Patterns of care for immediate and early delayed breast reconstruction following mastectomy

The purpose of this study was to analyze factors associated with immediate or early (up to 4 months) postmastectomy reconstruction and to update and extend knowledge of patterns of care for reconstruction, using data from a large, population-based surveillance program.

Procedures included analysis of data for 27,703 women diagnosed with breast carcinoma who underwent mastectomy in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program between 1998 and 2000. Descriptive, univariate, and multivariate logistic regression analyses were used to estimate the odds of selecting immediate or early reconstruction while simultaneously considering independent variables.

Results of multivariate analyses showed that, for those women who underwent reconstruction, the proportion of black women was approximately one-third less than that of white women (odds ratio, 0.64; 95 percent CI, 0.55 to 0.74). Women who chose reconstruction were between two and four times more likely [odds ratio range, 2.27 (95 percent CI, 2.04 to 2.52) to 3.56 (95 percent CI, 2.53 to 4.58)] to be younger compared with those women aged 65 years and older, and were nearly 75 percent more likely to be diagnosed at the in situ stage compared with those diagnosed at later stages. Women choosing reconstruction were significantly less likely to live in Iowa and Seattle/Puget Sound and more likely to live in Detroit and Atlanta compared with women in San Francisco/Oakland, Connecticut, Hawaii, New Mexico, and Utah, and were significantly less likely to have never married or be widowed compared with married women. Women undergoing reconstruction were more than twice as likely to have had mastectomy with removal of the uninvolved contralateral breast.

Results of this study updated previous research and showed that immediate or early reconstruction is used by a small but increasing proportion of women diagnosed with breast carcinoma who undergo mastectomy. Previous knowledge was extended by showing that use of reconstruction is most strongly associated with patient age and removal of the uninvolved contralateral breast and, to a lesser magnitude (but still significantly), with race, stage, marital status, and geographic location.