Large increase seen in breast reconstruction surgeries after mastectomy, especially in older women

By Liz Meszaros, MDLinx
Published October 12, 2017

Key Takeaways

The number of women electing to have breast reconstruction surgery after a mastectomy increased by a full 65% between 2009 and 2014, with the greatest increase (140%) in those aged 65 and older, according to a new analysis by the Agency for Healthcare Research and Quality (AHRQ).

The AHRQ’s analysis was based on data from hospitals and ambulatory surgery centers in 22 states, representing 59% of the US population.

"This new statistical brief, released during Breast Cancer Awareness Month, reflects AHRQ’s ongoing commitment to collecting, analyzing, and disseminating health care data," said AHRQ Director Gopal Khanna, MBA. "This type of information is essential for policymakers and health systems seeking to keep pace with important trends in clinical care."

The majority of this increase was due to a 150% increase in reconstruction surgeries that were performed in hospital-based ambulatory surgery centers. Breast reconstructions in these setting increased from 7 per 100,000 in 2009, to 18 per 100,000 in 2014. Another contributing factor was the large increase in reconstructions performed during a separate hospital stay after mastectomy, which comprised 61% of reconstructions in 2009 and rose to 71% in 2014.

Meanwhile, there was no increase in the rates for inpatient reconstructions from 2009 to 2014, which remained steady at 7 per 100,000 women.

When taking age into account, researchers found that the largest number of reconstructions for mastectomy occurred in women aged 35 to 44 years, from 37 reconstructions per 100 mastectomies in 2009 to 55 in 100 in 2014—a 47% increase.

Women aged 65 years and older had a lower rate of reconstruction, but theirs was the fastest growth. In 2009, among these women, 7 reconstructions were performed for every 100 mastectomies. By 2014, this had increased by 140%, to 17 reconstructions per 100 mastectomies.

When socioeconomic, demographic, and racial characteristics were analyzed, researchers found some striking differences as well.

Although women in the highest quartile of community income had the most breast reconstructive surgeries relative to mastectomies, those in the lowest community income quartile demonstrated the fastest growth. In the latter, in 2009, 17 reconstructions occurred for every 100 mastectomies. By 2014, this increased by a full 74% to 30 reconstructions per 100 mastectomies.

The gap between insured and uninsured women undergoing mastectomies was narrowed by a faster increase in uninsured women compared to privately insured women (104% vs 51%, respectively). Thus, for every 100 uninsured women undergoing a mastectomy, 44 also underwent reconstructive surgery. In privately insured women, for every 100 women, 52 underwent mastectomy.

"This information suggests that many uninsured women were willing to pay for reconstruction surgery out of pocket," said Anne Elixhauser, PhD, senior scientist at AHRQ.

Finally, these researchers found that black women were more likely to undergo breast reconstruction as an inpatient procedure with simultaneous mastectomy, compared with white and Hispanic women. Finally, women in rural areas had fewer reconstructions (29 per 100 mastectomies) compared with urban-dwelling women (41 per 100).

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