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Rise in Microsurgical Free-Flap Breast Reconstruction in Academic Medical Practices

Dasari, Chanukya R. MD*; Gunther, Sven MS*; Wisner, David H. MD*; Cooke, David T. MD*; Gold, Christopher K. MD; Wong, Michael S. MD*

doi: 10.1097/SAP.0000000000000483
Research Articles

Background Previous studies have examined national trends in breast reconstruction, using various data sets demonstrating increases in implant-based reconstruction and decreases in autologous reconstruction. However, academic breast reconstruction practices have never been specifically characterized. The University Health Consortium—Association of American Medical Colleges Faculty Practice Solutions Center database contains comprehensive, factual billing and coding data from 90 academic medical centers in the United States, and has been used to characterize practice patterns of various academic surgical specialties.

Objective To describe breast reconstruction trends unique to academic surgical practices, using the Faculty Practice Solutions Center database.

Methods Annual data for defined breast reconstruction procedures (current procedural terminology codes: 19340, 19342, 19357, 19361, 19364, 19366, 19367, 19369, and 19380) performed by university plastic surgeons during calendar years 2007 to 2013 were included in the study.

Results From 2007 to 2013, a 2-fold increase in the number of breast reconstruction procedures was observed (from a mean of 45.3 to 94.2 procedures per surgeon). During this period, implant-based reconstructions and autologous reconstructions rose in tandem (28.9–44.6 and 11.4–19.3, respectively), with a preserved 2.5:1 ratio between the 2 categories each year. When compared to reconstructions overall, the proportion of both implant reconstruction and autologous reconstruction procedures declined, since revision and other types of reconstructions increased (11% of all reconstructions in 2007 vs 32% in 2013). With regard to autologous reconstruction, microsurgical free flaps (mostly comprised of deep inferior epigastric artery perforator flaps) have supplanted latissimus flaps as the favored modality and comprised 13% to 14% of breast reconstruction cases overall from 2011 to 2013.

Conclusion In contrast to national trends, university-based plastic surgeons are performing a growing number of microsurgical free flaps as the preferred method for autologous breast reconstruction. Whereas implant-based reconstructions still predominate in academic practices, the trend of increasing preference toward implant-based reconstructions has slowed in recent years and revision reconstructions are on the rise.

From the *Division of Plastic Surgery, University of California Davis, Sacramento, CA; and †Division of Plastic Surgery, Travis Air Force Base, Fairfield, CA.

Received July 24, 2014, and accepted for publication, after revision, December 31, 2014.

Conflicts of interest and sources of funding: none declared.

Reprints: Michael S. Wong, MD, Division of Plastic Surgery, Department of Surgery, University of California Davis Medical Center, 2221 Stockton Blvd, Suite 2123, Sacramento, CA 95817. E-mail:

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