Postmastectomy Breast Reconstruction Research Articles

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< 0.001), being unmarried (63.1% vs. 39.3% p< 0.001), having no history of childbirth (53.7% vs 39.9% p< 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.

Multimodality Imaging of Postmastectomy Breast Reconstruction Techniques, Complications, and Tumor Recurrence.

For women undergoing mastectomy, breast reconstruction can be performed by using implants or autologous tissue flaps. Mastectomy options include skin- and nipple-sparing techniques. Implant-based reconstruction can be performed with saline or silicone implants. Various autologous pedicled or free tissue flap reconstruction methods based on different tissue donor sites are available. The aesthetic outcomes of implant- and flap-based reconstructions can be improved with oncoplastic surgery, including autologous fat graft placement and nipple-areolar complex reconstruction. The authors provide an update on recent advances in implant reconstruction techniques and contemporary expanded options for autologous tissue flap reconstruction as it relates to imaging modalities. As breast cancer screening is not routinely performed in this clinical setting, tumor recurrence after mastectomy and reconstruction is often detected by palpation at physical examination. Most local recurrences occur within the skin and subcutaneous tissue. Diagnostic breast imaging continues to have a critical role in confirmation of disease recurrence. Knowledge of the spectrum of benign and abnormal imaging appearances in the reconstructed breast is important for postoperative evaluation of patients, including recognition of early and late postsurgical complications and breast cancer recurrence. The authors provide an overview of multimodality imaging of the postmastectomy reconstructed breast, as well as an update on screening guidelines and recommendations for this unique patient population. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Patient factors associated with cancer worry post-breast reconstruction: A cross-sectional study

PurposeThe BREAST-Q Breast Cancer module is a patient-reported outcome measure for women with breast cancer diagnosis. Our research team developed and validated a novel BREAST-Q scale for this module that measures quality of life outcomes specific to cancer worry. The aim of this study was to investigate patient related breast reconstruction factors that are associated with worse scores on the new BREAST-Q Cancer Worry Scale. MethodsWomen with a history of breast cancer treated with mastectomy and reconstruction, aged ≥18 years, and English-speaking were recruited through the Love Research Army between October and November 2019. Participants completed demographic and clinical questions alongside the BREAST-Q Cancer Worry Scale. Univariable and multivariable regression analyses were used to identify participant characteristics associated with cancer worry scores. ResultsAmong the 554 potential respondents, 538 (97.1%) completed the Cancer Worry Scale. The average patient age was 58.4 (+9.8) years. Cancer Worry scores were normally distributed with a mean of 46.4 (+17.2). Cancer Worry scores were significantly associated (p < 0.01) with younger age, history of radiation therapy, complications associated with breast surgery since diagnosis, use of textured breast implants, and shorter duration since surgery. ConclusionsThis exploratory analysis provides evidence of patient characteristics that may be associated with cancer worry following postmastectomy breast reconstruction.

BREAST-Q REACT: Qualitative Assessment of the Design, Functionality, and Clinical Utility of a New Score Interpretation Tool.

The BREAST-Q real-time engagement and communication tool (REACT) was developed to aid with BREAST-Q score interpretation and guide patient-centered care. The purpose of this qualitative study was to examine the perspectives of patients and providers on the design, functionality, and clinical utility of REACT and refine the REACT based on their recommendations. We conducted three patient focus groups with women who were at least 6 postoperative months from their postmastectomy breast reconstruction, and two provider focus groups with plastic surgeons, breast surgeons, and advanced practice providers. Focus groups were audio-taped, transcribed verbatim, and analyzed thematically. A total of 18 breast reconstruction patients and 14 providers participated in the focus groups. Themes identified by thematic analysis were organized into two categories: (1) design and functionality, and (2) clinical utility. On the design and functionality of REACT, four major themes were identified: visual appeal and usefulness; contextualizing results; ability to normalize patients' experiences, noting participants' concerns; and suggested modifications. On the clinical utility of REACT, three major themes were identified: potential to empower patients to communicate with their providers; increase patient and provider motivation to engage with the BREAST-Q; and effective integration into clinical workflow. Patients and providers in this qualitative study indicated that with some modifications, REACT has a great potential to elevate the clinical utility of the BREAST-Q by enhancing patient-provider communication that can lead to patient-centered, clinically relevant action recommendations based on longitudinal BREAST-Q scores.

18 Clinical, Socioeconomic, and Facility Factors Influencing Receipt of Autologous Breast Reconstruction: Analysis of the National Cancer Database

OBJECTIVES/GOALS: The goal of this study is to leverage a national database to see if autologous reconstruction rates differ in patient and clinical characteristics, readmission rates, and overall survival (OS) compared to other forms of reconstruction. Autologous reconstruction has not been looked at in this way before. METHODS/STUDY POPULATION: • Aim 1: Use the National Cancer Data Base to construct three patient cohorts for women under 70 and above 18 treated surgically for breast cancer with A) mastectomy only, B) implant-based reconstruction, and C) autologous breast reconstruction. • Aim 2: Examine receipt rates of surgical intervention in Cohorts A vs. B vs. C based on clinical and patient demographic/socioeconomic characteristics. • Aim 3: Compare readmission and overall survival (OS) rates for Cohorts A vs. B vs. C while controlling for age and other key variables. RESULTS/ANTICIPATED RESULTS: Based on the literature, we expect rates of autologous reconstruction (Cohort C) to be lower for patients of minority backgrounds compared to white individuals. In addition, we do not expect overall survival to differ between implant-based (Cohort B) and Cohort C reconstruction. Still, we expect mastectomy-only (Cohort A) survival to vary from the two cohorts even when adjusting for different clinical factors, as similar but smaller studies have shown. Finally, we expect readmission rates to be higher for Cohort C, compared to Cohorts A &amp; B, as it is a more complicated procedure typically done in academic institutions with skilled surgeons. DISCUSSION/SIGNIFICANCE: Autologous reconstruction is now considered the gold standard due to its ability to restore the breast shape with higher patient satisfaction and superior long-term outcomes. Multiple studies have documented ongoing racial disparities in post-mastectomy breast reconstruction and autologous reconstruction, with lower rates and referrals.

Proliferation Patterns of MCF-7 Breast Cancer Cells in Lipoaspirate Conditioned Media.

Autologous fat grafting (AFG) is a common technique used to enhance aesthetic outcomes in postmastectomy breast reconstruction patients. Adipokines are hormones secreted by adipose tissue that play a critical role in regulating metabolic processes and the immune system. However, dysregulated adipokine secretion and signaling can contribute to the development and progression of cancer by promoting angiogenesis, altering the immune response, and inducing the epithelial mesenchymal transition. We aimed to assess how breast cancer cells behave in conditioned media derived from fat grafting lipoaspirates and gain a better understanding of the potential interactions that may occur within the tumor microenvironment. Patients who were undergoing AFG as a part of breast reconstruction at NY-Presbyterian/Weill Cornell Medical Center between March 2021 and July 2023 were consented and enrolled in the study. This study was approved by the Weill Cornell Medicine Institutional Review Board (#20-10022850-14). Conditioned media is created using 20% of patient lipoaspirate secretome and 80% starving media. The growth of MCF-7, a human ER/PR+ breast cancer cell line, in conditioned media is assessed using CyQUANT. The breast cancer cells incubated in conditioned media displayed similar growth trends as those in complete media, which is enriched for cell growth (P > 0.05). MCF-7 cell behavior in conditioned media differed significantly from their proliferation patterns when serum starved in 100% starving media (P < 0.05). Our results suggest that there may be inherent factors within the lipoaspirate that may promote MCF-7 proliferation. One potential implication is that AFG used for breast reconstruction should be delayed until local-regional disease control has been established. In addition, based on the in vitro proliferation patterns of breast cancer cells in conditioned media, the safety profile of AFG may be enhanced if the procedure is performed after attaining negative margins and the completion breast cancer treatment.

Triplane technique for breast reconstruction after breast cancer surgery: A case series report.

Implant-based breast reconstruction is an important method for post-mastectomy breast reconstruction. Currently, the most commonly used technique is the biplane technique. However, the high rate of postoperative complications, the inability of pockets to accommodate larger implants, and the expensive costs of biological mesh make the development of new surgical methods urgent. The triplane technique for breast reconstruction is an ideal candidate method. The main local symptoms were breast lump, abnormal breast skin, nipple discharge, and abnormal nipple or areola in 24 patients. The study included 24 female patients who underwent breast reconstruction using the triplane technique after radical breast cancer surgery. The surgical procedure involved measuring the dimensions of the breast, designing the incision, and creating a pocket for the implant using the triplane technique, which includes the pectoralis major muscle, the pectoralis major fascia continuing to the rectus abdominis fascia, and the latissimus dorsa muscle fascia continuing to the rectus abdominis fascia. Postoperative follow-up included regular assessments of pain and evaluation of breast appearance. No cases of postoperative infection were observed in all patients. During the 1-year follow-up period after surgery, 5 patients (20.8%) who needed radiotherapy after mastectomy for cancer showed slight darkening of skin flap pigment after using the triplane technique implant. No cases of exposure or infection of the expanders were reported, and 1 patient underwent expander replacement with a permanent prosthesis. All patients expressed satisfaction with the reconstructed breast shape. The 10 patients (41.7%) experiencing postoperative swelling and pain. However, the pain gradually subsided during the postoperative recovery period. No cases of local recurrence or distant metastasis of breast cancer were observed during the 1-year-follow-up period. The triplane technique for breast reconstruction after breast cancer surgery provides good implant coverage, reduces the risk of complications, and is cost-effective.

Dynamic insights into infection risk over time in two-stage implant-based breast reconstruction: a retrospective cohort study.

Infections following postmastectomy implant-based breast reconstruction (IBR) can compromise surgical outcomes and lead to significant morbidity. This study aimed to discern the timing of infections in two-stage IBR and associated risk factors. A review of electronic health records was conducted on 1,096 breasts in 1,058 patients undergoing two-stage IBR at ** National University Hospital (2015-2020). Infections following the first-stage tissue expander (TE) insertion and second-stage TE exchange were analyzed separately, considering associated risk factors. Over a median follow-up of 53.5 months, infections occurred in 2.9% (32/1096) after the first stage and 4.1% (44/1070) after the second stage. Infections following the first-stage procedure exhibited a bimodal distribution across time, while those after the second-stage procedure showed a unimodal pattern. When analyzing risk factors for infection after the first-stage procedure, axillary lymph node dissection (ALND) was associated with early (≤7 weeks) infection, while both ALND and obesity were independent predictors of late (>7 weeks) infection. For infections following the second-stage procedure, obesity, postmastectomy radiotherapy, a history of expander infection, ALND, and the use of textured implants were identified as independent risk factors. Postmastectomy radiotherapy was related to non-salvaged outcomes after infection following both stages. Infections following first and second-stage IBR exhibit distinct timelines reflecting different pathophysiology. Understanding these timelines and associated risk factors will inform patient selection for IBR and aid in tailored postoperative surveillance planning. These findings contribute to refining patient suitability for IBR and optimizing personalized postoperative care strategies.

Effect of hypothyroidism on short-term outcomes after autologous and implant-based breast reconstruction.

Hypothyroidism has high prevalence in elderly women, which overlaps with the patient population who opt for post-mastectomy breast reconstruction. While hypothyroidism was shown to impact outcomes in other surgeries, its effect on breast reconstruction has not been established. This study aimed to compare the short-term outcomes of patients with and without hypothyroidism who underwent autologous (ABR) and implant-based breast reconstruction (IBR), respectively. Patients having ABR or IBR were identified in the National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without hypothyroidism, adjusted for demographics, socioeconomic status, comorbidities, and hospital characteristics. There were 12,765 patients underwent ABR, where 1591 (12.46%) of them had hypothyroidism, while 17,670 patients had IBR with 1,984 (11.23%) having hypothyroidism. Hypothyroid patients had a higher risk of hemorrhage/hematoma (aOR = 1.254, 95 CI 1.079-1.457, p < 0.01) after ABR. However, there were no differences in terms of mortality and organ system complications, nor wound dehiscence, superficial/deep wound complications, seroma, flap revision, excessive scarring, venous thromboembolism, pulmonary embolism, vascular complications, infection, sepsis, transfer out, length of stay (LOS), nor hospital charge between patients with and without hypothyroidism after ABR. All postoperative outcomes were comparable between hypothyroid patients and controls after IBR. While breast reconstruction is generally safe for hypothyroid patients, preoperative screening for hypothyroidism may be beneficial for those undergoing ABR. In ABR, hypothyroidism correction and blood management may help prevent bleeding complications in hypothyroid patients. Future studies should explore the long-term prognosis of hypothyroid patients after breast reconstruction.

Investigating the Data and Outcomes for Tissue Expander Textures in Post-Mastectomy Breast Reconstruction.

Investigating the Data and Outcomes for Tissue Expander Textures in Post-Mastectomy Breast Reconstruction.

Post-Mastectomy Breast Reconstruction – a review on current trends

Post-Mastectomy Breast Reconstruction – a review on current trends

203 (PB-110) Poster - Uptake of post-mastectomy immediate breast reconstruction in older women – A real-world analysis from the European Society of Breast Cancer Specialists (EUSOMA) certified breast centres

203 (PB-110) Poster - Uptake of post-mastectomy immediate breast reconstruction in older women – A real-world analysis from the European Society of Breast Cancer Specialists (EUSOMA) certified breast centres

Characterization of Barriers to Post-mastectomy Breast Reconstruction using Machine Learning Techniques

Characterization of Barriers to Post-mastectomy Breast Reconstruction using Machine Learning Techniques

From Tip of Brush to Tip of Knife: The Relationship Between Post-Mastectomy Breast Reconstruction and the Classical Arts.

Breast reconstruction is highly complex, requiring navigation of not only clinical and operative realities, but of patient expectations as well. The authors sought to identify historical art pieces that exhibit breast asymmetries and deformities for comparison with photos of breast reconstruction patients seen at the clinic of the senior author to demonstrate that achievement of perfect breast cosmesis is challenging in both breast reconstruction as well as in the classical arts. Open access libraries and Creative Commons images were reviewed to identify appropriate works of art from various time periods and geographic locations. Following artwork selection, photos of breast reconstruction patients were reviewed and paired with selected artworks exhibiting cosmetically similar breasts. A total of 9 pieces of selected historic art were found to have at least one matching patient photo, with 11 correlative patient photos ultimately chosen. Common breast asymmetries and deformities identified included ptosis, asymmetric chest wall placement, asymmetric nipple placement, and absence of the nipple. This review identified diverse artworks of varying styles spanning vast expanses of both geography and time that exhibit breast deformities and asymmetries commonly encountered in patients seeking revision of breast reconstruction. This underscores that creating the cosmetically ideal breast is difficult both in the operating room and the art studio. Importantly, the authors emphasize that the arts frequently celebrate that which is considered beautiful, though to the trained eye of a plastic surgeon, that which is considered beautiful, is often classified as dysmorphic or asymmetric.

Complex breast reconstruction using bilateral profunda artery perforator-free-flaps in a resource-limited setting: a case report

Interestingly, the current shift in mastectomy patterns and advances in reconstruction techniques have contributed to an increasing number of patients requesting breast reconstruction postmastectomy every year. Depending on available expertise, patients can access breast reconstruction options (immediate or delayed), autologous, or implant-based. We present a case of a 36-year-old female patient 5 years into remission, having undergone mastectomy for invasive ductal carcinoma of the right breast and now preferred risk reduction surgery (prophylactic mastectomy) of her left unaffected breast with immediate reconstruction. The microsurgical technique utilized bilateral profunda artery perforator flaps from both thighs for (immediate and delayed) breast reconstruction. In our scenario, the authors had an unfavorable outcome on the side of delayed breast reconstruction (right) with a venous insufficiency diagnosis leading to unilateral complete flap loss, which was subsequently debrided and reconstructed with an obliquely-oriented pedicled Latissimus dorsi flap. In contrast, following risk reduction surgery and immediate reconstruction on the left side, the buried flap was a complete success, with the free nipple graft doing well postoperatively.

Post-mastectomy Breast Reconstruction Using Gas vs Saline Tissue Expanders: Does the Fill Type Matter?

The most common reconstruction technique following mastectomy is a two-stage technique that involves tissue expansion followed by definitive implant-based reconstruction (IBR). Tissue expanders (TEs) have classically used saline for initial fill; however, TEs with an initial gas fill (GTE) - including the CO2-based AeroForm TE and TEs initially filled with atmospheric air - have been increasingly used in the past decade. We aim to compare the outcomes in breast reconstruction for tissue expanders initially filled with saline vs. gas. PubMed was queried for studies comparing gas and saline-filled tissue expanders (STEs) used in IBR. A meta-analysis was performed on major postoperative outcomes and the required expansion and definitive reconstruction time. Eleven studies were selected and included in the analysis. No significant differences existed between tissue expansion with GTEs versus STEs for eleven of the thirteen postoperative outcomes investigated. Out of the complications investigated, only the risk of infection/cellulitis/abscess formation was significantly lower in the GTE cohort (OR = 0.62; 95% CI = 0.47 to 0.82; P = 0.0009). The time to definitive reconstruction was also significantly lower in the GTE cohort (MD = -45.85 days; 95% CI = -57.80 to -33.90; P < 0.00001). The total time to full expansion approached significance in the GTE cohort (MD = -20.33 days; 95% CI = -41.71 to 1.04; P = 0.06). A cost analysis considering TE cost and infection risk determined that GTE use saved a predicted $2,055.34 in overall healthcare costs. Surgical outcomes for both fill types are predominantly similar; however, GTEs were associated with a significantly decreased risk of postoperative infection compared to saline filled TEs. GTEs can also reduce healthcare expenditures and require less time until definitive reconstruction after placement.

Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM.

Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.

Breast Reconstruction: Focus on Implant-Based Reconstruction

Autologous tissue-based reconstruction and prosthetic implant-based reconstruction are the two main categories of breast reconstruction. The natural feel, size, and form of the breast can be restored by breast reconstruction with breast implants. Following a nipple- and skin-sparing mastectomy and a modified radical mastectomy, implant-based breast reconstruction is most readily executed. The most popular technique for immediate and delayed postmastectomy breast reconstruction is implant breast reconstruction, which makes use of silicone tissue expanders, which were initially utilized for breast reconstruction by Radovan in 1978 and Austad in 1979. As a sign of femininity, breasts might be lost, which can cause a woman great psychological discomfort and negatively impact her sexual life and self-image. Women are given the choice of breast reconstruction following a breast cancer removal treatment, which can enhance their quality of life. However, implant-based reconstruction ought not to be seen as an adjuvant treatment. Procedures like skin-sparing mastectomy and nipple-areola-sparing mastectomy, which enable conservative surgery with an instant implant breast reconstruction, can only be carried out with an early diagnosis.

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020.

With greater acceptance of postmastectomy breast reconstruction (PMBR) as a safe and reliable treatment option, the role of plastic surgeons in breast cancer management continues to rise. As Medicare reimbursements for surgical procedures decline, hospitals may increase charges. Excessive markups can negatively affect uninsured and underinsured patients. We aimed to analyze mastectomy and breast reconstruction procedures to gain insights into recent trends in utilization and billing. We queried the 2013 to 2020 Medicare Provider Utilization and Payment Data with 14 Current Procedural Terminology (CPT) codes to collect service count numbers, hospital charges, and reimbursements. We calculated utilization (service counts per million female Medicare enrollees), weighted mean charges and reimbursements, and charge-to-reimbursement ratios (CRRs). We calculated total and annual percentage changes for the included CPT codes. Among the 14 CPT codes, 12 CPT codes (85.7%) with nonzero service counts were included. Utilization of mastectomy and breast reconstruction procedures decreased from 1,889 to 1,288 (-31.8%) procedures per million female Medicare beneficiaries from 2013 to 2020. While the utilization of immediate implant placements (CPT 19340) increased by 36.2%, the utilization of delayed implant placements (CPT 19342) decreased by 15.1%. Reimbursements for the included CPT codes changed minimally over time (-2.9%) but charges increased by 28.9%. These changes resulted in CRRs increasing from 3.3 to 4.4 (+33.3%) from 2013 to 2020. Free flap reconstructions (CPT 19364) had the highest CRRs throughout the study period, increasing from 7.0 in 2013 to 10.3 in 2020 (+47.1%). Our analysis of mastectomy and breast reconstruction procedures billed to Medicare Part B from 2013 to 2020 showed increasingly excessive procedural charges. Rises in hospital charges and CRRs may limit uninsured and underinsured patients from accessing necessary care for breast cancer management. Legislations that monitor hospital markups for PMBR procedures may be considered by policymakers.

Early Complications in Prepectoral Tissue Expander-Based Breast Reconstruction.

Prepectoral implant placement for postmastectomy breast reconstruction has increased in recent years. Benefits of prepectoral reconstruction may include lack of animation deformities and reduced postoperative pain, but its complication profile is currently unclear. This study aimed to examine the complication profile of prepectoral tissue expanders (TEs) to determine factors associated with TE loss. A retrospective review was performed to identify all patients who underwent immediate prepectoral TE reconstruction from January 2018 to June 2021. The decision to use the prepectoral technique was based on mastectomy skin quality and patient comorbidities. Patient demographics, comorbidities, and operative details were evaluated. Outcomes of interest included TE loss, seroma, hematoma, infection/cellulitis, mastectomy skin flap necrosis requiring revision, and TE exposure. Logistic regression analysis was performed to identify factors associated with TE loss. The study identified 1225 TEs. The most frequent complications were seroma (8.7%, n = 106), infection/cellulitis (8.2%, n = 101), and TE loss (4.2%, n = 51). Factors associated with TE loss in the univariate analysis included ethnicity, history of smoking, body mass index, mastectomy weight, and neoadjuvant chemotherapy. In the multivariate regression analysis, only mastectomy weight had a positive association with TE loss (odds ratio, 1.001; p = 0.016). Prepectoral two-stage breast reconstruction can be performed safely with an acceptable early complication profile. The study data suggest that increasing mastectomy weight is the most significant factor associated with TE loss. Further research examining the quality of the soft tissue envelope and assessing patient-reported outcomes would prove beneficial.