Barriers to Post-Mastectomy Breast Reconstruction: A Comprehensive Retrospective Study

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Breast reconstruction after mastectomy significantly enhances quality of life and psychosocial well-being.
• Despite federal mandates, breast reconstruction rates remain suboptimal, with documented disparities among minority races, low socioeconomic status (SES) individuals, and those with public health insurance.
• Numerous barriers to breast reconstruction access are not fully understood or have not been adequately studied.

Purpose of the Study:

• To investigate the barriers to post-mastectomy breast reconstruction.
• To identify factors influencing the disparities in breast reconstruction rates.
• To inform strategies for promoting equitable access to breast reconstruction care.

Main Methods:

• Retrospective observational study utilizing the California Cancer Registry (SEER) and California Health and Human Services Agency Cancer Surgeries databases (2000-2021).
• Analysis included mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates.
• Data on patient demographics (age, race, insurance, SES) and treatment setting (hospital type, urban/rural) were analyzed using Pearson's chi-square test.

Main Results:

• Only 17.64% of mastectomy patients underwent reconstruction (IBR or DBR).
• Private insurance, higher socioeconomic status, cancer center care, and urban residency were associated with significantly higher reconstruction rates.
• Barriers identified include public insurance, rural residence, older age, low SES, and non-white race/ethnicity.

Conclusions:

• Breast reconstruction rates following mastectomy are low, with significant disparities linked to insurance, SES, and geographic location.
• Addressing financial and access barriers is crucial for improving equitable breast reconstruction rates.
• Further research and policy interventions are needed to overcome identified obstacles and ensure all eligible patients can access breast reconstruction.