Are There Disparities in Breast Reconstruction After Contralateral Prophylactic Mastectomy?

Courtney M Lattimore; Max O Meneveau; Raj Desai; T Fabian Camacho; Gabriella C Squeo; Shayna L Showalter

doi:10.1016/j.jss.2024.03.010

Are There Disparities in Breast Reconstruction After Contralateral Prophylactic Mastectomy?

J Surg Res. 2024 Apr 17:298:277-290. doi: 10.1016/j.jss.2024.03.010. Online ahead of print.

Authors

Courtney M Lattimore¹, Max O Meneveau¹, Raj Desai², T Fabian Camacho², Gabriella C Squeo³, Shayna L Showalter⁴

Affiliations

¹ Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
² Division of Translational Research & Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia.
³ Department of Plastic and Maxillofacial Surgery, University of Virginia Health System, Charlottesville, Virginia.
⁴ Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Electronic address: snl2t@uvahealth.org.

PMID: 38636184
DOI: 10.1016/j.jss.2024.03.010

Abstract

Introduction: Despite national guidelines against contralateral prophylactic mastectomy (CPM) in low- to moderate-risk breast cancer, CPM use continues to rise. Breast reconstruction improves health-related quality of life and satisfaction among women undergoing mastectomy. Given the lack of data regarding factors associated with reconstruction after CPM and the known benefits of reconstruction, we sought to investigate whether disparities exist in receipt of reconstruction after CPM.

Methods: The 2004-2017 National Cancer Database was queried to identify women diagnosed with breast cancer who underwent unilateral mastectomy with CPM. Patients were divided into two groups: those who underwent planned reconstruction at any timepoint and those who did not. A secondary analysis comparing types of reconstruction (tissue, implant, combined) was conducted. Patient, tumor, and demographic characteristics were analyzed using chi-square test and odds ratios were calculated using generalized estimating equations.

Results: The cohort included 1,73,249 women: 95,818 (55.3%) underwent reconstruction and 77,431 (45.7%) did not. Both the rate CPM and the proportion of women undergoing reconstruction after CPM increased between 2004 and 2017. Of the women who had reconstruction, 40,840 (51.7%) received implants, 29,807 (37.7%) had tissue, and 8352 (10.6%) had combined reconstruction. After adjusted analysis, factors associated with reconstruction were young age, Hispanic ethnicity, private insurance, and living in an area with the highest education and median income (P < 0.01). Patients who underwent reconstruction were less likely to have radiation (P < 0.01) and chemotherapy (P < 0.01), more likely to have stage I disease (P < 0.01), and to be treated at an integrated cancer center (P < 0.01).

Conclusions: Reconstruction after CPM is disproportionately received by younger women, Hispanics, those with private insurance, and higher socioeconomic status and education. While the rate of reconstruction after CPM is increasing, there remain significant disparities. Conscious efforts must be made to eliminate these disparities, especially given the known benefits of reconstruction after mastectomy.

Keywords: Breast; Cancer; Contralateral; Mastectomy; Prophylactic; Reconstruction.