A National and Regional Trend Analysis of 20 Year Experience on Breast Reconstruction: One-Stage Versus Two-Stage

A National Trend Analysis of a 20 Year Experience of Breast Reconstruction: One-Stage Versus Two-Staged Reconstruction

Abstract:

In 2015, an estimated 231.840 new cases of invasive breast cancer (BC) are expected to be diagnosed in the US. Of women undergoing post-mastectomy breast reconstruction, approximately 70% choose for the two-stage, tissue expander/implant procedure. However, due to improvement and increased availability in surgical technique, one-stage immediate implant breast reconstruction has gained momentum in the last decade.  We conducted a population-based study to evaluate national trends and evaluated the effect of sociodemographic and hospital characteristics in one-stage vs two-staged breast reconstruction from 1992 through 2012.

Patients and methods:

A serial cross-sectional study of immediate breast reconstruction trends was performed using the Nationwide Inpatient Sample database from 1992 to 2012. Data on mastectomies, reconstructive method (one-stage/two-stage), and sociodemographic/hospital predictors were obtained and analyzed using Chi-square. Trends were analyzed using a multivariable logistic regression.

Results:

Mastectomy rates increased 71% in 1992 to 81% in 2012 (p<0.001). A total of 35.233 (14.8%) patients underwent a one-stage breast reconstruction versus 202,722 (85.2%) two-stage breast reconstruction. After an initial increase of 16.3% to 20.1% from 1992 to 1997 (p<0.001), a decrease to 13.9% was observed in 2012. For two-staged breast reconstruction, between 1992 to 1994 rates decreased from 83.7% to 75,8%, followed by an increase to 86,1% in 2012 (p=<0.001) (Figure). Demographic characteristics between patients undergoing one-stage as two-stage breast reconstruction were comparable; both were more likely to undergo unilateral reconstruction, were 40-49 years old, white and to have private insurance. Most one-stage and two-stage breast reconstruction were performed in the Southern region of the USA (29.7% and 30.2% respectively). Interestingly, only the Northeast region showed an increase in both one-stage and two-staged breast reconstruction rates (11.5% and 10.1% respectively).

Conclusion:

Two-staged breast reconstruction rates continue to increase in the United States. There is an increased use of two-staged breast reconstruction in the United States, particularly in middle-aged white females. Despite overall decreasing rates, most two-stage breast reconstruction procedures are still being performed in the Southern region of the USA. After initial increase in one-stage breast reconstructions up to 1997, a downward trend has been recorded since then using this national database.