Treatment at Academic Centers Increases Likelihood of Reconstruction After Mastectomy for Breast Cancer Patients.

Background: Mastectomy rates continue to increase in women diagnosed with breast cancer (BC). There are limited data regarding reconstruction rates at academic centers (AC) versus community hospitals (CH). We aim to determine the effect of facility type on reconstruction rates.

Materials And Methods: The National Cancer Database was queried for BC patients treated with mastectomy from 2004 to 2014. Clinical characteristics and type of reconstruction were compared between treatment at AC or CH.

Results: A total of 860,509 patients were included. Patients treated at AC were younger (58.7 ± 12 y AC versus 61.6 ± 13 y CH; P < 0.001) and traveled farther to their treatment center (33.1 ± 122.8 miles AC versus 20 ± 75.3 miles CH; P < 0.001). Patients undergoing surgery at AC were more likely to have reconstruction than those at CH (43.7% AC versus 32.5% CH; P < 0.001). This trend remained across all reconstruction types including expander/implant-based reconstruction (immediate breast reconstruction) (14.4% AC versus 9.9% CH), autologous reconstruction (14.9% AC versus 11.7% CH), mixed reconstruction (5.2% AC versus 3.6% CH), and other reconstructions (9.2% AC versus 7.3% CH) (all P < 0.001). Patients in all age categories, across insurance statuses, and with comorbidities were more likely to receive reconstruction if treated at AC compared with CH. In multivariate analysis, having a mastectomy at AC was an independent predictor of reconstruction (adjusted odds ratio, 1.51; 95% confidence interval, 1.49-1.51; P < 0.001).

Conclusions: Undergoing mastectomy at AC results in higher rate of reconstruction compared with CH.