Adapting Perspectives: Analyzing Dynamic Shifts in Breast Surgical Trends and Reconstructive Choices over 16 Years

Over the past 16 years, novel approaches to breast cancer surgical care have emerged. This study aimed to provide a contemporary surgical trend analysis for patients with breast cancer and reports trends across all aspects of breast reconstruction, including oncoplastic surgery (OPS).

A retrospective cohort analysis was conducted using American College of Surgeons National Surgical Quality Improvement Program data from 2008 to 2023. Patients were categorized into surgical groups for partial mastectomy, mastectomy without reconstruction, mastectomy with autologous reconstruction (M+AR), mastectomy with implant reconstruction (M+IR), and OPS. A subgroup analysis was conducted to elaborate further within each reconstructive surgical group.

The primary cohort consisted of 360,731 patients; of those, 119,096 had reconstructive surgery. Annual surgical trends increased for partial mastectomy by 129% and OPS by 408%, and decreased for the mastectomy without reconstruction group by 38% and M+AR by 20% (all P < 0.01). M+IR had no significant trend shift ( P = 0.30). In the reconstructive subgroup analysis, most mastectomy procedures decreased (M+IR by 11%, mastectomy with latissimus dorsi flap by 65%, and mastectomy with transverse rectus abdominis myocutaneous flap by 95%), but mastectomy with free flap increased by 212%. The OPS groups had the most significant increase across all subcategories: level 1 OPS by 587%, level 2 OPS by 194%, and OPS volume replacement by 151% (all P < 0.01).

This study provides a comprehensive analysis of demographic profiles and surgical trends across common breast interventions and reconstructive surgical procedures. These findings suggest that the shift toward OPS and advanced reconstructive techniques is becoming more prevalent and mastectomy without reconstruction is decreasing.