Evaluating Breast Reconstruction Equity Using the Social Vulnerability Index: A Single-Institution Cohort Study

Socioeconomic disparities continue to influence access to and outcomes of postmastectomy breast reconstruction. The Social Vulnerability Index (SVI), a validated public health metric incorporating 16 socioeconomic and demographic factors, offers a standardized framework to assess community-level vulnerability. This study evaluated the association between SVI and breast reconstruction timing and outcomes at a single academic institution.

A retrospective cohort study was conducted of patients undergoing breast reconstruction following mastectomy for breast cancer between January 2021 and December 2024 by a single surgeon. Residential addresses were geocoded and linked to the 2020 CDC SVI census tract-level data. Patients were stratified into quartiles of vulnerability. The primary outcome was time from breast cancer diagnosis to earliest treatment. Kaplan-Meier and Cox proportional-hazards models were used for time-to-treatment analyses, adjusted for race, tumor stage, and grade.

Among 264 patients, higher SVI quartiles were associated with greater racial diversity, increased Medicaid/Medicare coverage, and fewer prior reconstructions. Median age and comorbidities were similar across quartiles. Time to earliest treatment did not differ significantly between quartiles. SVI was not independently associated with treatment delay; however, Black patients and those categorized as "Other" experienced significant delays compared to White patients. Tumor stage strongly predicted earlier treatment initiation.

While SVI correlated with demographic differences, it was not associated with treatment delays or worse perioperative outcomes in this cohort. These findings suggest that equitable institutional practices and national policy initiatives may mitigate structural disparities in reconstructive access, though racial inequities persist and warrant continued attention.