Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA.
MCW Cancer Center, Milwaukee, WI, USA.
Ann Surg Oncol. 2023 Oct;30(11):6374-6382. doi: 10.1245/s10434-023-13845-1. Epub 2023 Jul 17.
The "Going Flat" movement became widely publicized in 2016 and provides information and support to women who choose to forego post-mastectomy breast reconstruction (PMBR). The objectives of this study were to evaluate temporal trends in PMBR to ascertain the potential impact of this movement and assess which factors are associated with going flat.
A retrospective cohort analysis was performed using the NCDB of women with non-metastatic breast cancer who underwent mastectomy between 2004 and 2019. Trends in going flat after mastectomy were examined and stratified by age (< 50, 50-69, ≥ 70). A multivariate logistic regression model was used to identify factors associated with going flat.
650,983 patients met the inclusion criteria: 244,201 (37.5%) underwent PMBR and 406,782 (62.5%) went flat. Among women < 70, rates of going flat steadily decreased from 2004 to 2015 and then stabilized after 2015, coinciding with the rise of the "Going Flat" movement. In multivariate analysis, non-White race, older age, increasing comorbidities, government provided insurance, treatment at a community program, radiotherapy, and adjuvant chemotherapy were associated with a higher likelihood of going flat (p < 0.001).
In the first 2 years after the "Going Flat" movement, the number of women going flat after mastectomy has stabilized in women < 70 for the first time in over a decade. These trends suggest that the social and cultural impact of this movement may have contributed to the stabilization of PMBR rates.
“变平”运动在 2016 年广泛传播，为选择放弃乳房重建术（PMBR）的女性提供信息和支持。本研究的目的是评估 PMBR 的时间趋势，以确定该运动的潜在影响，并评估哪些因素与变平有关。
使用 NCDB 对 2004 年至 2019 年间接受乳房切除术的非转移性乳腺癌女性进行回顾性队列分析。检查乳房切除术后变平的趋势，并按年龄（<50 岁、50-69 岁、≥70 岁）进行分层。使用多变量逻辑回归模型来确定与变平相关的因素。
符合纳入标准的患者 650983 例：244201 例（37.5%）接受 PMBR，406782 例（62.5%）变平。在<70 岁的女性中，变平率从 2004 年到 2015 年稳步下降，然后在 2015 年后稳定下来，这与“变平”运动的兴起相吻合。多变量分析显示，非白人种族、年龄较大、合并症增多、政府提供的保险、在社区项目中治疗、放疗和辅助化疗与变平的可能性增加相关（p<0.001）。
在“变平”运动后的头两年，70 岁以下女性乳房切除术后变平的女性数量首次在十多年来稳定下来。这些趋势表明，该运动的社会和文化影响可能促成了 PMBR 率的稳定。
