Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p= <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%,p= <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%,p= <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p= <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care.
背景与目的：乳房切除术后乳房重建可改善患者生活质量及心理社会预后，但尽管存在多项联邦法规，该手术的实施率仍不稳定。现有数据显示少数族裔、社会经济地位较低及持有公共医疗保险的患者重建率更低。目前对诸多阻碍因素仍缺乏充分认知与研究。本研究旨在剖析乳房切除术后重建的障碍，通过解决影响公平获得治疗的多重因素，构建支持性临床环境。材料与方法：本回顾性观察研究利用加州癌症登记处数据监测、流行病学与最终结果（SEER）数据库及加州卫生与公共服务局癌症手术数据库（分别为2013-2021年与2000-2021年），分析乳房切除联合即刻乳房重建（IBR）、延期乳房重建（DBR）及单纯乳房切除（MO）手术率。收集年龄、性别、种族、保险类型、医院类型、社会经济地位及居住地数据，采用皮尔逊卡方检验进行分析。结果：共纳入168,494例乳房切除与重建手术（82.36% MO，7% IBR，10.6% DBR）。40-49岁年龄组MO率（38.1%）显著低于70-74岁年龄组（94.8%，p<0.001）。拥有商业保险、HMO或PPO保险的患者重建率显著更高（IBR 75.86%，DBR 75.32%，p<0.001）。绝大多数手术（96.02%）在城市地区开展，农村/偏远地区仅占1.55%（p<0.001）。种族间无显著差异。所有手术中7.46%在癌症中心完成，其IBR率显著更高。洛杉矶县、圣路易斯奥比斯波/文图拉县及北加州地区MO率显著高于其他区域（p<0.001）。结论：乳房切除术后重建率较低，仅17.64%患者接受重建。全国数据显示70.5%患者接受MO，29.6%接受重建。促进重建的显著积极因素包括商业保险、高社会经济地位、癌症中心治疗及城市居住。已识别的障碍涵盖公共医疗保险参保、农村或非城市居住、高龄、低社会经济地位及非白人种族/民族，提示经济因素可能对治疗选择产生影响。
Barriers to Post-Mastectomy Breast Reconstruction: A Comprehensive Retrospective Study
肿瘤(癌症)患者之家