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Trends in post-mastectomy reconstruction: A SEER database analysis

Authors

  • Julie E. Lang MD, FACS,

    Corresponding author
    1. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
    2. Department of Surgery, Division of Breast and Soft Tissue Surgery, University of Southern California, Los Angeles, California
    • Correspondence to: Julie E. Lang MD, FACS, Department of Surgery, Section of Breast and Soft Tissue Surgery, University of Southern California, 1510 San Pablo Street, Suite 412 Los Angeles, CA 90033-4612. Fax: +323-865-3539.

      E-mail: j ulie.lang@med.usc.edu

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  • Danielle E. Summers BS,

    1. Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, Arizona
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  • Haiyan Cui PhD,

    1. Department of Biometry, University of Arizona, Tucson, Arizona
    2. University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
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  • Joseph N. Carey MD,

    1. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
    2. Division of Plastic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
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  • Rebecca K. Viscusi MD,

    1. Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, Arizona
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  • Craig A. Hurst MD, FRCS,

    1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
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  • Amy L. Waer MD, FACS,

    1. Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, Arizona
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  • Michele L B. Ley MD, FACS,

    1. Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, Arizona
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  • Stephen F. Sener MD, FACS,

    1. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
    2. Department of Surgery, Division of Breast and Soft Tissue Surgery, University of Southern California, Los Angeles, California
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  • Aparna Vijayasekaran MD

    1. Division of Surgical Oncology, Department of Surgery, University of Arizona, Tucson, Arizona
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ABSTRACT

Background and Objectives

This study was performed to investigate recent trends and factors associated with immediate breast reconstruction (IBR) using a large population-based registry. We hypothesized that rates of IBR have increased since passage of the Women's Health and Cancer Rights Act of 1998.

Methods

The SEER (surveillance, epidemiology and end results) database was used to evaluate Stage I–III breast cancer (BC) patients who underwent total mastectomy from 1998 to 2008. Univariate and multivariate analyses were performed to study predictors of IBR.

Results

Of 112,348 patients with BC treated by mastectomy 18,001 (16%) had IBR. Rates of IBR increased significantly from 1998 to 2008 (P < 0.0001). Use of IBR significantly decreased as patient age increased (P < 0.0001), as stage increased (P < 0.0001), and as the number of positive lymph nodes increased (P < 0.0001). Estrogen receptor+/progesterone receptor+ (ER+/PR+) patients had significantly higher IBR rates than ER−/PR−patients (P < 0.0001). IBR was used in 3,615 of 25,823 (14.0%) of patients having post-mastectomy radiation (XRT) and in 14,188 of 86,513 (16.4%) of those not having XRT (P < 0.0001).

Conclusions

The utilization of IBR has increased significantly over the last decade. IBR was found to be significantly associated with age, race, geographical region, stage, ER, grade, LN status, and XRT (P < 0.0001). J. Surg. Oncol. 2013 108:163–168. © 2013 Wiley Periodicals, Inc.

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