Breast Reconstruction Rates Research Articles

"Legislative Impact and Persistent Disparities: Post-Mastectomy Breast Reconstruction Rates in the United States Among 224,506 Patients".

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to impact trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking. We analyzed National Surgical Quality Improvement Program (NSQIP) data spanning 2005-2022 to investigate the impact of ACA on racial and ethnic diversity in immediate breast reconstruction post-mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time. In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and Black or African American individuals underwent immediate breast reconstruction at lower rates compared to White patients (P < 0.001). Additionally, Hispanic patients were less likely to undergo breast reconstruction compared to non-Hispanic patients (28.0% vs 33.4%; P < 0.001). In the post-ACA period, this trend persisted with all racial groups undergoing immediate breast reconstruction at lower rates compared to White patients (P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared to non-Hispanic patients (53.8% vs 47.9%, P < 0.001). Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.

Immediate Breast Reconstruction After Mastectomy for Cancer Among US Military Health System Beneficiaries.

In the Military Health System (MHS), women with breast cancer may undergo surgical treatment in military hospitals (direct care) or in the civilian setting via the insurance benefit (private sector care). We conducted this study to determine immediate breast reconstruction rates among women undergoing mastectomy for cancer in the MHS by setting of care. Using the linked Department of Defense's Central Cancer Registry and MHS Data Repository, the Department of Defense's medical claims database, we identified adult women who underwent mastectomy for breast cancer from 1998 to 2014. Patients were then subgrouped by setting of care (direct vs private sector care). The primary outcome was the rate and type of immediate breast reconstruction. Regression models were constructed to determine factors associated with receipt of immediate breast reconstruction. The final sample included 3251 women who underwent mastectomy for cancer in the direct (67.0%) or private sector care (32.6%) settings. The overall rate of immediate breast reconstruction was 29.9% with an upward trend noted throughout the study (P < 0.001). Overall, implant-based reconstruction (81.4%) was more common than tissue-based reconstruction (18.6%). Compared with direct care, the immediate breast reconstruction rate was significantly higher in the private sector care setting (49.3% vs 20.5%, P < 0.001) despite accounting for differences in clinical characteristics (adjusted odds ratio = 4.51, 95% confidence interval [3.72-5.46]). Immediate breast reconstruction in the direct care setting lags that in the civilian community during the study time period. Further research is needed to ascertain current immediate reconstruction rates and understand factors contributing to any differences in rates between care settings.

Surgical complications after immediate implant-based breast reconstruction for breast cancer in women over 65 years.

While immediate breast reconstruction rates in breast cancer are increasing, they remain low in women over 65 years old. The aim was to investigate surgical outcomes in women older than 65 years receiving implant-based immediate breast reconstruction. The population-based Stockholm Breast Reconstruction Database includes all adult women with breast cancer receiving an implant-based immediate breast reconstruction in Stockholm, Sweden, 2005-2015. Primary outcomes within 30 days from immediate breast reconstruction were: infection requiring antibiotics and reoperation on. Implant removal was a secondary outcome. Women more than 65 years were compared with younger age groups. Chi-square tests and multivariable logistic regression were applied for the primary outcomes, and Kaplan-Meier analysis for the secondary outcome. Among 1749 cases of immediate breast reconstruction, 140 (8.0%) were in women more than 65 years. Median follow-up was 74 months (1-198). Postoperative infection was not more common in women older than 65 years old (22 of 140, 15.7%) than in women under 65 years old (303 of 1609, 18.8%; P = 0.221). Reoperation on was more frequent in women older than 65 years than in other age groups (more than 65: 8.6%; 50-64: 6.5%; 40-49: 3.5%; less than 40: 1.6%; P < 0.001), however, age older than 65 years was not an independent risk factor in the multivariable analysis (OR 1.00, 95% c.i. 0.44 to 2.28). Overall, 6-year probability of implant removal was 11.4%, (8.1% due to complications and 3.3% due to patient preference). There was no statistically significant difference between age groups for either reason (P = 0.085 and P = 0.794 respectively). Older age alone was not associated with worse surgical outcomes after implant-based immediate breast reconstruction in highly selected patients older than 65 years when compared with their younger counterparts.

Disaggregation of Asian American, Native Hawaiian, and Pacific Islander populations in postmastectomy breast reconstruction

PurposeAsian American, Native Hawaiian, and Pacific Islander (AANHPI) patient populations are often defined as one monolithic group in medical research despite cultural, socioeconomic, and clinical heterogeneity. Although the general AANHPI population is underrepresented in reception of postmastectomy breast reconstruction, existing literature has not characterized the disaggregation of such rates for AANHPI ethnic subgroups. MethodsPatients who underwent mastectomy were identified in the 2007 to 2020 registries within the Surveillance, Epidemiology and End Results database. Patients were stratified by race and ethnicity, and additional demographic and oncologic variables were collected. Multivariate binary logistic regression was conducted to assess for reception of postmastectomy immediate breast reconstruction (p < 0.05). ResultsAmong 33,422 AANHPI patients who underwent mastectomy, South Asian patients were associated with the highest breast reconstruction rates (33%) and Melanesians with the lowest (15%). Overall, AANHPI patients were associated with a lower breast reconstruction rate than non-Hispanic Whites (27% vs. 35%; p < 0.001). This difference increased from 6.4% in 2007 to 10% in 2020. After controlling for demographic and oncologic covariates, all AANHPI ethnic subgroups predicted a lower likelihood of breast reconstruction than non-Hispanic Whites (p < 0.001). Odds ratios for reconstruction ranged from 0.17 [95% confidence interval (95% CI), 0.11–0.27] for Melanesian patients to 0.45 (95% CI, 0.42–0.48) for South Asian patients. ConclusionsDisparities in the receipt of immediate breast reconstruction exist within the AANHPI patient population in the United States. This analysis supported the need for disaggregation in plastic surgery research for improved knowledge and targeted interventions.

Is immediate breast reconstruction surgery safe for elderly women? Assessment of postoperative complications in women aged 70 years and older

IntroductionThe rate of immediate breast reconstruction (IBR) in elderly women (EW) is lower than in younger patients because of concerns related to postoperative complications (POC) and their consequences. ObjectiveWe assessed POC 30 days after IBR, readmissions rate within 30 days, and the time to start adjuvant therapy in EW aged ≥ 70 years. Materials and MethodsWe conducted an observational, retrospective, single-center study between January 2014 and May 2022 at the University Cancer Institute of Toulouse-Oncopole (IUCT-O), including patients over 70 years old treated with mastectomy and IBR. Patients’ characteristics, medical treatments with the time between therapies and POC were recorded. ResultsA total of 125 women aged 70 to 84 years old were included in our study. The rate of IBR was 13.7 %. The rate of major POC was 17.6 % (n = 22), including 9.8 % (n = 11) implant removal. There was significantly more skin necrosis in patients with a history of homolateral radiotherapy (p = 0.016) but less hematoma (p = 0.004). Overweight or obese EW tending to have more than one surgical POC (p = 0.019). EW with nipple-areola complex (NAC) conservation had significantly more skin necrosis (p = 0.01). The median time for initiation of adjuvant chemotherapy (ACT) and hormonal therapy was 5.7 [1.6–11.9] and 4.3 [1.6–78.9] weeks respectively. The median time to initiate adjuvant radiotherapy (ART) when preceded by ACT or not, was 9.2 [5.1–22] and 21.1 [16.9–21.4] weeks respectively. ConclusionOur study confirms that IBR in women aged ≥ 70 years is safe and does not delay adjuvant therapies.

Racial Disparities in Immediate Breast Reconstruction after Mastectomy: A Systematic Review and Meta-Analysis

Background: In the past few decades, there has been a gradual increase in breast reconstruction post mastectomy; however, there exists a conflict about whether race has an influence on reconstruction rates. Methods: We conducted an electronic search from MEDLINE and Cochrane CENTRAL from their inception to September 2022. Primary outcome was disparity in rates of Immediate Breast Reconstruction (IBR) in racial minorities. Odds ratios were pooled using a random-effects model. All statistical analyses were performed on the Review Manager. Quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist. Results: Twenty studies ( n = 1 840 671) were identified. The pooled analysis of all the studies showed that subjects in racial minorities were significantly less likely to receive IBR as compared to White subjects (OR = 0.62, [95% confidence interval: 0.57-0.68; P &lt; .01, I2 = 97%]. Subgroup analyses revealed that Asian subjects were the least likely to undergo IBR among different minorities (OR = 0.43). Conclusion: There exists a significant disparity in rates of IBR in different racial minorities as compared to White subjects. Future studies are warranted to assess factors contributing to such disparities in provision of healthcare.

Complications After Prepectoral Versus Subpectoral Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy: A Systematic Review and Meta-Analysis.

Outcomes of immediate breast reconstructions can be influenced by postoperative radiotherapy. However, there is no clarity on the use of prepectoral or subpectoral breast reconstruction in the setting of postmastectomy radiation therapy (PMRT). We reviewed evidence on the complication rates of prepectoral and subpectoral breast reconstruction in women undergoing PMRT. PubMed, Web of Science, and Embase databases were scanned for studies comparing complication rates of prepectoral and subpectoral breast reconstruction with PMRT. All complications were pooled in a random-effect meta-analysis to obtain odds ratio (OR). Eight observational studies were included. Meta-analysis showed no difference in the risk of infections (OR: 1.22 95% CI 0.79, 1.88 I2=0%), implant loss (OR: 0.86 95% CI 0.50, 1.50 I2=14%), seroma (OR: 1.01 95% CI 0.43, 2.34 I2=50%), hematoma (OR: 0.44 95% CI 0.12, 1.71 I2=0%), wound dehiscence (OR: 0.95 95% CI 0.42, 2.17 I2=0%), and skin necrosis (OR: 0.61 95% CI 0.21, 1.75 I2=36%), contracture (OR: 0.46 95% CI 0.15, 1.48 I2=54%) and the need for revision surgeries (OR: 0.85 95% CI 0.45, 1.60 I2=15%) between the prepectoral and subpectoral groups. Data from observational studies indicates that in appropriately selected patients there may not be any difference in the risk of early complications with prepectoral or subpectoral breast reconstruction with PMRT. Current evidence is limited by the small number of studies, short follow-up and selection bias. There is a need for randomized controlled trials comparing the two approaches to obtain robust evidence on long-term outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract PO3-22-08: Impact of Zip Code-Based Income on Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients

Abstract Background: In the United States, 13% of women develop invasive breast cancer, with certain genetic mutations increasing the risk. Genetic screening is costly and burdensome for patients, particularly those from lower socioeconomic backgrounds. Moreover, lower income (LI) patients face barriers in accessing healthcare and have lower rates of breast reconstruction. This study aims to examine the impact of socioeconomic status, as indicated by ZIP code median income, on the type of breast surgery, reconstructive technique, and perioperative outcomes among mutation-positive (M+) patients. Methods: A multicenter retrospective cohort study included patients with a genetic predisposition for breast cancer and undergoing breast and reconstructive surgery between January 2016 and October 2022. Patient demographics, history, operative details, and postoperative outcomes were collected. Patient ZIP codes were cross-referenced with the American Community Survey to determine the median household income, which served as a proxy for the patient-specific household income. Four distinct income quartiles were established: quartile 1 (Q1) = $37,045-$81,586 (“LI”); quartile 2 (Q2) = $81,587-$103,703; quartile 3 (Q3) = $103,704-$129,768; and quartile 4 (Q4) = $129,769-$213,724. Results: Among the 170 patients analyzed, 42 (24.7%) were in Q1, 42 (24.7%) in Q2, 44 (25.9%) in Q3, and 42 (24.7%) in Q4. Most patients had BRCA1 (n=73, 42.9%), BRCA2 (n=68, 40.0%), PALB2 (n=11,6.5%), or CHEK2 (n=8, 64.7%) mutations, and underwent prophylactic mastectomy without evidence of breast cancer (n=119, 70.0%). Mean age and body mass index (BMI) were 41±16 years and 25.0±7.5 kg/m2, respectively. There was a significant association between patient race and income (p&amp;lt; 0.0001), such that 30.1% of White patients were in Q4 (vs. 8.3% of Black patients), compared to 38.9% of Black patients in Q1 (vs.19.0% of White patients). LI was significantly associated with higher BMI (p=0.0083) and obesity rates (p=0.0080). Nipple-sparing mastectomy (NSM) (n=103, 60.6%) was the most frequent surgical approach, followed by skin-sparing mastectomy (SSM) (n=42, 24.7%), simple mastectomy (n=13, 7.6%), lumpectomy (n=4, 2.4%), and radical mastectomy (n=4, 2.4%). Patients in Q3 underwent NSM significantly more often than those in Q1 (p=0.0080). Tissue expander (n=73, 42.9%) was the most common reconstruction method. 34.7% of patients (n=59) experienced postoperative complications. Short-term (&amp;lt; 30 days postoperatively) complications included delayed wound healing (n=22, 12.9%), surgical site infection (n=16, 9.4%), dehiscence (n=12, 7.1%), cellulitis (n=10, 5.9%), seroma (n=9, 5.3%) and hematoma (n=9, 4.7%). Long term (≥30 days postoperatively) complications included mastectomy flap necrosis (n=22, 12.9%), total reconstructive failure (n=8, 4.7%), and red breast syndrome (n=2, 1.2%). There was no significant association between income level and incidence of complications (p &amp;gt;0.05). Income level significantly correlated with cancer recurrence, as patients in Q2 (n=0, 0.0%) and Q4 (n=1, 2.4%) had significantly lower recurrence rates compared to Q1 (n=6, 14.3%) (p=0.0140). Of the 30.0% of patients with diagnosis of cancer at DOS, 66.7% (n=34) of patients had ductal carcinoma in situ (DCIS). Eleven of these patients were in Q1, five in Q2, six in Q3, and twelve in Q4 (p=0.259). Conclusion: LI M+ patients had lower NSM rates than higher income patients, despite similar rates of prophylactic mastectomies, possibly due to perceived costs of increased follow-up care. Moreover, LI patients experienced higher cancer recurrence, despite similar incidences of equivalent cancer subtypes at presentation, likely reflecting differences in post-diagnostic care and morbidity. These findings highlight the need to address financial barriers and ensure equitable access to comprehensive care for M+ patients of all income strata. Citation Format: Jaytin Gupta, Shrayus Sortur, Christian Lava, Margaret Lee, Lauren Berger, Varsha Harish, Daisy Spoer, Lindy Rosal, Ian Greenwalt, Lucy De La Cruz, David Song, Kenneth Fan. Impact of Zip Code-Based Income on Reconstructive Method and Outcomes in Mutation-Positive Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-08.

Abstract PO1-28-03: Impact of the Oncotype DX® test over time and association with clinicopathological characteristics of Peruvian patients with early breast cancer: Experience in the last 15 years

Abstract Introduction: Gene expression assays provide prognostic and therapy-predictive information that complements management of early breast cancer patients. Oncotype DX® had showed prognostic and prediction of adjuvant chemotherapy benefit. The present study evaluates the impact of Oncotype DX® on therapeutic decision-making for 15 years and explores the association of clinicopathological characteristics with the Recurrence Score (RS) in Peruvian patients with early breast cancer. Material and methods: A retrospective multicenter analysis of 759 breast cancer patients treated in three oncological centers in Lima-Peru (Instituto Nacional de Enfermedades Neoplásicas, Oncosalud and Ricardo Palma) between 2007 and 2022 was conducted. Risk groups were classified according to Oncotype DX® result and menopausal status. For premenopausal women ≤ 50 years: low (RS=0-20), intermediate (RS=21-25) and high-risk (RS=26-100). A descriptive analysis was evaluated to observe the trend and profile of the patients who used the Oncotype test in 5 time periods (2007-2009, 2010-2013, 2014-2016, 2017-2019, 2020-2022). Subsequently, chi-square, t-test, analysis of variance and Poisson linear regression tests were applied to compare clinicopathological features with RS. Finally, univariate and multivariate analyses were performed using Cox logistic regression to identify the probability of association with the high-risk group. Results: 642 patients were included, 78.5% were postmenopausal, and 64.2% had clinical stage (CS) I. Overall, 63.4% had no recommendation for chemotherapy and only 5.6% had recurrence. 74.8% were classified as low-risk according to the Oncotype DX® result. Postmenopausal patients had negative lymph nodes (95.4%), the majority had undergone conservative surgery (71.8%) and had a low rate of breast reconstruction (11.9%). An increase in the use of Oncotype DX® was observed over time, especially in premenopausal patients (from 4.5% in 2007 to 36.9% in 2022). A significant association was found between luminal B subtype (p &amp;lt; 0.0001), histological grade 3 (p &amp;lt; 0.0001) and T3 vs. T1/2 (p=0.025). In univariate analysis, luminal B subtype (vs. luminal A, OR=5.56, 95% CI, 2.80-12.3, p&amp;lt; 0.001), T3 (vs. T1/2, OR=2.84, 95% CI, 0.13-30.0, p=0.006), histological grade 3 (vs. 1/2, OR=13.1, 95% CI, 5.35-39.6, p&amp;lt; 0.001) and histology (other vs. ductal/lobulillar/mucinous, OR=2.94, 95% CI, 0.57-13.5, p=0.003) provided a higher probability of obtaining a high-risk RS result. Similar results were found in multivariate analysis. Conclusion: The use of the Oncotype DX® had a significant impact on therapeutic decision-making in Peruvian patients with early breast cancer, with an increase of use in the last 15 years. A high-risk RS was associated with luminal B subtype, histological grade 3 and T3 tumor size, which could facilitate risk stratification and provide valuable information for the need of adjuvant chemotherapy. Keywords: Early breast cancer, Oncotype DX®, clinicopathological characteristics, Recurrence Score (RS), Peru Oncotype PERU Table Citation Format: Steffi Katheryne Gonzalez Bocanegra, Guillermo valencia Mesías, Yomali Aroa Ferreyra Chombo, Karoll Tatiana Meza Garcia, Mariano Lopez-Pereyra, Jorge Torres Maldonado, Edgar Fermín Yan Quiroz, Zaida Morante Cruz, Jose Cotrina-Concha, Henry Gómez, Gabriela Calderon Valencia, Mauricio León Rivera. Impact of the Oncotype DX® test over time and association with clinicopathological characteristics of Peruvian patients with early breast cancer: Experience in the last 15 years [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-28-03.

Abstract PO1-17-11: Trends in post-mastectomy reconstruction by age in Korea and among Asian-Americans

Abstract Background: Post-mastectomy immediate breast reconstruction (PMIBR) has been underutilized in the elderly. This study examines the trends of PMIBR by age in a large Korean medical center and compares them to the Asian-American population in the National Cancer Database (NCDB). Methods: We analyzed 5,601 patients who underwent PMIBR out of 13,654 total mastectomy patients between 2001 and 2021 in a Korean Center. Patient characteristics associated with higher likelihood of receiving reconstruction were assessed and compared between patients under 60 years of age and those aged 60 years and older. Complications were investigated in 1,669 patients between 2010 and 2020. In addition, we compared this to 966,354 female patients in the NCDB from 2004-2020 with stage 0-3 breast cancer who underwent mastectomy. Results: The number of PMIBR at the Korean center increased almost ten-fold, but there was a discrepancy in the increase between younger and older women. In the younger group, the proportion of PMIBR rose from 13% (53/398) to 77% (508/664), while in the older group, it increased from 0% (0/60) to 26% (49/186). In the NCDB, Asian-Americans had the lowest rate of breast reconstruction (29%) compared to white (35.4%), black (30.1%), and Hispanic Americans (33.5%). As seen in the table, the rates increased in both age groups but plateaued around 2014 and remained stable until 2020. In 2020, the PMIBR rates were 37% for young Asian-Americans, 48% for young non-Asians, 14% for older Asian-Americans, and 24% for older non-Asians. At the Korean center, patients living in a metropolitan area (42.6% vs.39.8% p=0.001), having higher education (44.7% vs. 10.5% p&amp;lt; 0.001), being unmarried (63.1% vs. 39.3% p&amp;lt; 0.001), having no history of childbirth (53.7% vs 39.9% p&amp;lt; 0.001), having lower stage and hormone receptor-positive HER2-negative breast cancer were more likely to undergo reconstruction. These factors were all more common in the younger age group. In the NCDB, patients receiving PMIBR were more likely to be white or non-Asian, have higher income and education, reside in a metropolitan area and in the Northeast, have less comorbidities, be treated in an academic center, and have a luminal subtype, lower stage, and private health insurance. At the Korean center, autologous reconstruction was more common than implant reconstruction, (68.4% vs. 31.6% for younger women, and 63.3% vs. 36.9% for older women) and the complication rate was similar for both age groups. In contrast, in the NCDB, implant reconstruction was more common in both age groups, tissue-based (29% vs 31%), implant-based (40.7% vs 40%), combined (11% vs 10.8%) and other (18% vs 17.6%) for older and younger women respectively. Conclusion: Both the Korean and American data illustrate remarkably lower utilization of immediate breast reconstruction in older patients. There are notable demographic and clinical differences between age groups but negligible difference in complication rates. Further research and interventions to address barriers in older women are needed. The higher rates of PMIBR in South Korea mirrors that of white women in the northeast USA, suggesting a potential disparity for Asian-Americans. Percentage of PMIBR over total mastectomy (with or without reconstruction) by age and race PMIBR= post-mastecomy immediate breast reconstruction; NCDB= national cancer database Citation Format: Soo-Young Lee, Madhav KC, Hyun Ho Han, Leah Kim, Mehra Golshan, Eric Schneider, Rachel Greenup, Donald Lannin, Hyung Bae Kim, Byung Ho Son, Jong Won Lee, Sae Byul Lee, Hee Jeong Kim, Tristen Park. Trends in post-mastectomy reconstruction by age in Korea and among Asian-Americans [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-17-11.

Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period. The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria. The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%. No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.

Geographic variation in breast reconstruction surgery after mastectomy for females with breast cancer in Alberta, Canada.

Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada. Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction. A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. ≥ 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively. We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents.

The Influence of Inset and Shaping of Abdominal-Based Free Flap Breast Reconstruction on Patient-Reported Aesthetic Outcome Scores-A Systematic Review.

Background: Nowadays, multimodal cancer therapy results in very high survival rates of early-stage breast cancer and microsurgical flap-based breast reconstruction has become safe and reliable, with gradually increasing demand because of its durable and aesthetically pleasing results. This study aimed to explore the impact of different flap shaping and inset techniques on patient-reported outcome measures (PROMs) with regard to the aesthetic result in abdominal flap-based breast reconstruction. Methods: A systematic review was performed screening Pubmed, Cochrane Library and Web of Science for original articles reporting flap inset strategies, concomitantly providing PROMs on the aesthetic result. Results: Of 319 studies identified, six met the inclusion criteria. The studies described different flap rotation options according to the patient's morphology, different inset planes, and avoidance of the monitoring skin paddle, and suggested that a higher flap-to-mastectomy mass ratio was associated with better aesthetic results. In two comparative studies, according to the PROMs (BREAST-Q, Likert scale) and independent observer judgement, both higher patient satisfaction and superior aesthetic results were observed with the newly described techniques. Conclusions: Emphasis on the aesthetic outcome in terms of breast shape and symmetry, providing an individualized approach of flap inset, considering the contralateral breast's shape and volume, results in higher satisfaction scores.

Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy.

Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q (patient reported outcome measure for breast reconstruction patients, in patients receiving) in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. We retrospectively examined patients who received DIEP flaps at our institution from 2010 to 2019. Patients were divided into categories by insurance: commercial, Medicaid, or Medicare. Demographic factors, surgical factors, and complication data were recorded. Descriptive statistics, Fisher's exact, Kruskal-Wallis rank sum tests, and generalized estimating equations were performed to identify associations between insurance status and five domains of the BREAST-Q Reconstructive module. A total of 1,285 patients were included, of which 1,011 (78.7%) had commercial, 89 (6.9%) had Medicaid, and 185 (14.4%) had Medicare insurances. Total flap loss rates were significantly higher in the Medicare and Medicaid patients as compared to commercial patients; however, commercial patients had a higher rate of wound dehiscence as compared to Medicare patients. With all other factors controlled for, patients with Medicare had lower Physical Well-being of the Chest (PWBC) than patients with commercial insurance (β = - 3.1, 95% confidence interval (CI): -5.0, -1.2, p = 0.002). There were no significant associations between insurance classification and other domains of the BREAST-Q. Patients with government-issued insurance had lower success rates of autologous breast reconstruction. Further, patients with Medicare had lower PWBC than patients with commercial insurance regardless of other factors, while other BREAST-Q metrics did not differ. Further investigation as to the causes of such variation is warranted in larger, more diverse cohorts.

Disparity Reduction in United States Breast Reconstruction: An Analysis From 2005-2017 Using 3 Nationwide Data Sets.

Following passage of the Women's Health and Cancer Rights Act (WHCRA), a steady rise in breast reconstruction rates was reported; however, a recent update is lacking. This study aimed to evaluate longitudinal trends in breast reconstruction (BR) rates in the U.S. and relevant sociodemographic factors. Mastectomy cases with/without BR from 2005 through 2017 were abstracted from the National Surgical Quality Improvement Program (NSQIP), Surveillance, Epidemiology, and End Results (SEER) Program, and National Cancer Database (NCDB). BR rates were examined using Poisson regression. Multivariable logistic regression analysis of NCDB data was used to identify predictors of reconstruction. Race and insurance distributions were evaluated over time. Of 1,554,381 mastectomy patients, 507,631 (32.7%) received BR. Annual reconstruction rates per 1000 mastectomies increased from 2005 to 2012 (NSQIP: Incidence Rate Ratio (IRR) 1.077; SEER: 1.090; NCDB: 1.092) and stabilized from 2013 to 2017. NCDB data showed that patients who were younger (≤59 years), privately insured, had fewer comorbidities, and underwent contralateral prophylactic mastectomy were more likely to undergo BR (all p<0.001). Over time, the increase in BR rates was higher among Black (252.3%) and Asian (366.4%) patients than White patients (137.3%). BR rates increased more among Medicaid (418.6%) and Medicare (302.8%) patients than privately insured (125.3%) patients. This analysis demonstrates stabilization in immediate BR rates over the last decade; reasons behind this stabilization are likely multifactorial. Disparities based on race and insurance type have decreased, with a more equitable distribution of BR rates.

Characterizing differential risk effects of body mass index for Asian patients in the United States undergoing breast reconstruction

BackgroundAsian patient populations continue to be underrepresented in both plastic surgery research and rates of breast reconstruction. Better elucidation of reconstruction in Asian women may help guide patient-directed counseling. This study investigates the differential effect of body mass index (BMI), a well-known risk factor, for Asian patients in outcomes after breast reconstruction. MethodsAsian and White breast reconstruction patients were identified by CPT code in the National Surgical Quality Improvement Program. Within each cohort, BMI was converted into percentile ranks for standardized comparisons between cohorts. The effects of BMI on occurrence of complications for Asian and White patients were then quantified with multivariate logistic regression models. ResultsThe final cohort included 86,514 White patients and 4,813 Asian patients, of which 9,876 (11%) and 424 (8.8%) experienced at least one postoperative complication. The average BMI of White patients who experienced complications was 29.2±6.3kg/m2, a higher average than that of Asian patients, 25.6±4.8kg/m2. Higher BMI percentile was a significant predictor of increased risk of complications in White patients (OR: 1.005, 95% CI: 1.004-1.006, p<0.001). In Asian patients, however, BMI percentile was not a significant predictor of postoperative complications (OR: 1.001, 95% CI: 0.997-1.005, p=0.62). BMI percentile significantly predicted risk of unplanned reoperation in both cohorts (p<0.001 and p=0.029, respectively). ConclusionsWhereas BMI is a direct predictor of complications in White populations, this effect is held more inconsistently for Asian patients. Such trends can guide more informed interpretations of BMI in current risk algorithms. Data availability statementThe data that support the findings of this study are publicly available.

Effects of Marijuana Use in Patients Undergoing Abdominal Free Flap Breast Reconstruction.

Marijuana use has been associated with vascular inflammation and clotting, resulting in endothelial damage and arteritis. As marijuana use rises in the United States, few studies have evaluated its impact on surgical outcomes and wound healing in free flap breast reconstruction. A retrospective cohort study of patients undergoing abdominal free flap breast reconstruction between 2016 and 2022 at a large metropolitan healthcare system was performed. Patient demographics, comorbidities, procedural details, and complications were analyzed. Minor complications were defined as skin or fat necrosis not requiring intervention, nipple loss, any wound requiring management in the clinic, hematoma, and seroma. Major complications were defined as reoperation, flap loss, cardiac or thromboembolic events, and hospital readmission. Active marijuana users were those with marijuana use within 12 weeks of surgery. In total, 168 patients underwent 276 deep inferior epigastric artery-based flaps for breast reconstruction. There were 21 active marijuana users. There were no significant differences in patient demographics, cancer treatment, or minor and major complications. However, there were higher rates of active nicotine use (P = 0.001) and anxiety/depression amongst active marijuana users (P = 0.002). Active users had higher rates of bilateral breast reconstruction (P = 0.029), but no significant differences in other operative details. Active marijuana use of unknown frequency may be safe in patients undergoing breast free flap reconstruction. Advising marijuana abstinence preoperatively may not alter patient outcomes. Further studies of greater sample size are needed to evaluate marijuana's impact on outcomes associated with breast reconstruction using free flap.

Rates of breast reconstruction uptake and attitudes towardbreast cancer and survivorship among south asians: A literature review.

Our aim in this review was to ascertain rates of breast reconstruction among South Asian patients and identify attitudes towards breast cancer, survivorship, and breast reconstruction. Mastectomy rates for South Asian patients ranged from 52% to 77% and reconstruction following mastectomy varied from 0% to 14%. A negative perception of cancer, fears of social isolation, and taboos around breasts can prevent South Asian women from receiving surgical care after a breast cancer diagnosis.

Patterns of breast reconstruction and the influence of a surgical multidisciplinary clinic.

Of the 40% of breast cancer patients who have a mastectomy as part of their surgical treatment, only approximately 29% have a breast reconstruction. In 2016, Alfred Health established a multidisciplinary surgical clinic with breast and plastic surgeons, aiming to improve interdisciplinary collaboration. This study aimed to assess the provision of breast reconstruction at an Australian tertiary public hospital and examine whether the multidisciplinary surgical clinic have improved our reconstructive service provision. A retrospective cohort study of patients who underwent mastectomy at Alfred Health between October 2011 and September 2021 was conducted. Patients were divided into before and after groups, treated during the 5-year period before and after establishing the multidisciplinary clinic respectively. Demographic data, operative details, histopathology, and treatments were compared. Over the 10-year period, 423 mastectomies were performed for 351 patients. Of those, 153 patients underwent breast reconstruction, providing an overall reconstruction rate of 43.6%. There was a statistically significant increase in the breast reconstruction rate from 36.5% before to 53.4% after the creation of the multidisciplinary surgical clinic. Patient factors such as age and tumour receptor status did not differ significantly between the groups. The establishment of a surgical multidisciplinary clinic has led to a statistically significant increase in the rate of breast reconstruction from 36.5% to 53.4%, leading to improved healthcare provision for our patients. Factors identified to be associated with increased uptake in the reconstruction service include younger age and node negative disease.

The International Awareness of Breast Reconstruction.

To our knowledge, this is the first and largest study conducted to collect data among surgeons worldwide about breast reconstruction. We have aimed to collect data about breast reconstruction worldwide, the most popular breast reconstruction techniques, and the barriers behind the low rate of breast reconstruction according to surgeons. A comparative cross-sectional design was used in this study. A prepared questionnaire, which was developed after reviewing the literature review conducted for this study, was used to collect data. The questionnaire is multiple choice. It was distributed among surgeons online. The study includes 812 participants who live all over the world, representing 79 countries. More than a third of surgeons perform less than 10 breast reconstructions per year (33.38%), and 45.86% of them think that immediate surgery is the most frequent practice. A higher percentage of participants prefer implants over autologous reconstruction as a technique for breast reconstruction (54.9%). Moreover, 39.02% of participants shared that a lack of knowledge about the availability of breast reconstruction was a reason for refusing the surgery. This study demonstrates that the breast reconstruction rate is still low and that most surgeons prefer implants that are performed immediately. The lack of knowledge among patients about the availability of breast reconstruction is the most common reason for refusing reconstruction. Therefore, there is a need to increase patient awareness about the availability of this surgery.