Background/Aim: The aim of this study was to analyze how race, income, insurance, and education, affect breast reconstruction rates. Materials and Methods: We reviewed the National Cancer Database. χ 2 test and binary logistic regression were used to analyze the association between demographic characteristics and reconstruction rate. Results: White race and private insurance were associated with a higher risk of getting reconstruction when compared to black race (odd ratio [OR]=0.939; 95%CI=0.909-0.970) and government insurance (OR=0.459;. Patients with an estimated income >$63,000 were found to have higher odds of receiving breast reconstruction than patients with income less than $38,000 (OR=1.868;. Patients who live in a zip code area with a higher education average have higher odds of receiving postmastectomy breast reconstruction than patients living in a zip code with a lower education average (OR=1.152,. Conclusion: Differences in reconstruction rates exist based on race, income, insurance, and education level.The United States has 3.5 million breast cancer survivors, and with the improvement of breast cancer treatment, this number is expected to increase (1). Survival is not the only challenge with breast cancer; women undergo surgeries that affect the appearance of their breast and their body image.Many female survivors who undergo breast reconstruction report improvements in quality of life, satisfaction with appearance, and overall sexuality (2, 3). The Women's Health and Care Rights Act was passed in 1998, mandating that health insurance companies cover postmastectomy breast reconstruction (4). In 2010, the Patient Protection and Affordable Care Act was approved, requiring physicians to discuss the option of breast reconstruction and coverage by insurance with patients who will undergo a mastectomy. If the patient is not covered in that institution, the physician must remit them to an institution at which they are covered (5). These laws were passed with the intention of improving access to breast reconstruction, thus reducing disparities among patients undergoing reconstruction (5). Although some studies using national databases have shown a downtrend in disparities in recent years, they are still present (6-13). Socioeconomic disparities, such as race, income, insurance, and education, have been proven to affect breast reconstruction rates (7,(14)(15)(16)(17)(18).We hypothesize that, despite the laws, increased awareness, and a higher rate of reconstruction, there are still disparities in favor of white race, higher income, private insurance, and higher education level.
