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Factors influencing incidence and type of postmastectomy breast reconstruction in an urban multidisciplinary cancer center.

Abstract：

BACKGROUND:On January 1, 2011, New York State amended the Public Health Law to ensure that patients receive "information and access to breast reconstruction surgery." The purposes of this study were to investigate the early impact of this legislation on reconstruction rates and to evaluate the influence of patient variables versus physician variables on the incidence and type of breast reconstruction performed. METHODS:A retrospective study was conducted on all patients who underwent mastectomy between January 1, 2010, and December 31, 2011. Reconstruction rates were analyzed in relation to timing of legislation, breast surgeon variables, plastic surgeon faculty status, type of reconstruction, and patient variables. RESULTS:Two hundred fifty-eight patients met inclusion criteria. The overall reconstruction rate was 56.59 percent. There was no statistically significant increase in reconstruction rate after the 2011 legislation (OR, 0.45; p = 0.057). Patients whose breast surgeon was female were more likely to undergo reconstruction (OR, 5.17; p = 0.001). Patients who were Asian (OR, 0.22; p = 0.002), older than 60 years (OR, 0.09; p = 0.001), or had stage 3 and 4 cancer (OR, 0.04; p = 0.03) were less likely to undergo reconstruction. Patients reconstructed by a hospital-employed plastic surgeon were significantly more likely to undergo autologous versus implant reconstruction (OR, 6.85; p = 0.001) and to undergo microsurgical versus nonmicrosurgical autologous reconstruction (78.2 percent versus 0 percent; p = 0.001). CONCLUSIONS:Breast surgeon sex and plastic surgeon faculty status were the factors that most affected the rate and type of reconstruction, respectively. Legislation mandating the discussion of breast reconstruction options had no impact on reconstruction rate. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Iskandar ME,Dayan E,Lucido D,Samson W,Sultan M,Dayan JH,Boolbol SK,Smith ML

doi

10.1097/PRS.0000000000000888

subject

Has Abstract

pub_date

2015-02-01 00:00:00

pages

270e-276e

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201502000-00008

journal_volume

135

pub_type

杂志文章

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Factors influencing incidence and type of postmastectomy breast reconstruction in an urban multidisciplinary cancer center.