, such as ventilators and hemodynamic monitoring equipment, necessary to resuscitate and stabilize critically ill patients until they can be transferred to another facility.
6: Surgeon Dedication and Qualified Call Coverage
Each applicant surgeon spends a significant portion of their efforts in the field of breast reconstruction and has active, full privileges in plastic surgery at the applicant facility.
Each applicant surgeon is board-certified or an active candidate for board certification in plastic surgery by the highest certifying authority available.
Each applicant surgeon must complete at least 12 hours of continuing medical education (CME) focused on breast reconstruction every three years. Only American Medical Association Physician’s Recognition Award Category 1 Credits or similar credits from a CME accrediting body outside the United States or three national or international meetings qualify.
The applicant facility has policies in place that require all breast reconstruction surgeons to have qualified call coverage, and each applicant surgeon certifies that each covering surgeon is capable of identifying and treating breast reconstruction complications. Each covering surgeon is board-certified or an active candidate for board certification in plastic surgery by the highest certifying authority available and has admitting privileges at the co-applicant facility.
7: Clinical Pathways and Standardized Operating Procedures
The applicant formally develops and implements clinical pathways that facilitate the standardization of perioperative care for breast reconstruction procedures. The following pathways are required:
- Anesthesia, including monitoring and airway management
- Perioperative care, including monitoring, pain management and airway management
- Deep vein thrombosis (DVT) prevention and management
The first three pathways will be deemed satisfied if the facility has accreditation from The Joint Commission (formerly known as JCAHO), DNV-GL or an equivalent healthcare organization approved by SRC.
- Instructions for identification, evaluation and management of early warning signs of complications.
- Preoperative patient preparation, evaluation, patient education, counseling, consent and plan of action for discharge that includes follow-up and any necessary patient education
- Evaluation and plan of action for patients at high risk for malignancy, including when a malignancy is detected
- Post-operative patient education including drain care and management, wound care management, plan of action for discharge that includes follow-up and any necessary patient education
Each applicant surgeon performs each surgical procedure in a standardized manner as allowed by variations in operative circumstances.
Each applicant surgeon uses a template for operative note dictation that ensures proper collection of data for surgical procedures.
8: Surgical Team and Support Staff
The applicant facility employs nurses and/or physician extenders who provide education and care to patients as well as an operative team trained to care for breast reconstruction patients. The applicant facility also appoints a program coordinator who supervises program development, patient and staff education, multidisciplinary team meetings, and ongoing breast reconstruction program compliance.
The applicant facility provides ongoing, regularly scheduled staff education in-services to ensure applicable staff have a basic understanding of breast reconstruction and the appropriate management of the breast reconstruction patient. In-service topics must include:
- Signs and symptoms of common postoperative complications
- Equipment and surgical instruments
- Clinical pathways
9: Patient Education
The facility and each applicant surgeon must provide all breast reconstruction patients with comprehensive preoperative patient education.
The facility and each applicant surgeon must also have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for each patient’s condition.
The applicant provides organized and supervised support groups for all patients who have been diagnosed with breast cancer or may undergo or have undergone breast reconstruction.
10: Continuous Quality Assessment
Each applicant surgeon must collect prospective outcomes data on all patients who undergo breast reconstruction procedures in SRC’s Outcomes Database (or a similar qualifying database) in a manner consistent with applicable patient privacy and confidentiality regulations. This de-identified data must be available to SRC for initial and renewal inspections or upon request.
Facility Application Fee: $3,975 USD
Surgeon Application Fee: $650 USD
- Discounts may be available for surgeons that participate in multiple accreditation programs. Contact SRC for details.
- Upon payment of application fees, applicants achieve Provisional Status and gain access to SRC’s Outcomes Database at no additional charge.
Site Inspection Fees
Domestic Site Inspection Fee (US, Canada, Mexico): $1,850 USD
International Site Inspection Fee: $5,450 USD
- The site inspection fee covers a one-day inspection with one site inspector and includes one COE program with up to four co-applicant surgeons. A day will be added to your site inspection for every four additional co-applicant surgeons or each additional COE program. Each additional day is $925.
- Applicant facilities are responsible for arranging and paying for the site inspector’s hotel, ground transportation and, if needed, an interpreter/translator. These items are not included in the standard site inspection fee.
- Renewal inspections are required every three years to ensure ongoing program compliance.
Facility Annual Fee: $3,975 USD
Surgeon Annual Fee: $650 USD
- Annual participation fees will be billed one year after applicants achieve Provisional Status and each year thereafter.
Fees are subject to change without notice and are not refundable. Payment of required fees does not guarantee accreditation.