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Increases in Post-Mastectomy Reconstruction in New York State Are Not Related to Changes in State Law

Gooch, Jessica C. MD1; Guth, Amber MD1; Yang, Jie PhD2; Zhu, Chencan MS3; Park, Jihye PhD3; Telem, Dana MD6; Bui, Duc MD4; O’Hea, Brian MD5; Khan, Sami MD4

Plastic and Reconstructive Surgery: May 6, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005794
Original Article: PDF Only

Introduction: Post-mastectomy reconstruction (PMR) remains underutilized. In 2011, new legislation in the State of New York mandated discussion of reconstructive options prior to mastectomy. Our study assesses the impact of this policy on immediate breast reconstruction rates.

Methods: The SPARCS database was queried to identify women undergoing mastectomy from January 2005-to October 2015 and follow them for at least one year postoperatively to determine incidence and timing of reconstruction. Demographic and socioeconomic characteristics were collected. Chi-square test and multivariable logistic regression were used to compare periods before (2005-2010) and after (2011-2015) the legislative change.

Results: Of 52,837 records, there were 24,340 patients (46%) with immediate breast reconstruction (IBR). Incidence of IBR increased over the study time period, most significantly in 2008-2009. Rates of IBR continued to increase, although at a slower rate, post 2011 as compared to pre-2011 across all subgroups. Both implant (IR) and autologous (AR) reconstructive techniques increased over time. IR increased steadily while AR increased most significantly between 2008-2009.

Conclusion: Despite an overall increase in IBR, there was an overall lack of effect on post-2011 reconstructive rates attributable to the legislative changes. Reconstructive rates have increased significantly in NYS over the past decade and these changes appear to be largely independent of the 2011 NYS Breast Reconstruction Act. There are likely non-legislative drivers of breast reconstruction utilization.

1Department of Surgery, Division of Breast Surgery, New York University Medical Center, New York, New York

2Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York

3Department of Applied Mathematics and Statistics, Stony Brook University Medical Center, Stony Brook, New York

4Department of Plastic Surgery Stony Brook University Medical Center, Stony Brook, New York

5Department of Breast Surgery, Stony Brook University Medical Center, Stony Brook, New York

6Department of Surgery, University of Michigan, Ann Arbor, Michigan

Presented in part at: American College of Surgeons Clinical Congress 2016; Washington, D.C. October 16-20, 2016 and the Plastic Surgery Research Council Annual Meeting 2017; Durham, N.C. May 4-7, 2017.

FD - None of the authors has a financial interest in any of the products, devices or drugs mentioned in this manuscript.

Acknowledgement:We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at the School of Medicine, Stony Brook University.

Corresponding Author: Sami Khan, MD, Department of Plastic Surgery, Stony Brook University Medical Center, Stony Brook, New York.

©2019American Society of Plastic Surgeons