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American Association of Plastic Surgeons

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Breaking Barriers To Breast Reconstruction Among Socioeconomically Disadvantaged Breast Cancer Patients: Lessons Learned At A Large Safety-net Hospital
Anna Meade, MD1, Samantha Cummins, MD1, Jordyn T. Farewell, M.S.1, Sofia Duque, BA2, Sydney Mulqueen, BS1, Ashleigh Chuah, BS1, Andrew Y. Zhang, MD1.
1University of Texas Southwestern, Dallas, TX, USA, 2Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

PURPOSE: Socioeconomic disparities remain widely prevalent among those who undergo breast reconstruction. The purpose of this study was to examine mastectomy and reconstruction modalities at a large safety-net hospital and determine the impact of socioeconomic factors on breast reconstruction enrollment, choice, and completion.
METHODS: A retrospective chart review of patients who underwent mastectomies at a large safety-net hospital from 2016 to 2019 was completed. Surgical, medical, and demographic data were compared across varying socioeconomic factors. Eligibility for elective breast reconstruction at our institution includes a pre-operative hemoglobin A1c level less than 7%, body mass index less than 40 kg/m2, and non-smoking status for one month prior to surgery.
RESULTS: Of the 645 patients included in this study, more patients of a racial minority had government-based insurance than Caucasian patients (89% vs. 82%; p=0.01). Those with government-based insurance had higher average hemoglobin A1c values (6.26 vs. 6.0; p=0.03), proportion of ASA scores greater than III (46% vs. 40%; p=0.01), and smokers (23% vs. 8%; p=0.02) than those with private insurance. Patients with government-based insurance underwent stage I breast reconstruction at rates lower than those with private insurance (57% vs. 69%; p=0.01).
CONCLUSION: Significantly higher number of socioeconomically disadvantaged patients failed to meet preoperative clearance criteria for breast reconstruction due to obesity, diabetes, smoking, and poor overall health. Concerted effort through multidisciplinary teams is needed to maximize eligibility of socioeconomically disadvantaged breast cancer patients for reconstruction.


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