Determinants of receiving immediate breast reconstruction: An analysis of patient characteristics at a tertiary care center in the US.
BACKGROUND
Breast reconstruction is an option for women undergoing mastectomy for breast cancer. Previous studies have reported underutilization of reconstructive surgery. This study aims to examine the role demographic, clinical and socio-economic factors may have on patients' decisions to undergo breast reconstruction.


METHODS
We analyzed data from our institutional database. Using multivariable and multinomial logistic regression, we compared breast cancer patients who had undergone mastectomy-only to those who had immediate breast reconstruction (overall and by type of reconstruction).


RESULTS
We analyzed data on 1459 women who underwent mastectomy during the period 2003-2015. Of these, 475 (32.6%) underwent mastectomy-only and 984 (67.4%) also underwent immediate breast reconstruction. After adjusting for potential confounders, older age (OR = 0.18, 95%CI:0.08-0.40), Asian race (OR = 0.29, 95%CI:0.19-0.45), bilateral mastectomy (OR = 0.71, 95%CI:0.56-0.90), and higher stage of disease (OR = 0.44, 95%CI:0.26-0.74) were independent risk factors for not receiving immediate breast reconstruction. Furthermore, patients with Medicare or Medicaid insurance were less likely than patients with private insurance to receive an autologous reconstruction. There was no evidence for changes over time in the way socio-demographic and clinical factors were related to receiving immediate breast reconstruction after mastectomy.


CONCLUSIONS
Clinical characteristics, sociodemographic factors like age, race and insurance coverage affect the decision for reconstructive surgery following mastectomy.
['Siotos|Charalampos|C|', 'Lagiou|Pagona|P|', 'Cheah|Michael A|MA|', 'Bello|Ricardo J|RJ|', 'Orfanos|Phillipos|P|', 'Payne|Rachael M|RM|', 'Broderick|Kristen P|KP|', 'Aliu|Oluseyi|O|', 'Habibi|Mehran|M|', 'Cooney|Carisa M|CM|', 'Naska|Androniki|A|', 'Rosson|Gedge D|GD|']
D000328:Adult D000368:Aged D001943:Breast Neoplasms D005260:Female D005500:Follow-Up Studies D006801:Humans D019458:Insurance Coverage D016462:Mammaplasty D008408:Mastectomy D008875:Middle Aged D011379:Prognosis D012959:Socioeconomic Factors D062606:Tertiary Care Centers D014481:United States
Breast reconstruction Mastectomy Breast cancer