Trends and Variation in Use of Breast Reconstruction in Patients With Breast Cancer Undergoing Mastectomy in the United States

Abstract

Purpose Concerns exist regarding breast cancer patients' access to breast reconstruction, which provides important psychosocial benefits. Patients and Methods Using the MarketScan database, a claims-based data set of US patients with employment-based insurance, we identified 20,560 women undergoing mastectomy for breast cancer from 1998 to 2007. We evaluated time trends using the Cochran-Armitage test and correlated reconstruction use with plastic-surgery workforce density and other treatments using multivariable regression. Results Median age of our sample was 51 years. Reconstruction use increased from 46% in 1998 to 63% in 2007 (P < .001), with increased use of implants and decreased use of autologous techniques over time (P < .001). Receipt of bilateral mastectomy also increased: from 3% in 1998 to 18% in 2007 (P < .001). Patients receiving bilateral mastectomy were more likely to receive reconstruction (odds ratio [OR], 2.3; P < .001) and patients receiving radiation were less likely to receive reconstruction (OR, 0.44; P < .001). Rates of reconstruction receipt varied dramatically by geographic region, with associations with plastic surgeon density in each state and county-level income. Autologous techniques were more often used in patients who received both reconstruction and radiation (OR, 1.8; P < .001) and less frequently used in patients with capitated insurance (OR, 0.7; P < .001), patients undergoing bilateral mastectomy (OR, 0.5; P < .001), or patients in the highest income quartile (OR, 0.7; P = .006). Delayed reconstruction was performed in 21% of patients who underwent reconstruction. Conclusion Breast reconstruction has increased over time, but it has wide geographic variability. Receipt of other treatments correlates with the use of and approaches toward reconstruction. Further research and interventions are needed to ensure equitable access to this important component of multidisciplinary treatment of breast cancer.

Trends in breast reconstruction practices in a specialized breast tertiary referral centre

“…This compares favourably with rates of 16–59 per cent internationally3 8, 19 27, 28, 29, 30. The strongest predictors of PMBR cited were: age under 50 years; white race; higher income and education; and earlier disease stage31.…”

“…As a consequence of both the increasing volume of risk‐reducing surgery and improved survival of patients with breast cancer, surgical techniques for both mastectomy (such as skin‐ and nipple‐sparing approaches18) and PMBR have evolved significantly over the past decade in an effort to maximize aesthetic and quality‐of‐life outcomes19.…”

Impact of the Poly Implant Prosthesis Breast Implants Recall in Women With Breast Reconstruction: A South-Eastern French Cross-Sectional Survey Nested in a Prospective Cohort

“…One of the strength of the study was its geographically based sampling with prospective follow-up of the women at the time of the PIP recall. However if one considers that one third of breast cancer women have a mastectomy and one fourth to half of them have breast reconstruction which is not immediate in most of the times, 1 it was difficult to have a larger number of cases in a regional cohort.…”

“…tion after mastectomy continue to rise, 1 but enormous differences can be observed: a median overall reconstruction rate of 24% has been reported, ranging from 5-81%. 2 Implants seem to be the most frequent type of reconstruction, whereas the use of autologous techniques is decreasing.…”

“…2 Implants seem to be the most frequent type of reconstruction, whereas the use of autologous techniques is decreasing. 1,3 Several Breast Implant crises were generated in the 90's 4 and more recently the Poly Implant Prosthesis (PIP) Breast Implants in 2010. 5,6 The U.S had not been involved in the PIP crisis, 7 but the European countries and Australia have reacted in different ways to this issue [7][8][9][10] which clinical implications have been reviewed recently.…”