Research has shown that immediate breast reconstruction after mastectomy improves psychological well-being and quality of life and provides women with improved body image and self-esteem compared with delaying the procedure. However, a recent study by Dawn Hershman, MD, MS, assistant professor of medicine and epidemiology at Columbia University Medical Center (CUMC), New York, New York, and co-director of CUMC’s Breast Cancer Program at the Herbert Irving Comprehensive Cancer Center (HICCC), indicates that only about one-third of women undergo breast reconstruction after mastectomy.
The data was presented at the 2011 CTRC-AACR (Cancer Therapy & Research Center and the American Association for Cancer Research) San Antonio Breast Cancer Symposium, Texas, held December 6–10.
Hershman and colleagues identified 106,988 women with breast cancer who underwent mastectomy between 2000 and 2010. They identified these women using insurance codes and then examined data on the frequency of reconstruction by a number of factors including age, race, number of procedures performed in the hospital, and type of insurance.
Of the women examined, 22.6 percent underwent immediate reconstruction. Although overall rates of reconstruction have increased since 2000, the greatest increases were seen among women with commercial insurance—from 25.3 percent to 54.6 percent, and among women aged younger than 50 years—from 29 percent to 60 percent. Among women aged 50 years or younger who also had commercial insurance, 67.5 percent underwent immediate breast reconstruction. Overall, women with commercial insurance had more than a threefold higher likelihood of undergoing immediate reconstruction compared with women without health insurance.
Researchers found that patients were more likely to undergo immediate reconstruction if their surgeon did more mastectomies or they were in a hospital where more mastectomies were performed.Other factors associated with a decreased likelihood for undergoing post-mastectomy reconstruction were increasing age, black race, rural hospital location, nonteaching hospital, or having other medical illnesses.
Women who underwent immediate breast reconstruction post-mastectomy did have a longer hospital stay, but in-hospital complication rates were similar between women who had reconstruction and those who did not.