Legislative Impact and Persistent Disparities: Postmastectomy Breast Reconstruction Rates in the United States among 224,506 Patients.

BACKGROUND

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to have an impact on trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking.

METHODS

The authors analyzed National Surgical Quality Improvement Program data spanning 2005 to 2022 to investigate the impact of the ACA on racial and ethnic diversity in immediate breast reconstruction following mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time.

RESULTS

In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and black or African American individuals underwent immediate breast reconstruction at lower rates compared with white patients ( P < 0.001). In addition, Hispanic patients were less likely to undergo breast reconstruction compared with non-Hispanic patients (28.0% versus 33.4%; P < 0.001). In the post-ACA period, this trend persisted, with all racial groups undergoing immediate breast reconstruction at lower rates compared with white patients ( P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared with non-Hispanic patients (53.8% versus 47.9% ; P < 0.001).

CONCLUSION

Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.