Geographic Variation in Breast Reconstruction Modality Following Mastectomy for Cancer
Michelle Sieffert, MD1, Spencer Anderson, MD1, Ron Michael Johnson, MD1, Justin P. Fox, MD2
1Wright State University Division of Plastic and Reconstructive Surgery, Beavercreek, OH, USA, 2Plastic and Reconstructive Surgeon, 88th Medical Group, Wright Patterson Airforce Base, OH, USA.
Purpose: Despite changes in legislation and an increase in public awareness, many women may not have access to various types of breast reconstruction. The purpose of this study was to evaluate variation in reconstructive modality at the health service area (HSA) level, and its relationship to the plastic surgeon workforce in the same area.
Methods: Using inpatient data from five states, we conducted a cross-sectional study of women undergoing mastectomy for cancer from 2009-2012. The primary outcomes were receipt of reconstruction, and reconstructive modality (autologous tissue vs implant). All data was aggregated to the HSA-level, and correlation coefficients were calculated for the relationship between outcomes and workforce data.
Results: The final sample included 67,984 women treated across 102 health service areas. Nearly half of women (49.3%) underwent breast reconstruction. At the HSA-level, immediate breast reconstruction rates varied widely with a median of 25.0% (inter-quartile range=43.2%). The median autologous and free tissue reconstruction rates were low, 10.2% and 0.4% respectively, with more than 25% of HSAs never using autologous tissue. There was a direct correlation between an HSAs plastic surgeon density and autologous reconstruction (r=0.81, p <0.001).
Conclusion: Despite efforts to remove financial barriers and improve patientsí awareness, accessibility to the various modalities of reconstruction is inadequate for many women with breast cancer. Efforts are needed to improve the availability of more comprehensive breast reconstruction care.
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