March 04, 2014
Breast reconstruction rates increase following mastectomies
BY Will Fitzgerald
Women who underwent a mastectomy as part of their treatment for breast cancer are increasingly opting for reconstructive surgery, according to new research published in the Journal of Clinical Oncology.
The observational study, led by MD Anderson and The University of Michigan, evaluated insurance claims from 20,506 women from 1998-2007 and found a nearly 20 percent increase in breast reconstruction. The research also noted bilateral mastectomies (removal of both breasts) increased from 3 percent to 18 percent over the same period.
While overall rates of reconstruction increased, women who received radiation therapy were less likely to have reconstructive procedures.
"In appropriately selected patients radiation saves lives and is generally well-tolerated, however, radiation does cause a certain degree of damage to normal tissue which complicates and often delays breast reconstruction," said senior author Benjamin Smith, M.D., in Radiation Oncology.
The study also provided further insight into regional disparities that exist with regard to reconstructive procedures. Smith and colleagues found a dramatic geographic variation of reconstruction from a low of 18% in North Dakota to a high of 80% in Washington D.C.
This particular finding was largely related to the number of surgeons in the area, however, concerns exist that patients are not receiving appropriate care based on their location.
Additional findings showed that the rates of autologous reconstructive techniques (recreating breasts using tissue from other parts of the body) decreased as more women opted for implant-based reconstruction. While autologous techniques often deliver improved cosmetic appearance, they are more complex and require a longer recovery time.
The authors say reimbursement rates could be the culprit as surgeons face financial disincentives from performing longer, more demanding reconstruction. One recent study estimated surgeons were reimbursed $587 per hour for implants versus $322 for autologous reconstructive.
Ultimately, the observations provide insight to clinicians and policy-makers to help ensure equitable care is provided for women with breast cancer facing reconstructive procedures.
To learn more about the study, listen to a podcast with the authors.