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Defining Disparities in Breast Reconstruction at an Academic Medical Center
Suma Yalamanchili MD, Doug Dembinkski MD, Michael Ortman BS, Roman Jandarov PHD, Joseph Easton, MD, Ryan Gobble MD
University
2019-02-13
Presenter: Suma Yalamanchili, MD
Affidavit:
This represents original work by the resident
Director Name: Ann Schwentker, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: Identify the rate of breast reconstruction after mastectomy for patients undergoing unilateral or bilateral mastectomies for a diagnosis of breast cancer/history of positive genetic testing at the University of Cincinnati Medical Center over the last five years.
Background: Despite the benefits of breast reconstruction, rates of reconstruction remain low. We are the only academic medical center in the Greater Cincinnati area and therefore treat both privately and publicly insured patients.
Methods: Retrospective chart review of patients who have undergone mastectomy with or without reconstruction.
Results: A total of 488 patient underwent mastectomies at the University of Cincinnati Medical Center during the time period. 253 patients underwent reconstruction (51.8%) and 235 patients did not (48.2%). Patients with higher socioeconomic status as determined by median income were more likely to undergo reconstruction, although this was not statistically significant (OR 1.4, p value 0.14). Patients with public insurance were 44% less likely to undergo reconstruction than patients with private insurance (OR 0.56, p value 0.01). This trend persisted even when accounting for age, race, and smoking status. Of the patients who did not undergo reconstruction, 55 patients (23%) declined referral to a plastic surgeon and 60 patients (25%) met with a plastic surgeon but ultimately did not undergo reconstruction.
Conclusions: The rate of breast reconstruction at the University of Cincinnati Medical Center is higher than the national average (~35%), however, we are disproportionally reconstructing patients with private insurance over patients with public insurance even after accounting for age, race, and smoking status.
