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A Paradigm Shift in U.S. Breast Reconstruction: Increasing Implant Rates

Albornoz, Claudia R. M.D., M.Sc.; Bach, Peter B. M.D., M.A.P.P.; Mehrara, Babak J. M.D.; Disa, Joseph J. M.D.; Pusic, Andrea L. M.D., M.H.S.; McCarthy, Colleen M. M.D., M.S.; Cordeiro, Peter G. M.D.; Matros, Evan M.D., M.M.Sc.

Plastic & Reconstructive Surgery: January 2013 - Volume 131 - Issue 1 - p 15–23
doi: 10.1097/PRS.0b013e3182729cde
Breast: Outcomes Article
Discussion
Press Release
Basic

Background: Despite its benefits in body image, self-esteem, sexuality, and quality of life, historically fewer than 25 percent of patients undergo immediate breast reconstruction. After passage of the Women Health and Cancer Rights Act, studies failed to demonstrate changes in reconstructive rates. A recent single-year report suggests significant shifts in U.S. breast reconstruction patterns. The authors' goal was to assess long-term trends in rates and types of immediate reconstruction.

Methods: A serial cross-sectional study of immediate breast reconstruction trends was performed using the Nationwide Inpatient Sample database from 1998 to 2008. Data on mastectomies, reconstructive method (autologous/implant), and sociodemographic/hospital predictors were obtained.

Results: Immediate breast reconstruction rates increased on average 5 percent per year, from 20.8 percent to 37.8 percent (p < 0.01). Autologous reconstruction rates were unchanged. Implant use increased by an average of 11 percent per year (p < 0.01), surpassing autologous methods as the leading reconstructive modality after 2002. The strongest predictors of implant use were procedures performed after 2002, bilateral mastectomies, patients operated on in Midwest/West regions, and Medicare recipients. In contrast to bilateral mastectomies, which increased by 17 percent per year (p < 0.01), unilateral mastectomies decreased by 2 percent per year (p < 0.01). Bilateral mastectomy defects had significantly higher reconstruction rates than unilateral counterparts (p < 0.01).

Conclusions: The significant rise in immediate reconstruction rates in the United States correlates closely to a 203 percent expansion in implant use. Although the reason for the increase in implant use is multifactorial, changes in mastectomy patterns, such as increased use of bilateral mastectomies, are one important contributor.

New York, N.Y.

From the Plastic and Reconstructive Surgical Service and the Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center.

Received for publication May 15, 2012; accepted July 20, 2012.

Presented at the 91st Annual Meeting of the American Association of Plastic Surgeons, in San Francisco, California, April 14 through 17, 2012.

Disclosure: Dr. Bach is a consultant for Genentech. Dr. Cordeiro collaborates in a multicentric study sponsored by Allergan. The remaining authors have no financial interest to disclose. No external funding was received.

Evan Matros, M.D., M.M.Sc.; Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI 1036, New York, N.Y. 10065, matrose@mskcc.org

©2013American Society of Plastic Surgeons