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Assessing the Shift: Increasing Rates of Immediate Breast Reconstruction by Nonplastic Surgeons-Insights from a
Lee Kilmer1, Jessica Pawly1, Hibo M Wehelie2
1From the Department of Plastic Surgery, Maxillofacial and Oral Health, University of Virginia.
Plastic and Reconstructive Surgery
|March 13, 2025
Summary
General surgeons are increasingly performing breast reconstruction, including oncoplastic breast reductions and implant-based procedures. This trend is not linked to proximity to specialized cancer centers, highlighting a shift in care delivery.
Area of Science:
- Oncology
- Plastic Surgery
- Health Services Research
Background:
- Breast reconstruction is a common procedure, with significant advancements in techniques over 50 years.
- A perception exists that non-plastic surgeons are increasingly performing these procedures, but this trend lacks validation.
- Understanding the drivers behind this shift in care is crucial for patient outcomes.
Purpose of the Study:
- To investigate the trend of breast reconstruction procedures performed by general versus plastic surgeons in the United States.
- To analyze the types of reconstruction (oncoplastic reduction, implant-based, autologous tissue) and physician specialty over time.
- To determine if proximity to cancer centers or plastic surgery programs influences this trend.
Main Methods:
- A national insurance database (2010-2021) was queried for patients undergoing mastectomy and immediate reconstruction.
- Reconstructive procedures were categorized and stratified by physician specialty (General Surgery vs. Plastic Surgery).
- Demographics, annual trends, and distances to NCI Cancer Centers and plastic surgery residency programs were compared between groups.
Main Results:
- General surgeons' performance of oncoplastic breast reductions surpassed plastic surgeons by 2021 (53.3% vs. 46.7%).
- General surgeons also increased their share of implant-based breast reconstructions, exceeding plastic surgeons in 2021 (50.9% vs. 49.1%).
- No significant difference in proximity to NCI Cancer Centers or plastic surgery residency programs was observed between the groups.
Conclusions:
- General surgeons are performing a growing proportion of breast reconstruction procedures, indicating a shift from specialized plastic surgery care.
- This trend varies geographically but is not significantly associated with proximity to specialized care centers.
- Further research is needed to identify the factors driving this shift and to ensure continued patient access to specialized breast reconstruction services.
