More women are choosing reconstructive breast surgery after mastectomy; however, there is a large variation in the rate of reconstructive surgery throughout different areas of the United States, according to the results of a study published early online in the Journal of Clinical Oncology.
For some women, treatment of breast cancer involves a single or double mastectomy (removal of one or both breasts). In order to restore the appearance of a breast, women may choose to undergo breast reconstruction after their mastectomy. Research suggests that immediate breast reconstruction can improve psychological wellbeing.
Breast reconstruction surgery has become increasingly refined and can be successfully accomplished in almost all women treated with mastectomy. The goal of breast reconstruction surgery is to create a breast that matches the opposite breast. This can be accomplished by using a breast implant alone, by actually reconstructing the breast with the patient’s own tissue, or by utilizing a combination of these two techniques.
Breast reconstruction can provide important psychosocial benefits, but there are concerns about women’s access to the procedure. The Women’s Health and Cancer Rights Act of 1998 requires health insurers who offer mastectomy coverage to also provide for all stages of breast reconstruction. Since the law was passed, there has been little data regarding the rates of breast reconstruction.
To examine the rates of reconstruction, researchers analyzed data from 20,560 women who underwent mastectomy for breast cancer from 1998 to 2007. The average age of the patients was 51. The rate of reconstructive breast surgery increased from 46 percent in 1998 to 63 percent in 2007. There was an increased use of implants and decreased use of autologous techniques over time.
The number of double mastectomies—which high-risk women sometimes choose as a preventive measure—increased from 3 percent to 18 percent during the same period. Patients who underwent double mastectomy were more likely to undergo reconstruction—three-quarters of these patients opted for reconstruction. Patients receiving radiation therapy were less likely to undergo reconstruction.
Reconstruction rates varied dramatically by geographic region and appeared to be influenced by plastic surgeon density and county-level income. For example, only 18 percent of breast cancer patients opted for reconstructive surgery in North Dakota, compared to 80 percent of women in Washington, D.C. The researchers noted that this variation in rates could reflect healthcare disparities—some women may not have access or are not being referred to reconstructive surgeons. What’s more, it’s possible that reimbursement for the procedure has declined over the years.
The researchers concluded that the use of breast reconstruction has increased over time, but it has wide geographic variability. More research may be necessary to ensure equitable access to this important part of breast cancer treatment—as reconstruction is important to the physical, mental and social wellbeing of patients.
Jagsi R, Jiang J, Momoh AO, et al: Trends and variation in use of breast reconstruction in patients with breast cancer undergoing mastectomy in the United States. Journal of Clinical Oncology. Published early online February 18, 2014.
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