Trends in Breast Reconstruction After Mastectomy

February 25, 2014

Trends in Breast Reconstruction After Mastectomy

  1. Henry Mark Kuerer, MD, PhD, FACS

A significant rise in reconstructions was driven largely by increased use of implant-based techniques.

  1. Henry Mark Kuerer, MD, PhD, FACS

The quality-of-life and psychosocial benefits of breast reconstruction following mastectomy are well known. But recent trends data regarding the use of the procedure are lacking.

Investigators have now analyzed an employment-based, medical-claims database to evaluate breast reconstruction in 20,560 women undergoing mastectomy for breast cancer in the U.S. from 1998 to 2007. Results were as follows:

  • Overall, 56% of patients received breast reconstruction during the 10-year period; usage rose significantly from 46% to 63% (P<0.001) and was driven mostly by increased use of implant-based techniques.

  • The proportion of patients who received reconstruction with autologous tissue decreased from 56% to 25% (P<0.001).

  • Approximately 20% of reconstructions were performed after, rather than concurrently with, mastectomy.

  • Use of bilateral mastectomy increased from 3% to 18% (P<0.001); 75% of patients undergoing bilateral mastectomy received reconstruction.

  • The rate of reconstruction was lower in patients who received radiation therapy than in those who did not (41% vs. 62%; P<0.001).

  • Rates of reconstruction varied widely by geographic region, ranging from 18% in North Dakota to 80% in Washington, D.C.


It is not surprising that breast-reconstruction rates increased among employed women given that the safety of the approach and the more aesthetically pleasing techniques of skin-sparing mastectomy grew and flourished during this same period. The data highlight the clinicians' subjective impression regarding increasing requests for bilateral mastectomy with immediate reconstruction. A marked and substantial decline was noted in the use of autologous-based reconstruction in favor of implant-based reconstruction. Why this is occurring may be multifactorial and possibly related to patients' desires for less involved surgery with shorter recovery times or to financial disincentives associated with reimbursements to plastic surgeons for more complex, labor-intensive procedures. Geographical disparities in breast reconstruction are clear opportunities for improvements.

Editor Disclosures at Time of Publication

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Consultant / Advisory board Bayer Pharma AG Speaker's bureau AstraZeneca Grant / research support Susan G. Komen Foundation Leadership positions in professional societies Alliance for Clinical Trials in Oncology (Chair, Education Committee)


Reader Comments (2)

Dott. Francesco D'Errico Physician, Surgery, Specialized, Monza- Italy


Sita Kaura MD Physician, Emergency Medicine, Urgent care clinic

I would like to have these summaries in my email

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