21 October 2017

Here's why more women are choosing breast reconstruction after mastectomy

In the US, breast reconstruction after mastectomies increased from less than 25% in 2009 to 40% in 2014.

Over five years, the proportion of US breast cancer patients opting for breast reconstruction after mastectomy grew by about two-thirds, a new government report shows.

An analysis of patient data shows breast reconstruction followed 40% of breast-removal surgeries in 2014 – up from less than one-quarter in 2009, according to the US Agency for Healthcare Research and Quality (AHRQ).

Keeping pace with trends

Among age groups, women aged 65 and older accounted for the largest increase in breast reconstructive surgery – 140%.

"This type of information is essential for policymakers and health systems seeking to keep pace with important trends in clinical care," Gopal Khanna, agency director, said in an AHRQ news release.

The overall increase during the study period was 65%, researchers said.

While reconstruction procedures increased in all insurance groups, the jump was highest for Medicare patients. Even so, the Medicare reconstruction rate was lowest – 19 reconstructions per 100 mastectomies – compared to other insurance plans.

A dramatic rise in reconstruction surgeries also occurred among women without insurance, the data from 22 states revealed.

Considerations before reconstruction

A previous Health24 article discussed things that need to be considered before the decision to have breast reconstruction is made:

  • The best time to have breast reconstruction is during your mastectomy.  Although not essential, the results and psychological well-being tend to be better when breast reconstruction is done at the same time as the mastectomy during one operation.
  • It’s important to note that the sensations in your breast will no longer be the same.  There won’t be feeling in the nipple for example.
  • Having a reconstruction does mean that recovery will be longer so it will take longer to return to normal activities – although I believe the longer term benefits far outweigh the initial inconvenience. 
  • If you have a very active job or are an athlete then it’s important to consider how your motion will be affected once you have fully recovered.  Down time is less after implant reconstruction compared to reconstruction with abdominal perforator flaps for example.

Postoperative complications

"This information suggests that many uninsured women were willing to pay for reconstruction surgery out of pocket," said Anne Elixhauser, a senior scientist at the agency.

Another study however indicated that not all women are necessarily interested in breast reconstruction, the most common reasons being that they felt it wasn't important, they weren't interested in more surgery or they were focused on their cancer treatment.

Medical, sexual and physical concerns come into play when deciding for or against breast reconstruction, according to the report.

"Medical considerations include concerns that breast reconstruction surgery lengthens recovery time and increases the chance for infection and other postoperative complications," the authors say.

"Sexual considerations involve the impact of the mastectomy on future sexual encounters. Physical features include how breasts may define femininity and sense of self," they noted.

Other notable findings:

  • Most of the growth in reconstructive procedures occurred in hospital-based outpatient surgical centres (150% increase). The rate for inpatient reconstructions remained unchanged.
  • In 2014, reconstruction surgery was less common among women in rural areas than among those in cities.
  • Black women were more likely to undergo breast reconstruction surgery in an inpatient setting and along with mastectomy than white and Hispanic women.

Image credit: iStock


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