Background: Concern exists that plastic surgeons have lost interest in postmastectomy breast reconstruction, which has helped enable the oncoplastic movement by general surgery. The authors evaluated patterns and correlates of postmastectomy breast reconstruction among U.S. plastic surgeons.
Methods: A survey was mailed to a national sample of 500 randomly selected members of the American Society of Plastic Surgeons (73 percent of eligible subjects responded; n = 312). The dependent variable was surgeon's annual volume of breast reconstructions (dichotomized into >50 and ≤50 cases per year). Logistic regression was used to evaluate factors associated with annual volume, including surgeon demographic and practice characteristics, community support for reconstruction, and surgeons' attitudes toward insurance reimbursement.
Results: Ninety percent found doing breast reconstruction personally rewarding, and nearly all enjoyed the technical aspects of the procedure. The majority of surgeons, however, were low-volume to moderate-volume providers, and 43 percent reported decreasing their volume over the past year due to poor reimbursement. Resident availability was significantly associated with high volume (odds ratio, 4.93; 95 percent CI, 2.31 to 10.49); years in practice and perceived financial constraints by third-party payers were inversely associated with high volume (>20 years compared with ≤10 years: odds ratio, 0.23. 95 percent CI, 0.07 to 0.71; odds ratio, 0.22, 95 percent CI, 0.08 to 0.56, respectively).
Conclusions: Although plastic surgeons find breast reconstruction professionally rewarding, many are decreasing their practice. Factors associated with low volume include lack of resident coverage and perceived poor reimbursement. Advocacy efforts must be directed at facilitating reconstructive services for this highly demanding patient population.
Ann Arbor, Mich.; and Iowa City, Iowa
From the Section of Plastic Surgery, Department of Surgery, and the Departments of General Medicine and Internal Medicine, The University of Michigan Medical Center; the Department of General Surgery, St. Joseph Mercy Hospital; the Department of General Surgery, University of Iowa; and the Ann Arbor Veterans Affairs Center for Clinical Management Research.
Received for publication May 3, 2010; accepted October 12, 2010.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
Amy K. Alderman, M.D., M.P.H. Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-0340, firstname.lastname@example.org