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Geographic Plastic Surgeon Workforce Density Is Independently Associated with Immediate Postmastectomy Breast Reconstruction Utilization: A 23-Year County-Level Analysis
Nadeem E. Jones
*, Dylan K. Kim, Lee D. Yang, Kathleen Gu, Jarrod T. Bogue
Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
BackgroundThe impact of local plastic surgeon workforce availability on access to post-mastectomy breast reconstruction has not been well defined at a longitudinal population level. We evaluated whether county-level plastic surgeon density was independently associated with immediate postmastectomy breast reconstruction utilization among women residing in that county.
MethodsUsing the Surveillance, Epidemiology, and End Results Research Plus database linked to the Area Health Resources File, we performed a county-year analysis of female patients with primary breast cancer undergoing mastectomy from 2000 to 2022. County-level exposures included plastic surgeon density, overall physician density, rurality, and state. Multivariable linear regression assessed the association between plastic surgeon density and reconstruction rates.
ResultsThe cohort included 14,007 county-years across 11 states. Mean reconstruction utilization was 21.1% (standard deviation 21.7), with marked geographic variation. Higher plastic surgeon density was independently associated with higher reconstruction rates: each additional plastic surgeon per 100,000 female residents was associated with a 0.7 percentage-point increase in overall reconstruction utilization (95% confidence interval 0.5-0.9, p<0.001). This relationship persisted for implant-based (β 0.4, p<0.001) and autologous reconstruction (β 0.2, p<0.001). Rurality was inversely associated with reconstruction utilization (β −0.09, p<0.001). State-level differences remained pronounced, with median county reconstruction rates ranging from 10.2% in Louisiana to 37.6% in New Jersey, and the lowest rates consistently observed in counties without plastic surgeons.
ConclusionsPlastic surgeon workforce distribution was strongly associated with postmastectomy reconstruction utilization across counties over time. These findings suggest that geographic disparities in reconstruction access reflect structural limitations in reconstructive workforce capacity.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
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Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
