Rates of Breast Reconstruction After Mastectomy Have Stabilized
Disparities in reconstruction are also decreasing, reports Plastic and Reconstructive Surgery®

The percentage of patients opting for breast reconstruction after mastectomy has leveled off in recent years, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our analysis of US national databases shows that rates of immediate breast reconstruction have stabilized over the past decade," comments Jonas A. Nelson, MD, MPH, of Memorial Sloan Kettering Cancer Center, New York. "In addition, previously documented disparities based on race and insurance also appear to have decreased – albeit slowly – with a more equitable distribution of postmastectomy breast reconstruction."

Updated study shows shift in national breast reconstruction trends...

For women undergoing mastectomy for treatment of breast cancer, breast reconstruction has important benefits, including improvement in body image and sexual functioning. Under the Women's Health and Cancer Rights Act (WHCRA), insurance payer coverage for breast reconstruction has been mandated in the United States since 1998.

Subsequent studies have reported rising rates of immediate breast reconstruction after mastectomy from 1998 to 2014. Those studies have also found disparities in breast reconstruction linked to patient factors, including age, race, income, and insurance status.

To assess more recent trends, Dr. Nelson and colleagues analyzed data on more than 1.5 million patients undergoing mastectomy for breast cancer from 2005 through 2017, based on three national databases. In addition to changes in breast reconstruction rates, factors associated with reconstruction choices were analyzed.

During the study period, nearly one-third of patients (32.7%) underwent immediate breast reconstruction after mastectomy. In all data sources, reconstruction rates increased each year from 2005 to 2012. However, reconstruction rates stabilized in subsequent years, with little or no change from 2013 to 2017.

...including decreases in breast reconstruction disparities

At all times, most patients undergoing immediate breast reconstruction were White. However, the proportion of mastectomy patients opting for breast reconstruction decreased among White women while increasing for Black, Asian/Pacific Islander, and Native American patients. After adjustment for other factors, Black and White patients had similar breast reconstruction rates.

Most patients undergoing breast reconstruction had private insurance. However, this proportion decreased over time: from 85.0% to 75.1%. Meanwhile, the proportion of breast reconstruction patients increased among those with public health insurance: from 3.3% to 6.6% for patients on Medicaid and 9.9% to 15.6% for those on Medicare.

The researchers discuss several possible explanations for the stabilization of breast reconstruction, including population-level increases in age and accompanying health problems (comorbidity). Other contributors may include patient concerns about the safety of breast implants and the trend toward less-intensive treatments such as breast conservation.

"An alternative explanation...is that we have simply reached market saturation for the number of women interested in pursuing breast reconstruction after mastectomy," according to the authors. They also note the possible effect of "go flat" campaigns, with some women opting for "aesthetic flat closures" rather than breast reconstruction.

The findings highlight the "preference-sensitive" nature of breast reconstruction and the need for "a greater qualitative understanding of the reasons – whether by personal choice or due to limited access – why women do not undergo reconstruction after mastectomy." Dr. Nelson and coauthors conclude: "[W]ork remains to be done to ensure that underrepresented groups in breast reconstruction receive timely and equal access to care."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Disparity Reduction in U.S. Breast Reconstruction: An Analysis from 2005 to 2017 Using 3 Nationwide Data Sets"

Article: "Disparity Reduction in U.S. Breast Reconstruction: An Analysis from 2005 to 2017 Using 3 Nationwide Data Sets" (doi: 10.1097/PRS.0000000000011432)