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Adapting Perspectives: Analyzing Dynamic Shifts in Breast Surgical Trends and Reconstructive Choices Over 15 Years
Gary Dong B.A.
1; Michael M. Jonczyk M.D.,MS.
2; Carly Wareham M.D.
3; Sarah Persing M.D.
3; Abhishek Chatterjee M.D., MBA.
3
1Tufts University School of Medicine, Boston, MA, 2Broward Health, Department of Plastic Surgery, Fort Lauderdale, FL, 3Tufts Medical Center: Department of Surgery, Plastic Surgery, Boston, MA
Background: In the last 15 years, breast cancer surgical care has advanced. Plastic surgery now includes oncoplastic surgery for breast-conserving partial mastectomies. This study analyzes surgical trends using ACS-NSQIP data, focusing on partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with autologous reconstruction (M+AR), mastectomy with implant reconstruction (M+IR), and oncoplastic surgery (OPS).
Methods: A retrospective cohort analysis was conducted using the ACS-NSQIP database (2008-2022). Patients were categorized by CPT codes for PM, M, M+IR, M+AR, and OPS. Subgroup analysis focused on oncoplastic surgery types. Data analysis used Pearson's chi-squared test, linear regression, Mann-Kendall test, and Sen’s slope.
Results: The cohort included 420,863 patients, with 6,585 excluded. Annual trends (2008-2022) showed: PM 39.3% to 46.4%, M 38% to 25.3%, M+IR 18% to 20%, OPS 1.3% to 4.8% (all p<0.01), and M+AR 3.4% to 3.5% (p>0.05). Among 119,096 patients with reconstruction, M+Implant declined from 78.6% to 70.2%, M+Latissimus Dorsi Flap from 1.7% to 0.6%, M+TRAM flap from 7.9% to 0.4%, and M+Free Flap increased from 5.3% to 11.2%. OPS categories also increased (p<0.01).
Conclusion: This study analyzes trends in breast interventions and reconstructive surgeries, aiding pre-operative decision-making to optimize outcomes and improve access to breast cancer reconstruction.
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