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Regional and National Trends over 15 Years in One-Stage vs Two-staged Implant Based Breast Reconstruction
Parisa Kamali, MD, Pieter Koolen, MD, Marek Paul, Marc Shermerhorn, MD, Samuel J. Lin.
Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA.

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 1998 to 2012. Data on mastectomy rates, reconstructive protocol (one-stage/two-stage), and sociodemographics were obtained and analyzed.
Results: In total, 35,233 (13.6%) patients underwent one-stage vs 202,722 (86.2%) undergoing two-staged breast reconstruction. Following an initial increase in one-stage BR from 14.8% to 18.8% in the first year (p<0.001), a drop to 13.9% was observed in 2012. Two-stage BR rates increased from 85.2%, in 1998, 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.

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