Sustainability in breast surgery: a narrative review and guide for change.

Introduction: The purpose of this review was to evaluate sustainable interventions in breast surgery that reduce carbon dioxide equivalent (CO₂e) emissions and financial costs, supporting the National Health Service (NHS) goal of net zero carbon emissions by 2040.

Methods: A literature search was conducted using MEDLINE via PubMed up to 2024, targeting studies on sustainability in breast surgery. Search terms included sustainability-related and breast surgery-specific keywords. Owing to limited evidence, a narrative review was performed, incorporating findings from published literature, local audits and environmental impact assessments. Interventions were analysed across the perioperative pathway.

Findings: Only one study specifically addressed sustainability in breast surgery, highlighting a significant evidence gap. However, multiple practical interventions were identified. The use of total intravenous anaesthesia reduced CO₂e emissions by more than 90% compared with inhalational agents. Reusable surgical gowns and drapes offered a lower CO₂e (0.44kg vs 0.77kg per gown) and were cost effective. Switching from intravenous to oral paracetamol saved 47kg CO₂e annually and reduced costs (£0.02 vs £0.49 per dose). Other sustainable practices included waste segregation, minimising unused equipment and implementing electronic documentation. Local audits revealed that 7.5% of opened sutures were unused, highlighting opportunities to reduce waste.

Conclusions: Simple, sustainable changes in breast surgery can significantly reduce both environmental and financial costs. Despite a lack of robust data, practical measures already in use show clear benefits. Future research should focus on whole lifecycle analyses of sustainable interventions, providing evidence to support sustainable practices. Incorporating these interventions across surgical disciplines can meaningfully contribute to achieving NHS net zero goals.