National And Regional Trends In Autologous Breast Reconstruction
Parisa Kamali, MD1, Marek A. Paul, MD1, Pieter G.L. Koolen, MD2, Ahmed M.S. Ibrahim, MD, PhD3, Winona Wu, BSc1, Marc L. Schermerhorn, MD4, Bernard T. Lee, MD, MBA1, Samuel J. Lin, MD, MBA1.
1Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Division of Plastic Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, Netherlands, 3Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA, 4Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
The incidence of breast cancer(BC) cases has increased significantly over the last decades. Hence, breast reconstructive procedures follow this trend constituted both by autologous and implant based reconstructions. The aim of this study was to assess national and regional trends in different types of autologous breast reconstruction(ABR).
Using the Nationwide Inpatient database(2008 to 2012), data on BC and mastectomy rates, type of ABR and sociodemographics were obtained and analyzed. Furthermore, national and regional trends over time for ABR were plotted and analyzed.
A total of 427,272 patients were diagnosed with BC, of which 343,165 underwent mastectomy and 152,256 received BR of which 16.4% had ABR. Overall, ABR demonstrated a significant increase over time (6.4% to 17.6% between 2008 and 2012, p<0.001), but when stratified per region, this positive trend was only seen in the Midwest and the Southern region. Most ABR over time was performed in the Southern region (37.4%). Subgroup analysis demonstrated a significant increasing trend for both LD and DIEP flap, both nationally and regionally (Figure 1). Interestingly, most pTRAM, fTRAM, SIEA and GAP flaps were performed in the Northeast region, while most DIEP and LD flaps were performed in the Southern region.
Overall, autologous breast reconstruction showed a significantly positive trend over time but when stratified into region, this was only seen in the Midwest and the Southern region.
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