Trends in breast reconstruction techniques at a large safety net hospital: a 10-year institutional review

Abstract

Background: Multiple barriers in obtaining breast reconstruction were recently elucidated; however, long-term trends in those who undergo the procedure remain unclear. The purpose was to evaluate breast reconstruction technique within a large safety net hospital over 10 years. Methods: Single center, retrospective, observation study of breast reconstructions from 2005 to 2014. Outcome data were grouped into two consecutive 5-year periods (period 1: 2005–2009; period 2: 2010–2014) and evaluated for changes over time. Results: Over a 10-year period, 188 patients underwent breast reconstruction. Eighty percent carry MediCal, 57% are non-English speaking, and 73% are Hispanic. The mean age was 48 (range, 17–70) years. From period 1 to 2, there were no changes in breast cancer diagnosis type (P>0.19), in timing of reconstruction (P>0.05), or in implant-based reconstructions (P=0.77). There was an increase in the number of therapeutic, prophylactic, and bilateral mastectomies, and in breast reconstruction procedures performed overall (P<0.01). There was a significant increase in free flap reconstructions from 33.3% in period 1 to 50.8% in period 2 (P<0.03) and a decrease in pedicled breast procedures from 31.7% to 12.4% (P<0.01). Conclusions: In a predominantly low-income population, there was a significant rise in the use of the free flap, amidst an increase in the number of breast reconstructions overall. Autologous reconstruction and delayed reconstruction remain dominant.