Persistent and interdependent: Racial disparities and their mechanisms in postmastectomy breast reconstruction

Burke, Jonathan; Friedman-Eldar, Orli; Halfteck, G.; Silva, Iago De Castro; Baumrucker, Camille; Reyes, Fernando Valle; Lessard, Anne-Sophie; Kassira, Wrood; Franceschi, Dido; Kesmodel, Susan B.; Avisar, Eli; Goel, Neha; Möller, Mecker G.

doi:10.1016/j.surg.2022.01.036

Cited by 3 publications

(1 citation statement)

References 43 publications

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“…The higher proportion of White patients in the ADM cohort relative to Black/African American patients may reflect racial disparities in postmastectomy breast reconstruction related to insurance or socioeconomic factors. [41][42][43][44] Burke et al 41 found that Black/African American patients were less likely than patients of other races to undergo postmastectomy breast reconstruction, which was mediated by insurance status. Our study suggests that ADMs, a costly reconstructive adjunct, may also be unequally used in different racial populations.…”

Section: Discussionmentioning

confidence: 99%

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction

Graziano

Plotsker

Rubenstein

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Implant-based reconstruction is the most common method of immediate breast reconstruction in the United States, with acellular dermal matrices (ADMs) playing a significant role in implant support and coverage. This study evaluated recent national trends in ADM use in immediate breast reconstruction and assessed patient characteristics and 30-day complication rates. Methods: The authors queried the American College of Surgeons National Surgical Quality Improvement Program database for all patients undergoing immediate breast reconstruction from 2015 to 2020. Primary outcomes were major surgical and medical complications, as well as ADM use per year. Subset analysis was performed to compare patients undergoing immediate breast reconstruction with ADM in 2015 versus 2020. Results: In 39,800 immediate breast reconstructions, ADMs were used in 55.5% of cases (n = 22,087). ADM usage increased annually from 2015 through 2020. Direct-to-implant reconstruction was significantly associated with ADM use (P < 0.001). Compared with the no-ADM cohort, there was a significantly increased rate of return to the operating room for any reason (P < 0.001). When comparing the 2015 and 2020 ADM cohorts, the 2020 ADM cohort had a significantly higher rate of superficial infections. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wounds in patients receiving ADM. Conclusions: ADM use in immediate breast reconstruction increased significantly from 2015 to 2020, likely reflecting national trends in increasing direct-to-implant and prepectoral breast reconstruction. Obesity, smoking history, and insulin-dependent diabetes were independent risk factors for superficial wound infections in the ADM cohort. Patients with ADM had a slight increased incidence of return to the operating room. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

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Section: Discussionmentioning

confidence: 99%

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction

Graziano

Plotsker

Rubenstein

et al. 2023

Plastic &Amp; Reconstructive Surgery

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A Tale of Two Hospitals: Effect of Access to Care Through a Safety Net Hospital on Adjuvant Therapy, Imaging Compliance and 5-Year Survival Rates Compared to the University Hospital Served by the Same Breast Cancer Clinical Teams

Mootz,

Ozcan,

Polat

et al. 2024

Academic Radiology

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Post-Mastectomy Breast Reconstruction Disparities: A Systematic Review of Sociodemographic and Economic Barriers

Vangsness,

Juste,

Sam

et al. 2024

Medicina

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Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients.

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Persistent and interdependent: Racial disparities and their mechanisms in postmastectomy breast reconstruction

Cited by 3 publications

References 43 publications

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction

National Trends in Acellular Dermal Matrix Utilization in Immediate Breast Reconstruction

A Tale of Two Hospitals: Effect of Access to Care Through a Safety Net Hospital on Adjuvant Therapy, Imaging Compliance and 5-Year Survival Rates Compared to the University Hospital Served by the Same Breast Cancer Clinical Teams

Post-Mastectomy Breast Reconstruction Disparities: A Systematic Review of Sociodemographic and Economic Barriers

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