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Speaking of Reconstruction: Language-Associated Disparities in Immediate Breast Reconstruction After Mastectomy
Michael Stigliano, Carson Gundlach, Paneed Jalili, Fiona R. Fragomen, Daana Bajnauth
*, David Otterburn
Weill Cornell Medicine, New York, NY
BackgroundDisparities in postmastectomy breast reconstruction have been described by race and ethnicity, but the association with documented language status remains understudied. The aim of this study was to evaluate whether non-English speaking patients were less likely to undergo immediate breast reconstruction after mastectomy and to compare postoperative complication rates between cohorts.
MethodsThe TriNetX database was used to identify patients with breast cancer who underwent mastectomy from 2019 to 2024. Patients were stratified as English-speaking or non-English-speaking based on documented language, with non-English-speaking defined as documentation of another spoken language without documentation of English. Propensity matching was performed on age, race, ethnicity, BMI, tobacco use, diabetes, hypertension, chemotherapy, and radiation.
ResultsAfter propensity matching, there were 1,282 patients in each cohort. Non-English-Speaking patients were less likely than English-speaking patients to undergo immediate breast reconstruction (29.41% vs 42.00%, RR 0.70, p<0.001), but not delayed reconstruction (5.90% vs 7.25%, RR 0.81, p=0.27). This disparity was most apparent in immediate alloplastic reconstruction (27.54% vs 39.39%, p<0.001), while rates of immediate autologous reconstruction were numerically lower but not statistically significant (2.57% vs 3.74%, p=0.09).
Among matched patients undergoing immediate alloplastic reconstruction, 30-day outcomes were similar between non-English- and English-speaking patients, including ED visits (8.13% vs 5.63%, p=0.21), wound complications (5.00% vs 6.25%, p=0.49), and procedural re-intervention (4.34% vs 4.69%, p=0.85).
ConclusionNon-English-speaking patients were significantly less likely to undergo immediate breast reconstruction after propensity matching. Early postoperative outcomes among immediate alloplastic reconstructions did not differ significantly by language. This disparity warrants closer attention to communication during preoperative reconstructive counseling.
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