More Women Undergoing Breast Reconstruction Immediately after Mastectomy
Implants Now Most Common Approach to Reconstruction, Study Finds

Arlington Heights, Ill. - The number of women undergoing immediate breast reconstruction after mastectomy for breast cancer has risen sharply in recent years, reports a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"The significant rise in U.S. immediate reconstruction rates correlates closely to a 203 percent expansion in implant use," according to the study by ASPS Member Surgeon Evan Matros, MD, and colleagues of Memorial Sloan Kettering Cancer Center, New York. Researchers believe the trend toward immediate reconstruction and implant use signals a "paradigm shift" in breast reconstruction after mastectomy in the United States.

More Immediate Reconstructions, Most Using Implants

Using a national database, the researchers assessed trends in immediate breast reconstruction after mastectomy for breast cancer from 1998 to 2008. The analysis included the type of reconstruction-autologous (using the woman's own tissue) or implant-as well as factors associated with reconstruction.

Out of approximately 178,600 mastectomies, 51,400 were followed by immediate breast reconstruction. From the late 1990s to the late 2000s, the rate of immediate reconstruction after mastectomy increased from about 21 percent to 38 percent-an average increase of five percent per year.

During this period, the number of autologous breast reconstruction procedures remained relatively unchanged. In contrast, the rate of reconstructions using implants increased dramatically: by an average of 11 percent per year.

In the past, most breast reconstructions were done using the woman's own tissue, such as the TRAM flap reconstruction which uses tissue from the abdomen. The new findings suggest that implants are now the most common approach to reconstruction, having surpassed autologous reconstruction after 2002.

Double Mastectomy, Insurance Coverage May Affect Trends

Several factors contributed to the increased rate of immediate implant reconstruction, including the rising number of women undergoing double mastectomies. Double mastectomies increased by an average of 17 percent per year during the period studied, as a means of preventing breast cancer in women at high genetic risk, or in reducing the risk of second breast cancers. Furthermore, women who underwent double mastectomy were twice as likely to be reconstructed using implants than those who underwent a single-sided mastectomy.

Immediate implant reconstruction was also more likely for women in the West and Midwest, compared to other U.S. regions. Women on Medicare were also more likely to undergo implant reconstruction.

<>Another contributor may have been the 1998 Women's Health and Cancer Rights Act (WHCRA), which ensured coverage for breast reconstruction after mastectomy. Past studies have found no significant change in reconstruction following passage of the law. Although it's difficult to prove a direct causal effect of the WHRCA, "the steady increase in reconstruction rates since its introduction is suggestive," Dr. Matros and colleagues write.

"The observed rise in reconstruction rates correlates to a paradigm shift away from autologous tissue to implant based techniques as the major reconstructive modality," Dr. Matros and coauthors believe. They discuss the "multifactorial" reasons behind the increase in immediate breast reconstruction after mastectomy. The authors also call for further research to understand the reasons behind the growing use of implant, rather than autologous, reconstruction.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.