Trends and variations in post‐mastectomy breast reconstruction rates in Australia over 10 years

Abstract

Background Offering breast reconstruction (BR) at the time of mastectomy is standard of care in Australia with proven quality‐of‐life benefits. Previously BR rates in Australia have been low compared to similar countries. Accurate up‐to‐date information is needed to promote equity in access to BR and inform future planning of services. This study analysed recent trends and variations of BR uptake in Australia. Method Data from the BreastSurgANZ Quality Audit (BQA) were used to identify patients who underwent mastectomy with or without reconstruction for invasive or in situ breast carcinoma from 2010 to 2019. The association between BR uptake and the variables of jurisdiction (state or territory), age, hospital type and remoteness, and remoteness of patients' home addresses were analysed. Results A total 41 880 women underwent mastectomy between 2010 to 2019. The national BR rate steadily increased from 12.8% in 2010 to 29% in 2019, with a 10‐year national average of 21.3%. Statistically significant differences in BR uptake (P < 0.001) were found between states with higher rates in New South Wales and Victoria, with BR more likely in private hospitals and in younger women (P < 0.001), and less likely in remote areas (P < 0.001). Conclusion The Australian BR rate has increased over the 10‐year period, but significant variation still exists between states. BR is lower in older women and those living in regional and remote areas. While the steady increase in BR uptake is encouraging, barriers that exist to equitable provision of reconstructive surgical services for all women living with breast cancer still need to be corrected.

Rising age‐specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit

“…In England, the numbers of IBR have doubled from 8389 in 1996 to 16 430 in 2012 18 . Rates of breast reconstruction in Australia steadily increased from 12.8% in 2010 to 29% in 2019, with a 10‐year national average of 21.3% 19 . The European Leadership Forum of the European Society of Plastic, Reconstructive, and Aesthetic Surgery conducted a survey on breast reconstruction in 21 European countries.…”

“…18 Rates of breast reconstruction in Australia steadily increased from 12.8% in 2010 to 29% in 2019, with a 10-year national average of 21.3%. 19 The European Leadership Forum of the European Society of Plastic, Reconstructive, and Aesthetic Surgery conducted a survey on breast reconstruction in 21 European countries. IBR was conducted with great variability, in only 1%-40% of cases irrespective of patient age.…”

The development of a rural breast reconstruction service: patient reported outcomes and benefits

“…The Australian Access to Breast Reconstruction Collaborative Group published a position statement in 2021 stating ‘ That all women in Australia requiring mastectomy for the management of their breast cancer have timely access to breast reconstruction regardless of geographical location or financial circumstance ’ 13 . However, current Australian data show that we are not meeting this goal, as the national rate of breast reconstruction in metropolitan areas was 33% compared to 13% in regional and remote areas in 2019 14 …”

“…13 However, current Australian data show that we are not meeting this goal, as the national rate of breast reconstruction in metropolitan areas was 33% compared to 13% in regional and remote areas in 2019. 14 This study aims to build on the current data surrounding rural breast reconstruction through analysing a single rural breast reconstruction service's impact on community living in a Modified Monash Model 3 region. The primary outcome is to demonstrate to what extent having a rural breast reconstruction unit improves access to a breast reconstruction for women living in a rural area.…”

Novel single‐centre experience – evaluation of outcomes post‐implementation of a coordinated combined breast reconstruction service

“…1,2 In the last decade, Australia witnessed a two-fold increase in the national reconstruction rate (12.8-29%). 3 Reconstruction can either be autologous or implant-based. Of the two, autologous breast reconstruction is increasingly preferred due to its superior clinical and patient-reported outcomes, namely lower rates of reconstructive failure, lower incidence of seroma, and better breast satisfaction and sexual well-being without compromising oncological parameters.…”