Breast Reconstruction Practices in North America: Current Trends and Future Priorities

The Women's Health and Cancer Rights Act (WHCRA) became federal law on January 1, 1999, mandating health care payer coverage for postmastectomy breast reconstruction. Despite passage of this legislation, breast reconstruction rates in the United States remain low. The Surveillance, Epidemiology and End Results (SEER) database for mastectomy patients in 11 regions across the United States show overall rates for immediate and early delayed reconstruction (performed within 4 months of mastectomy) of 15.4% for 1998 and 18.0% for 2000. Reconstruction rates vary significantly by region as well as by patient age, race, and income. The paper examines potential etiologies for low utilization of breast reconstruction and outlines possible remedies.

KEYWORDS

Breast reconstruction - breast implant - TRAM - SEER

REFERENCES

• 1 Dean C, Chetty U, Forrest A P. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy.  Lancet. 1983;  320 459-462
• 2 Schain W S. Breast reconstruction: update of psychosocial and pragmatic concerns.  Cancer. 1991;  68 1170-1175
• 3 Cederna P S, Yates W R, Chang P, Cram A E, Ricciardelli E J. Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous versus breast implant reconstruction.  Ann Plast Surg. 1995;  35 458-468
• 4 SEER Web site . About SEER.  , Available at http://seer.cancer.gov/AboutSEER.html
• 5 Polednak A P. Geographic variation in postmastectomy breast reconstruction rates.  Plast Reconstr Surg. 2000;  106 298-301
• 6 Alderman A K, Mcmahon L, Wilkins E G. The national utilization of immediate and early delayed breast reconstruction and the effect of sociodemographic factors.  Plast Reconstr Surg. 2003;  111 695-703
• 7 Polednak A P. How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases.  Plast Reconstr Surg. 2001;  108 73-77
• 8 2002 Plastic Surgery Statistics. Arlington Heights, IL; American Society of Plastic and Reconstructive Surgeons 2003
• 9 Finlayson C A, MacDermott T A, Arya J. Can specific preoperative counseling increase the likelihood a woman will choose postmastectomy breast reconstruction?.  Am J Surg. 2001;  182 649-653
• 10 American Society of Plastic Surgeons . , Web site at www.plasticsurgery.org
• 11 Amey C H, Miller M K, Albrecht S L. The role of race and residence in determining stage at diagnosis of breast cancer.  J Rural Health. 1997;  13 99-108
• 12 Mitchell J B, Khandker R K. Black-white treatment differences in acute myocardial infarction.  Health Care Financ Rev. 1995;  17 61-70
• 13 Hargraves J L, Cunningham P J, Hughes R G. Racial and ethnic differences in access to medical care in managed care plans.  Health Serv Res. 2001;  36 853-868
• 14 Blendon R J, Aiken L H, Freeman H E, Corey C R. Access to medical care for black and white Americans. A matter of continuing concern.  JAMA. 1998;  261 278-281
• 15 Marmot M G, Shipley M J, Rose G. Inequalities in death-specific explanations of a general pattern?.  Lancet. 1984;  1 1003-1006
• 16 Nattinger A B, Hoffmann R G, Shapiro R et al.. The effect of legislative requirements on the use of breast-conserving surgery.  N Engl J Med. 1996;  335 1035-1040
• 17 Tereskerz P M, Pearson R D, Jagger J. Infected physicians and invasive procedures: national policy and legal reality.  Milbank Q. 1999;  77 511-529
• 18 Chassin M R, Brook R H, Park R E et al.. Variations in the use of medical and surgical services by the Medicare population.  N Engl J Med. 1986;  314 285-290
• 19 Birkmeyer J D, Sharp S M, Finlayson S RG et al.. Variation profiles of common surgical procedures.  Surgery. 1998;  124 917-923
• 20 Carlisle D M, Valdez R B, Shapiro M F, Brook R H. Geographic variation in rates of selected surgical procedures with Los Angeles County.  Health Serv Res. 1995;  30 27-42
• 21 Chassin M R. Explaining geographic variations. The enthusiasm hypothesis.  Med Care. 1993;  31(Suppl) YS37-YS44
• 22 Leape L L, Solomon D H, Chassin M R et al.. Relation between surgeons' practice volumes and geographic variation in the rate of carotid endarterectomy.  N Engl J Med. 1989;  321 653-657