Low Rates of Post-Mastectomy Reconstruction
Despite the cosmetic and psychological benefits of breast reconstruction following mastectomy, only a minority of women undergo the procedure. In a study presented at the San Antonio Breast Cancer symposium on December 9, 2011, Dawn Hershman, MD, MS, and colleagues evaluated the association of demographic factors, number of procedures performed in the hospital, and type of insurance with post-mastectomy breast reconstruction.
Of 106,988 women with breast cancer who underwent mastectomy between 2000 and 2010, 22.6 percent had immediate reconstruction. Older women and African-American women were less likely to undergo reconstruction, as were women treated in rural and non-teaching hospitals. Although women who had reconstruction immediately post-mastectomy had longer hospital stays, their complication rates were similar to those of women who did not have reconstruction.
Co-author Jason Wright, MD, says, “We were surprised to see that although the use of immediate post-mastectomy reconstruction has increased, the rates still remain low. Just under 42 percent of women younger than 50 and fewer than 20 percent of women older than 50 had reconstruction during the period covered by the study.”
Overall, women with private insurance were more than three times as likely to have immediate reconstruction than were women who were uninsured or on Medicare or Medicaid. According to Hershman, public policy should ensure that all women have access to reconstructive surgery, regardless of ability to pay.