National Trends in "Going Flat" After Mastectomy

Area of Science:

• Oncology
• Surgical Oncology
• Public Health

Background:

• The
• Going Flat" movement, gaining prominence in 2016, supports women choosing to forgo post-mastectomy breast reconstruction (PMBR).
• Understanding the impact of this movement on patient decisions is crucial for breast cancer care.

Purpose of the Study:

• To evaluate temporal trends in PMBR rates following the rise of the
• Going Flat" movement.
• To identify demographic and clinical factors associated with the decision to go flat after mastectomy.

Main Methods:

• Retrospective cohort analysis of 650,983 women with non-metastatic breast cancer undergoing mastectomy (2004-2019) using the National Cancer Data Base (NCDB).
• Examination of trends in going flat, stratified by age.
• Multivariate logistic regression to determine factors associated with choosing to go flat.

Main Results:

• From 2004-2015, rates of going flat decreased among women under 70, then stabilized post-2015, coinciding with the
• Going Flat" movement.
• Factors associated with a higher likelihood of going flat included non-White race, older age, increased comorbidities, government insurance, treatment at community programs, radiotherapy, and chemotherapy.
• Overall, 62.5% of patients went flat, while 37.5% underwent PMBR.

Conclusions:

• The stabilization of going flat rates in women under 70 after 2015 suggests a potential impact of the
• Going Flat" movement.
• This stabilization marks a significant shift after over a decade of declining rates.
• The findings highlight the growing social and cultural influence on reconstructive surgery decisions post-mastectomy.