The Impact of Race and Ethnicity on Rate of Postmastectomy Immediate Breast Reconstruction in an Integrated Healthcare Model.

Abstract

Immediate breast reconstruction (IBR) after mastectomy for breast cancer has been shown to improve overall quality of life. However, rates of IBR have been shown to vary by race and ethnicity. In an integrated healthcare model within the United States that provides access to multispecialty care, we sought to determine whether racial and ethnic disparities in immediate postmastectomy breast reconstruction persist. A retrospective cohort of women undergoing mastectomy for newly diagnosed breast cancer between January 2018 and December 2022 was established to identify factors associated with access to and selection of IBR. Factors of interest included self-reported race and ethnicity, as well as demographic, social, medical, and oncologic variables. Bivariate and multivariable analysis was performed to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CI). A total of 4,039 cis-gender women underwent mastectomy of which 1,760 selected IBR (43.6%). Referral to plastic surgery was negatively impacted by older age, higher BMI, active tobacco use, poorly controlled diabetes, and uncontrolled hypertension (p<0.01) and ranged from 68.3% for Asian women to 81.7% for Hispanic women (p<0.01). Implant-based reconstruction was the most common type of reconstruction (87.4%); however, Black/African American women selected autologous reconstruction more frequently than White women (aOR [95% CI]: 2.5 [1.5-4.2], p<0.01). In an integrated healthcare model with access to multispecialty care, variables in addition to race and ethnicity impact selection of immediate post-mastectomy breast reconstruction. Further studies are warranted to examine the impact of socioeconomic characteristics, social support, and patient preferences on acceptance of IBR.Level of Evidence: Level III, retrospective cohort.