Plastic Surgery Research Council
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FACTORS AFFECTING ACCESS TO BREAST RECONSTRUCTION
Presenter: Benjamin C Wood, MD
Co-Authors: DAVID LR; MCNATT MH; LEVINE EA; THOMPSON JT
Wake Forest Baptist Health

PURPOSE: Despite a paradigm shift with regard to the perceived safety of immediate breast reconstruction, more than 75% of women currently undergoing mastectomy do not have breast reconstruction performed. While this has prompted legislation in some states designed to increase access to breast reconstruction, there is a paucity of information related to the trends in breast reconstruction and the barriers that exist to its delivery. The primary aim of this study was to identify factors impairing the utilization of reconstruction in patients receiving breast cancer treatment in North Carolina.

METHOD: An IRB-approved, retrospective study was performed of data collected from the National Cancer Data Base (NCDB), a joint program by the Commission on Cancer (CoC) of the American College of Surgeons (ACoS) and the American Cancer Society (ACS). Patients identified in the database as having undergone mastectomy for the treatment of breast cancer from 2000-2009 as reported by the 46 facilities in North Carolina accredited by the CoC, were analyzed to determine trends in the rate of breast reconstruction related to demographic, socioeconomic, and hospital system-based factors.

RESULT: A total of 15,136 patients were included in the study. The breast reconstruction rate in the US population (23.3%) was significantly higher than NC (20.6%), and has increased at a significant rate (p<0.0001), while the rate of breast reconstruction in NC has not changed. Patients receiving treatment at a Teaching Research Cancer Center, age less than 50 years, Caucasian, private insurance, income >$49,000/year, and higher educational level were all independently more likely to have breast reconstruction (p <0.0001).

CONCLUSION: Although efforts to promote use of breast reconstruction in the US have led to an upward trend in the rate of reconstruction, post-mastectomy breast reconstruction continues to be underutilized in North Carolina relative to national data. Numerous disparities exist related to demographic, socioeconomic, and hospital-based factors among patients in North Carolina that impact access to breast reconstruction.


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