Immediate Breast Reconstruction After Mastectomy for Cancer Among US Military Health System Beneficiaries

Area of Science:

• Oncology
• Surgical Oncology
• Health Services Research

Background:

• Women with breast cancer in the Military Health System (MHS) may receive care in military hospitals (direct care) or civilian settings (private sector care).
• Understanding immediate breast reconstruction rates by care setting is crucial for equitable patient outcomes.

Purpose of the Study:

• To determine and compare immediate breast reconstruction rates among women undergoing mastectomy for breast cancer within the MHS.
• To identify factors associated with receiving immediate breast reconstruction based on the care setting.

Main Methods:

• Utilized linked Department of Defense (DoD) cancer registry and claims data (1998-2014).
• Identified adult women undergoing mastectomy for breast cancer, subgrouped by direct vs. private sector care.
• Analyzed rates and types of immediate breast reconstruction using regression models.

Main Results:

• 3251 women were included; 29.9% underwent immediate breast reconstruction with an increasing trend over time.
• Implant-based reconstruction (81.4%) was more common than tissue-based (18.6%).
• Immediate breast reconstruction rates were significantly higher in the private sector (49.3%) versus direct care (20.5%), even after adjusting for clinical factors (aOR=4.51).

Conclusions:

• Immediate breast reconstruction rates lag in military direct care compared to the civilian sector.
• Disparities in reconstruction rates between care settings warrant further investigation.
• Current rates and contributing factors to differences in reconstruction rates require additional research.