Geographic Variation Immediate and Delayed Breast Reconstruction Utilization in Ontario, Canada and Plastic Surgeon Availability: A Population‐Based Observational Study

Platt, Jennica; Zhong, Toni; Moineddin, Rahim; Booth, Gillian L.; Easson, Alexandra; Fernandes, Kimberly A.; Gozdyra, Peter; Baxter, Nancy N.

doi:10.1007/s00268-015-3060-2

Cited by 34 publications

(28 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Higher rates of reconstruction may also simply reflect a greater availability of reconstructive plastic surgeons at academic centers as well. Platt et al found that there was a strong correlation between rates of breast reconstruction and the presence of a plastic surgeon in the hospital where mastectomy was done …”

Section: Discussionmentioning

confidence: 99%

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

et al. 2020

View full text Add to dashboard Cite

In the last decade, there has been an increase in women undergoing immediate breast reconstruction (IBR) at the time of mastectomy. Recent literature suggests a shift in practice: Surgeons are becoming more comfortable with IBR in the setting of possible postoperative adjuvant radiotherapy, despite the known complications. This study sought to investigate, at a population level, the patient and surgeon characteristics associated with the use of IBR and which of these factors were predictive of adjuvant radiotherapy. This retrospective population‐based cohort study included all adult women who underwent mastectomy in the province of Ontario from 2007 to 2014. The Canadian Institute for Health Information (CIHI) administrative data base was used to generate patient demographic and clinical data. The Ontario Health Insurance Plan (OHIP) data base was used to elicit surgeon characteristics including clinical experience and volume of practice dedicated to breast surgery. Outcome variables included reconstruction concurrent with mastectomy, alloplastic vs autologous reconstruction, and use of radiation. A total of 25 861 patients underwent mastectomy and 2972 had IBR (11.5%). The rate of IBR after mastectomy increased over time from 7.2% in 2007 to 17.2% in 2014 (P < .001). There was also an increase in the proportion of patients with IBR who received radiation over the time period, from 19.4% in 2007 to 28.2% in 2014 (P = .003). In the first regression analysis, IBR was associated with younger patient age, residing in closer proximity to cancer clinics, absence of malignant breast disease (ie, prophylactic mastectomy), having a younger surgeon performing the mastectomy, and receiving care at a teaching hospital. A second analysis showed that patient variables predictive of radiation after IBR were a younger age and a more advanced cancer stage and no variables specific to surgeon or institution were predictive of radiation in patients with IBR. A significant increase in the rate of IBR as well as the use of radiation occurred over the 7‐year study period. Multiple patient and surgeon factors were associated with IBR. Variables associated with radiation in IBR were harder to predict. Given the increase in the use of radiation in IBR, further research is needed to look at long‐term outcomes in these patients at the population level.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…4,5 In Canada, the uptake of IBR is considerably lower, with only 16% of women having IBR. 6,7 For women who do not have IBR, delayed BR is an option anytime after mastectomy. Postmastectomy BR can include either implant reconstruction or autologous tissue reconstruction.…”

mentioning

confidence: 99%

Survival Differences in Women with and without Autologous Breast Reconstruction after Mastectomy for Breast Cancer

Semple

Metcalfe

Shoukat

et al. 2017

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

Background:Breast reconstruction (BR) is an option for women who are treated with mastectomy; however, there has been concern regarding the oncologic safety of BR. In this study, we evaluated recurrences and mortality in women treated with mastectomy and compared outcomes in those treated with mastectomy alone to those with mastectomy plus transverse rectus adbominis (TRAM) flap BR.Methods:The prospective cohort study included women treated with mastectomy at Women’s College Hospital from 1987 to 1997. Women with TRAM flap BR were matched to controls based on age and year of diagnosis, stage, and nodal status. Patients were followed from the date of diagnosis until death or date of last follow-up. Hazard ratios were generated to compare cases and controls for outcome variables using Cox’s proportional hazards models.Results:Of 443 women with invasive breast cancer, 85 subjects had TRAM flap BR. Sixty-five of these women were matched to 115 controls. The mean follow-up was 11.2 (0.4–26.3) years. There were no significant differences between those with and without BR with weight, height, or smoking status. Women with TRAM flap were less likely to experience a distant recurrence compared to women without a TRAM flap (relative risk, 0.42; P = 0.0009) and were more likely to be alive (relative risk, 0.54; P = 0.03).Conclusions:Women who elect for TRAM flap BR after an invasive breast cancer diagnosis do have lower rates of recurrences and mortality than women treated with mastectomy alone. This cannot be explained by differences in various clinical or lifestyle factors.

show abstract

“…This examination at the surgeon level provides evidence that the medico-social context of the patient's treatment environment, or health system, influences the decision to undergo mastectomy with CPM. These results also lead one to consider if the stable CPM rates in Canada are actually lower overall than in the United States due to these possible practice or health system differences, or if the trends in Canada will eventually mimic those of the United States over time given the surgeons' anecdotal observations, as a similar "lag" was observed regarding IBR trends in Canada [16,17] . Within our single institution study, we were able to evaluate CPM trends among a large sample of patients undergoing mastectomy for unilateral breast carcinoma at a high-volume academic breast center.…”

Section: Discussionmentioning

confidence: 99%

“…Differences between the surgeons' practices were noted mainly by the availability of immediate breast reconstruction -a product of the health system. The majority of United States surgeons had ready access to immediate breast reconstruction whereas this was less commonly available to Canadian breast surgeons [15][16][17] . Barriers to access immediate breast reconstruction may contribute to more women in Canada seeking out a delayed CPM with bilateral reconstruction years after their initial unilateral therapeutic mastectomy.…”

Section: Discussionmentioning

confidence: 99%

Contralateral prophylactic mastectomy rate stable at major Canadian breast cancer center

Roberts

Sandhu

Cil

et al. 2016

WJCO

Self Cite

View full text Add to dashboard Cite

AIM:To examine trends of contralateral prophylactic mastectomy (CPM) rates at a Canadian academic breast cancer center. METHODS:A single-institution retrospective cohort study was completed. Women of any age who underwent at least a unilateral mastectomy (UM) for primary unilateral breast carcinoma between January 1, 2004 and December 31, 2010 were included. Patients who underwent CPM on the same day as UM were isolated to create two distinct cohorts. Patient and procedure characteristics were compared across groups using R software (version 3.1.0). The percentage of CPMs per year was determined. The Cochrane-Armitage test was used to assess the trend of CPMs over time. A P value of < 0.05 was considered significant. RESULTS:A total of 811 women met the inclusions/ exclusion criteria; 759 (93.6%) underwent UM alone and 52 (6.4%) underwent UM with immediate CPM. The absolute number of procedures (UM and UM + CPM) increased over time, from 83 in 2004 to 147 in 2010 reflecting an increase in mastectomy volume. Annual CPM rates did not increase over time (P = 0.7) and varied between 2.6% to 10.7%.

show abstract

Geographic Variation Immediate and Delayed Breast Reconstruction Utilization in Ontario, Canada and Plastic Surgeon Availability: A Population‐Based Observational Study

Abstract: Geographic access to a plastic surgeon is a major determinant of BR. Targeted interventions for regions without high access to plastic surgeons may improve overall rates and reduce geographic disparities in care, particularly for IBR.

Cited by 34 publications

References 34 publications

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

Trends in immediate breast reconstruction and radiation after mastectomy: A population study

Survival Differences in Women with and without Autologous Breast Reconstruction after Mastectomy for Breast Cancer

Contralateral prophylactic mastectomy rate stable at major Canadian breast cancer center

Contact Info

Product

Resources

About