Department of Surgery, New York University School of Medicine, New York, NY, USA.
Ann Surg Oncol. 2019 Mar;26(3):821-826. doi: 10.1245/s10434-018-6994-4. Epub 2018 Nov 7.
Breast reconstruction can help restore the shape and appearance of breasts after surgery. Studies have shown that minority and uninsured patients are less likely to receive breast reconstruction after mastectomy.
We sought to determine if post-mastectomy reconstruction varied by patient ethnicity and insurance status in a medically underserved population.
This was a retrospective study of mastectomy patients seen at Bellevue Hospital Center, a safety-net hospital in New York City, between January 2010 and December 2015. The Chi square test was used to compare patient characteristics versus type of reconstruction chosen and likelihood of reconstruction. Logistic regression was used to examine likelihood of reconstruction, controlling for patient insurance status, race, age, stage at presentation, and contralateral prophylactic mastectomy.
Of the 750 patients included in the database, 220 underwent mastectomy. Overall, 73.6% of our patient population received breast reconstruction. Patients with Medicare insurance were less likely to get reconstruction compared with patients with other types of insurance (37.5%, p = 0.04). Hispanic patients were most likely to receive reconstruction (89.1%), followed by Black patients (80%) and Asian patients (66.7%) [p = 0.03]. There were no significant associations between patient race or stage at presentation and type of reconstruction. In a multivariate logistic regression, advancing age was associated with a decreased likelihood of reconstruction (adjusted odds ratio 0.91, p < 0.001).
In our underserved patient population, patients received breast reconstruction at rates higher than the national average. Institutional availability of patient navigators and preoperative counseling may contribute to more equal access to breast reconstruction.
乳房重建可以帮助在手术后恢复乳房的形状和外观。研究表明，少数民族和没有保险的患者在接受乳房切除术后接受乳房重建的可能性较小。
我们试图确定在医疗服务不足的人群中，患者的种族和保险状况是否会影响乳房切除术后的重建情况。
这是一项对 2010 年 1 月至 2015 年 12 月在纽约市贝尔维尤医院中心就诊的乳房切除术患者进行的回顾性研究。使用卡方检验比较患者特征与选择的重建类型以及重建的可能性。使用逻辑回归检查重建的可能性，同时控制患者的保险状况、种族、年龄、就诊时的分期和对侧预防性乳房切除术。
在数据库中的 750 名患者中，有 220 名患者接受了乳房切除术。总体而言，73.6%的患者接受了乳房重建。与其他类型保险的患者相比，拥有医疗保险的患者接受重建的可能性较低（37.5%，p=0.04）。西班牙裔患者最有可能接受重建（89.1%），其次是黑人和亚洲患者（分别为 80%和 66.7%）[p=0.03]。患者种族或就诊时的分期与重建类型之间没有显著关联。在多变量逻辑回归中，年龄增长与重建可能性降低相关（调整后的优势比 0.91，p<0.001）。
在我们服务不足的患者群体中，接受乳房重建的患者比例高于全国平均水平。机构提供患者导航员和术前咨询可能有助于更公平地获得乳房重建。
