Plastic surgery market share of breast reconstructive procedures: An analysis of two nationwide databases

Abstract

Background and ObjectivesGiven advances that streamline breast reconstruction (e.g., prepectoral placement, acellular dermal matrix [ADM], oncoplastic surgery), there is concern that nonplastic surgeons are performing a growing proportion of breast reconstructive procedures. The purpose of this study was to evaluate US trends in the market share of breast reconstruction performed by plastic compared to general surgeons.MethodsIBM® MarketScan® Commercial Claims 2006–2017 and NSQIP 2005–2020 were queried to identify women who underwent mastectomy with alloplastic (tissue expander or implant‐based) or free flap reconstruction, or lumpectomy with oncoplastic reconstruction (breast reduction, mastopexy, or local/regional flap). MarketScan included immediate and delayed reconstructions, while all NSQIP reconstructions were immediate. Poisson regression with incident rate ratios (IRRs) modeled trends in surgeon type over time.ResultsThe cohort included 65 168 encounters from MarketScan and 73 351 from NSQIP. Plastic surgeons performed 95.8% of free flap, 93.8% of alloplastic, and 64.9% of oncoplastic reconstructions. Plastic surgeons performed an increasing proportion of immediate oncoplastic reduction and mastopexy (MarketScan IRR: 1.077, 95% confidence interval [CI]: 1.060–1.094, p < 0.001; NSQIP IRR: 1.041, 95% CI: 1.030–1.052, p < 0.001). There were no clinically significant trends for delayed oncoplastic, alloplastic, or free flap reconstructions. Plastic surgeons were more likely to use ADM compared to general surgeons in NSQIP (p < 0.001).ConclusionsPlastic surgeons gained market share in immediate oncoplastic breast reduction and mastopexy over the past two decades without any loss in alloplastic or free flap breast reconstruction. Plastic surgeons should continue collaboration with breast surgical oncologists to reinforce the shared surgeon model for management of breast cancer.

Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps

“…Despite the proposed benefits of flap-based breast reconstructions, between 63.2% and 92.5% of postmastectomy breast reconstructions conducted in the United States are nonautologous. 12,13 Abdominally based breast reconstructions require microsurgical expertise and may not be as easily accessible in certain geographic regions. Because of the complexity of the operation and the involvement of two surgical sites, the length of the operation and recovery time is longer for flap-based reconstructions compared with implant-based reconstructions.…”