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A Paradigm Shift in U.S. Breast Reconstruction: Part 2. The Influence of Changing Mastectomy Patterns on Reconstructive Rate and Method

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

Plastic and Reconstructive Surgery: March 2013 - Volume 131 - Issue 3 - p 320e–326e
doi: 10.1097/PRS.0b013e31827cf576
Breast: Original Articles
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Background: The aims of the current study were to (1) measure trends in the type of mastectomy performed, (2) evaluate sociodemographic/hospital characteristics of patients undergoing contralateral prophylactic mastectomy versus unilateral mastectomies, and (3) analyze reconstruction rates and method used following different mastectomy types.

Methods: Mastectomies from 1998 to 2008 were analyzed using the Nationwide Inpatient Sample database. Mastectomies (n = 178,603) were classified as either unilateral, contralateral prophylactic, or bilateral prophylactic. Reconstructive procedures were categorized into either implant or autologous. Longitudinal trends were analyzed with Poisson regression and sociodemographic/hospital variables were analyzed with logistic regression.

Results: Unilateral mastectomies decreased 2 percent per year, whereas contralateral and bilateral prophylactic mastectomies increased significantly by 15 and 12 percent per year, respectively (p < 0.01). Independent predictors for contralateral prophylactic mastectomy (compared with unilateral mastectomy) were patients younger than 39 years, Caucasian and Hispanic race, private insurance carriers, treated in teaching hospitals, and from South and Midwest regions. Contralateral prophylactic mastectomy is the only group with increased reconstruction rates throughout the study period (p < 0.01). Although implant use increased for all mastectomy types, it remains greater in bilateral and contralateral prophylactic mastectomy.

Conclusions: There is increasing use of bilateral mastectomies in the United States, particularly in patients with unilateral cancer. Although implant use has increased for all mastectomy types, they are used most commonly following bilateral and contralateral prophylactic mastectomies. Changing mastectomy patterns are one factor underlying the paradigm shift away from autologous tissue to implant-based reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

New York, N.Y.

From the Plastic and Reconstructive Surgical Service, Memorial Sloan-Kettering Cancer Center.

Received for publication August 20, 2012; accepted September 21, 2012.

The first two authors contributed equally to this work.

Presented at the 57th Annual Meeting of the Plastic Surgery Research Council, in Ann Arbor, Michigan, June 14 through 16, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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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