Breast reconstruction after mastectomy at a comprehensive cancer center

Abstract

BackgroundBreast reconstruction after mastectomy is an integral part of breast cancer treatment that positively impacts quality of life in breast cancer survivors. Although breast reconstruction rates have increased over time, African American women remain less likely to receive breast reconstruction compared to Caucasian women. National Cancer Institute-designated Comprehensive Cancer Centers, specialized institutions with more standardized models of cancer treatment, report higher breast reconstruction rates than primary healthcare facilities. Whether breast reconstruction disparities are reduced for women treated at comprehensive cancer centers is unclear. The purpose of this study was to further investigate breast reconstruction rates and determinants at a comprehensive cancer center in St. Louis, Missouri.MethodsSociodemographic and clinical data were obtained for women who received mastectomy for definitive surgical treatment for breast cancer between 2000 and 2012. Logistic regression was used to identify factors associated with the receipt of breast reconstruction.ResultsWe found a breast reconstruction rate of 54 % for the study sample. Women who were aged 55 and older, had public insurance, received unilateral mastectomy, and received adjuvant radiation therapy were significantly less likely to receive breast reconstruction. African American women were 30 % less likely to receive breast reconstruction than Caucasian women.ConclusionThese findings suggest that racial disparities in breast reconstruction persist in comprehensive cancer centers. Future research should further delineate the determinants of breast reconstruction disparities across various types of healthcare institutions. Only then can we develop interventions to ensure all eligible women have access to breast reconstruction and the improved quality of life it affords breast cancer survivors.

Disparities in Rural Breast Cancer Care: Factors Affecting Choice of Breast Reconstruction in a West Virginia Tertiary Care Hospital

“…Previously published literature has shown that women who undergo bilateral mastectomy are more likely to pursue reconstruction than those who choose unilateral mastectomy. [12][13][14] Our study supports this observation by showing that patients at our institution who underwent bilateral mastectomy for unilateral disease were more likely to undergo reconstruction than patients who underwent only unilateral mastectomy.…”

“…These factors include non-white race, older age, obesity, associated comorbidities, lower educational level, advanced-stage disease, nonprivate insurance, primary operation performed by a male surgeon, rural residence, below average income zip codes, unilateral (versus bilateral) mastectomy, and need for postoperative radiation therapy. 3,[5][6][7][8][9][10][11][12][13][14] West Virginia represents a unique rural population within the United States, both geographically and socioeconomically. All 55 counties of West Virginia fall within the Appalachian region.…”

Disparities in Use and Access to Postmastectomy Breast Reconstruction Among African American Women

“…The authors found the adjusted OR for AA women to be 0.70 (95% CI = 0.56-0.87) compared to white women in multivariate analysis that included age race, insurance type, tumor stage, progestin receptor status, and receipt of chemo and/or radiation. 17 They did not analyze the rate of change in breast reconstruction rates over time, despite the long study period. Socioeconomic status of the patients was not obtained.…”

Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap

“…Many women who undergo mastectomy are interested in having a breast reconstruction, either directly or at a later stage. Breast reconstruction can be performed using autologous tissue, implants or a combination of these.…”