Understanding Disparities in Breast Reconstruction Rates in Regional Populations Following Oncologic Resection of Breast Cancer: A 10-Year Retrospective Observational Cohort Study.

Introduction: Breast cancer is the most common cancer among women globally, with 2.3 million new cases in 2020. Globally, incidence rates of breast cancer are highest in Australia, yet only 29% of Australian women opt for breast reconstruction (BR). The decision-making process for BR is complex, involving various surgical and nonsurgical considerations. Approximately 50% of women would choose BR if adequately informed and given the option. This study evaluates the factors contributing to reduced BR rates in regional and rural New South Wales over a 10-year period. Methods: A multicentre, retrospective observational cohort study analysed 2052 women who were diagnosed with breast cancer in the Illawarra Shoalhaven Local Health District between 2012 and 2022, focussing on primary resection outcomes and other objective factors that contributed to BR rates. Descriptive statistics, chi-squared tests and logistic regression were used to assess relationships between age, comorbidities, language and rurality, with reconstruction rates. Results: Among the 2052 women diagnosed with breast cancer who required oncologic resection, the mean age was 65 years. Only 127 (6.2%) underwent BR across the total cohort of 2052 patients, and just 65 of the 724 (9%) patients in the post-mastectomy subgroup underwent BR, significantly lower than state averages. Significant relationships were found between age and reconstruction rates ( Conclusion: Women aged < 55 years old and those residing in metropolitan areas showed a higher likelihood of opting for BR, highlighting the influence of age and rural residency on access to reconstruction services. These findings emphasise the need for targeted interventions to enhance BR access, particularly for older and rural patients.