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J Surg Res. 2019 Jun;238:207-217. doi: 10.1016/j.jss.2019.01.010. Epub 2019 Feb 14.

Factors Leading to Decreased Rates of Immediate Postmastectomy Reconstruction.

Author information

1
Department of Surgery and Norris Comprehensive Cancer Center, Division of Breast, Soft Tissue and Endocrine Surgery, University of Southern California (USC), Los Angeles, California.
2
Department of Surgery, School of Medicine, Catholic University of Daegu, Daegu, South Korea.
3
Department of Preventive Medicine, USC, Los Angeles, California.
4
Department of Surgery, Division of Plastic and Reconstructive Surgery, USC, Los Angeles, California.
5
Department of Preventive Medicine and Pediatrics (CHLA) and Norris Comprehensive Cancer Center, USC, Los Angeles, California.
6
Department of Radiation Oncology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California.
7
Department of Surgery and Norris Comprehensive Cancer Center, Division of Breast, Soft Tissue and Endocrine Surgery, University of Southern California (USC), Los Angeles, California. Electronic address: Julie.Lang@med.usc.edu.

Abstract

BACKGROUND:

This study was performed to determine if there was a difference in immediate breast reconstruction (IBR) rates between our public hospital and private cancer center, which share a common faculty with a consistent management philosophy in multidisciplinary care. We investigated the factors affecting postmastectomy reconstruction and IBR rates.

MATERIALS AND METHODS:

We retrospectively identified women with clinical stage I-II breast cancer who underwent mastectomy at our public hospital, Los Angeles County Medical Center, and our private cancer center, Keck Hospital of USC/Norris Comprehensive Cancer Center. Univariate and multivariate analyses were performed to study predictors of IBR and any breast reconstruction.

RESULTS:

Of 293 mastectomy patients, the rate of any breast reconstruction at the private cancer (56.6%) center was higher than that at the public hospital (36.2%). IBR rates for the private cancer center (93.6%) and for patients with private insurance were higher than for the public hospital (40.8%) and likewise for those without insurance (86.7% versus 45.5%). In a multivariate analysis, the odds of IBR at our private cancer center were 22.96 times higher than that at our public hospital. Age >50 y and radiotherapy were independent predictive factors associated with less likelihood of any breast reconstruction.

CONCLUSIONS:

Patients at the public hospital had a much lower rate of breast reconstruction than the private cancer center patients, even after controlling for stage and the team of treating physicians. Our results showed that older age and radiotherapy affect rates of breast reconstruction, as do hospital system and insurance status.

KEYWORDS:

Breast cancer; Disparities; Immediate breast reconstruction; Postmastectomy reconstruction

PMID:
30772679
DOI:
10.1016/j.jss.2019.01.010

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