National Trends in Immediate and Early Delayed Postmastectomy Breast Reconstruction: An Updated Population-Based Study of 84,088 Reconstructed Patients.

backgroundThere remain ongoing concerns regarding the accessibility of breast reconstruction. We aimed to analyze recent data from the Surveillance, Epidemiology, and End Results (SEER) database to reveal trends in immediate and early delayed breast reconstruction across the United States.

methodsPatients undergoing mastectomy from 2010 to 2020 were identified using the SEER database. The trends of postmastectomy reconstruction were described. Multivariate logistic regressions were performed to identify covariates associated with reconstruction. Multiple comparisons based on logistic models were employed to assess interactions among reconstruction-related factors.

resultsA total of 84,088 patients underwent reconstruction within four months following mastectomy, accounting for 36.4% of all postmastectomy patients. Immediate and early delayed reconstruction use increased from 26.4% in 2010 to 41.8% in 2020, with increased proportion of implant-based techniques over time. The receipt of reconstruction among younger patients not only demonstrated a higher proportion, but also exhibited a more significant upward trend over the years (P for interaction < 0.001). The correlation between substantial partner support and willingness for reconstruction was stronger among older patients (P for interaction < 0.001). While patients exhibiting favorable responses to neoadjuvant therapy typically displayed heightened propensities for reconstruction, this disparity was particularly pronounced among older individuals (P for interaction < 0.001).

conclusionBreast reconstruction has increased over time, with implant-based reconstruction being the most common approach employed. The decision-making process for reconstruction is influenced by various factors, with noteworthy interactions among them. Collaboration among patients, tumor surgeons, and reconstructive surgeons is essential for reconstruction decisions. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .