The percentage of patients who opt for breast reconstruction after mastectomy have a discount level in recent years, reports a study in the December edition of Plastic and reconstructive surgery®, the official medical magazine of the American Society of Plastic Surgeons (ASP). The magazine is published in the Lippincott portfolio by Wolters Kluwer.
“Our analysis of the US national databases shows that the immediate sinus reconstruction rates have stabilized in the last decade,” says Jonas A. Nelson, MD, MPH or Memorial Sloan Kettering Cancer Center, New York. “In addition, previously documented disparities based on race and insurance also seem to have decreased, although slowly, with a more equitable distribution of postmastectomy breast reconstruction.”
Updated study changes change in national breast reconstruction trends …
For women subject to mastectomy for breast cancer treatment, breast reconstruction has important benefits, including the improvement of body image and sexual functioning. According to the Women’s Health and Cancer Rights Law (Whcra), the coverage of the insurance payer for breast reconstruction has been mandatory in the United States since 1998.
Subsequent studies have reported increasing rates of immediate breast reconstruction after the mastectomy from 1998 to 2014. These studies have also found disparities in breast reconstruction linked to patient factors, including age, race, income and insurance status.
To evaluate the most recent trends, Dr. Nelson and his colleagues analyzed data on more than 1.5 million patients undergoing mastectomy for breast cancer from 2005 to 2017, according to three national databases. In addition to changes in breast reconstruction rates, the factors associated with reconstruction options were analyzed.
Duration The study period, almost a third of patients (32.7%) underwent immediate breast reconstruction after mastectomy. In all data sources, reconstruction rates increased each year between 2005 and 2012. However, reconstruction rates were stabilized in later years, with little or no change from 2013 to 2017.
… including decreases in breast reconstruction disparities
At all times, most patients undergoing immediate breast reconstruction were white. However, the proportion of patients with mastectomy who opt for breast reconstruction decreased among women and increased for black patients, Asian/islands of the Pacific and American natives. After adjustment for other factors, black and white patients had similar breast reconstruction rates.
Most patients undergoing breast reconstruction had private insurance. However, this proportion decreased over time: from 85.0% to 75.1%. Meanwhile, the proportion of patients with breast reconstruction increased among those with public health insurance: from 3.3% to 6.6% for patients in Medicaid and 9.9% to 15.6% for people in Medicare.
Researchers discuss several possible explanations for the stabilization of breast reconstruction, including increases at the population level and accompanied health problems (comorbidity). Other taxpayers may include patient conerns on the safety of breast implants and the trend towards less intensive treatments such as breast conservation.
“An alternative explanation … is that we have simply reached the saturation of the market for the number of women interested in pursuing breast reconstruction after mastectomy,” according to the authors. They also notice the possible effect of “Go Flat” campaigns, with some women who opt for “aesthetic flat closures” instead of breast reconstruction.
The findings highlight the “sensitive to preference” nature of breast reconstruction and the need for “greater qualitative understanding of reasons, either by personal choice or due to limited access, why women do not suffer a reconstruction after the mastectomy of mastectomy.” Dr. Nelson and co -authors conclude: “[W]It remains to be guaranteed that underrapeered groups in breast reconstruction receive timely and equal access to attention. “
Plastic and reconstructive surgery® is published by Wolters Kluwer.
Click here to read “Reduction of disparity in the reconstruction of US breasts: an analysis from 2005 to 2017 using 3 data sets nationwide”
Article: “Reduction of disparity in breast reconstruction in the United States: an analysis from 2005 to 2017 using 3 data sets nationwide” (DOI: 10,1097/PRS.000000001432)
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