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A 10 Year Review of Racial Disparities in 1387 Breast Reconstruction Patients
Dev Vibhakar, D.O., Hamid Abdollahi, Stefanos Boukovalas, MD, Richard Bleicher, MD, Eric I. Chang, MD.
Fox Chase Cancer Center, Philadelphia, PA, USA.
Background:
Socioeconomic backgrounds and ethnicity have previously been shown to impact access to various aspects of healthcare. Certainly breast reconstruction is not immune to these factors especially since reconstruction may be considered elective surgery. This study aims to evaluate whether racial disparities exist in breast reconstruction.
Patients and Methods:
A retrospective review of all patients undergoing mastectomy surgery between January 2002 and December 2012 at a single cancer center was performed. Patient demographics were examined, and the rates of breast reconstruction were evaluated in relation to ethnic backgrounds. our minority outreach program was examined to assess the impact and effectiveness in ameliorating the discrepancies in breast reconstruction among different ethnicities.
Results:
A total of 1387 patients were evaluated during the study period. Overall, 554 patients (39.9%) underwent breast reconstruction with 305 patients (55.1%) undergoing free tissue transfer and 249 patients (44.9%) undergoing implant reconstruction. A total of 444 free flaps were performed for breast reconstruction with 438 breasts reconstructed with implants. The incidence of breast reconstruction increased from 30.5% to 67.3% between the first and second halves of the study period. Although no significant differences were identified in rates of implant-based reconstruction among the ethnic groups, free flap reconstruction increased dramatically. There were significant racial disparities during the first half of the study period with Caucasian (11.0%) and Asian (23.1%) women being more likely to undergo autologous tissue reconstruction compared to African-American (2.7%) or Hispanic (0%) women (p0.05).
Conclusions:
Ethnicity is one of many factors that may impact the decision to undergo breast reconstruction. The previous racial disparities in breast reconstruction have dissipated in the past 5 years with near-equivalent as well as increasing rates of reconstruction across all ethnicities. Community outreach programs may play an important role in increasing the reconstructive rates in certain ethnic groups. Certainly further efforts are necessary to improve upon the delivery of breast reconstruction to all patients regardless of ethnic background.
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