Purpose Breast cancer surgical techniques are evolving. Few studies have analyzed national trends for the multitude of surgical options that include partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with reconstruction (M+R), and PM with oncoplastic reconstruction (OS). We hypothesize that the use of M is declining and likely correlates with the rise of surgery with reconstructive options (M+R, OS). Methods A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2005 to 2016 and ICD codes for IBC and DCIS. Patients were then grouped together based on current procedural terminology (CPT) codes for PM, M, M+R, and OS. In each group, categories were sorted again based on additional reconstructive procedures. Data analysis was conducted via Pearson’s chi-squared test for demographics, linear regression, and a non-parametric Mann-Kendall test to assess a temporal trend. Results The patient cohort consisted of 256,398 patients from the NSQIP data base; 197,387 meet inclusion criteria diagnosed with IBC or DCIS. Annual breast surgery trends changed as follows: PM 46.3–46.1% (p = 0.21), M 35.8–26.4% (p = 0.001), M+R 15.9–23.0% (p = 0.03), and OS 1.8–4.42% (p = 0.001). Analyzing the patient cohort who underwent breast conservation, categorical analysis showed a decreased use of PM alone (96–91%) with an increased use of OS (4–9%). For the patient cohort undergoing mastectomy, M alone decreased (69–53%); M+R with muscular flap decreased (9–2%); and M+R with implant placement increased (20–40%)—all three trends p < 0.0001. Conclusion The modern era of breast surgery is identified by the increasing use of reconstruction for patients undergoing breast conservation (in the form of OS) and mastectomy (in the form of M+R). Our study provides data showing significant trends that will impact the future of both breast cancer surgery and breast training programs.

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Purpose Breast cancer continues to be the most prevalent cancer affecting women. Many reconstructive options exist after oncologic resection. Breast reconstruction can have a lasting impact on many areas of the patient's life, and therefore, a high consideration for patient satisfaction is crucial. Patient‐reported outcome measures (PROMs) provide an important tool in the evaluation of different surgical methodologies. The aim of this comprehensive systematic review is to look at various surgical modalities in breast reconstruction as they relate to patient satisfaction. Methods A PubMed PRISMA search was performed. Criteria for inclusion included nipple‐sparing or skin‐sparing mastectomy with autologous or implant‐based reconstruction, level 2 volume displacement or volume replacement oncoplastic surgery, and measurement of patient‐reported outcomes using the BREAST‐Q or other validated PROMs. From the data set, weighted proportions were generated and analyzed using the Kruskal‐Wallis rank sum test and a post hoc Dunn's test. Results After obtaining 254 full text copies, 43 articles met inclusion criteria and were included. Analysis of BREAST‐Q data showed oncoplastic breast surgery was significantly preferred over mastectomy regardless of the type of reconstruction. Nipple‐sparing was significantly preferred over skin‐sparing mastectomy, autologous reconstruction was significantly preferred over implant‐based reconstruction, and prepectoral implant placement was preferred over subpectoral implant placement. Validated PROMs other than BREAST‐Q showed similar trends in all but type of mastectomy. Conclusions In this comprehensive systematic review, oncoplastic surgery showed the most favorable PROMs when compared to other reconstructive modalities. Autologous was preferred over implant‐based reconstruction, and prepectoral was preferred over subpectoral implant placement.