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Regional and National Trends over 20 Years in One-Stage vs Two-staged Implant Based Breast Reconstruction
Parisa Kamali, MD, Pieter G.L. Koolen, MD, Marek A. Paul, MD, Jinesh Shah, MD, Callie Medin, MD, Marc Shermerhorn, MD, Samuel J. Lin, MD
Beth Israel Deaconess Medical Center/Harvard Medical School
2015-03-15
Presenter: Parisa Kamali
Affidavit:
This work is a representation of Dr. Kamali's primary project and Dr. Kamali is the primary person who worked on this project from its inception to its current state. I provided guidance throughout the project.
Director Name: S.J. Lin, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Abstract: Approximately 70% of patients undergoing reconstruction following mastectomy will receive implant-based breast reconstruction. However, the literature reports inconsistent breast reconstruction (BR) rates in terms of one-stage versus two-staged reconstruction protocols. The aim of this study was to assess national and regional trends in one-stage versus two-stage implant based breast reconstruction in the United States.
Patients and methods: A serial cross-sectional study of immediate implant-breast reconstruction trends was performed using the Nationwide Inpatient Sample database from 1992 to 2012. Data on mastectomy rates, reconstructive protocol (one-stage/two-stage), and sociodemographics were obtained and analyzed.
Results: In total, 35,233 (14.8%) patients underwent one-stage vs 202,722 (85.2%) undergoing two-staged breast reconstruction. Following an initial increase in one-stage BR from 16.3% to 20.1% until 1997 (p<0.001), a drop to 13.9% was observed in 2012. Two-stage BR rates increased from 83.7%, in 1992, to 86.1% in 2012 (p<0.001). In both groups patients were more likely to be 40-49 years of age, Caucasian, to have private insurance and to undergo unilateral reconstruction. A majority of both one-stage and two-stage BR were performed in the Southern region of the USA (29.7% and 30.2% respectively). Interestingly, one-stage BR rates grew mostly in the Northeast region, while two-stage BR showed the biggest increase in the Midwest.
Conclusion: In the United States, two-staged implant based breast reconstruction followed a significantly positive trend particularly in middle-aged white females. Whereas one-stage BR has been increasingly reported in the Northeast, two-staged implant based BR has gained most of its popularity in the Midwestern region.
