Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital

Abstract

Background: In Australia, the rate of immediate breast reconstruction (IBR) following breast cancer surgery is highly variable. This study aimed to identify the rate of IBR within an Australian public tertiary breast oncology referral centre and analyse the tumour and demographic factors that impact upon IBR uptake. Methods: A retrospective cohort study of 288 admissions of women requiring mastectomy between January 2012 and March 2015 was performed. Data collected included demographic data, tumour pathology, operative details and neoadjuvant therapy. Demographic data included a Socioeconomic Index for Area score, based on individual residential postcode, country of birth and need for an interpreter. Results: Our study demonstrated an IBR rate of 41.3% and included a wide variety of reconstructions. Factors that increased the IBR rate included younger age and negative lymph node status. Our patient population was ethnically and linguistically diverse, with over 50 different countries of birth represented and with 53 patients requiring interpreters in 19 different languages. Our analysis shows that the requirement for an interpreter is negatively correlated with having an IBR. Conclusions: Our research demonstrates a high rate of IBR that includes a wide range of autologous and alloplastic reconstructions. Our study represents a unique opportunity to identify socioeconomic barriers that influence patient choice for reconstruction following mastectomy. This can lead to improved health care provision for our patients. This is particularly important in tertiary services with a strong multicultural and multi-linguistic population.

Trends and variations in post‐mastectomy breast reconstruction rates in Australia over 10 years

“…An IBR rate of 40% has been estimated in United States; however, legislation and insurance coverage differences make direct comparisons difficult. While BQA presents the best available surgeon‐level data, BR rates in Australia have been highly variable, with specialist metropolitan breast cancer centres having BR rates upwards of 40% 9,22,23 . The improvement in the national BR rate is positive; however, improved data collection and collaboration among surgical specialities is necessary to ascertain a more accurate national BR rate (Appendix 2).…”

“…While BQA presents the best available surgeon-level data, BR rates in Australia have been highly variable, with specialist metropolitan breast cancer centres having BR rates upwards of 40%. 9,22,23 The improvement in the national BR rate is positive; however, improved data collection and collaboration among surgical specialities is necessary to ascertain a more accurate national BR rate (Appendix 2). The increased BR rates in Australia over the last decade is positive and has been due to various reasons.…”

Comparing direct-to-implant and two-stage breast reconstruction in the Australian Breast Device Registry

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Breast cancer affects almost 20,000 Australians annually, 1 and the national average rate of breast reconstruction is 18.3%. 2 For women undergoing mastectomy, the positive effects of breast reconstruction after mastectomy are well established. 2 Prosthetic breast reconstruction is either twostage expander/implant reconstruction or single-stage direct-to-implant (DTI) reconstruction.

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“…2 For women undergoing mastectomy, the positive effects of breast reconstruction after mastectomy are well established. 2 Prosthetic breast reconstruction is either twostage expander/implant reconstruction or single-stage direct-to-implant (DTI) reconstruction. The choice of reconstructive method continues to spark debate.…”

“…Breast cancer affects almost 20,000 Australians annually, 1 and the national average rate of breast reconstruction is 18.3%. 2 For women undergoing mastectomy, the positive effects of breast reconstruction after mastectomy are well established. 2…”