Microsurgical reconstruction, a process that surgeons use to rebuild women’s breasts after a mastectomy, involves removing the women’s own fat and muscle tissue from other parts of their bodies (usually their abdomens) and uses that tissue to reconstruct the breasts. Cosmetic surgeons sometimes prefer microsurgical reconstruction; yet, many women do not receive the procedure or even have the option of undergoing the procedure after their mastectomies. 

According to “The Influence of Sociodemographic Factors and Hospital Characteristics on the Method of Breast Reconstruction,” published in the May 2012 issue of Plastic and Reconstructive Surgery, many factors weigh into the kind of reconstruction a woman receives. The type of hospital that the patient visits for her surgery (teaching, private, or public hospital), her race, age, socio-economic status, and insurance coverage (Medicaid, Medicare, or private insurance) all play some role in whether a woman will receive the more familiar silicone implants during her reconstruction or whether the surgeon will perform microsurgical reconstruction. 

The Study

Dr. Claudia Albornoz, Dr. Peter Bach, Dr. Andrea Pusic and their research colleagues used 2008 data from 1,000 hospitals in 43 states on 6,035 reconstructive surgeries performed at the same time as the mastectomies, and 1,282 reconstructive surgeries that were performed at some time after the mastectomy. 

The data the researchers examined included what type of breast reconstruction surgery women underwent (microsurgical flaps, pedicled flaps, or implants) as well as information about each woman’s age, race, median income, and teaching hospital status, hospital size, who paid for the procedure (the patient or an insurance company), and hospital location by state. 

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The Results

The researchers discovered that the state where the patient lived or had surgery, the patient’s age, and the patient’s income all played a role in determining what type of reconstructive surgery she received. Only 5.5 percent of patients received microsurgical reconstruction, and nearly 40 percent of those microsurgical reconstructions took place in New York, California, and Texas.

If women had their surgeries performed at teaching hospitals and were between 50 and 59 years of age, they were more likely to receive the microsurgical reconstruction than they were to receive implants.

The researchers also found that those patients who had private insurance rather than Medicare were more likely to receive microsurgical reconstruction. These results led the researchers to conclude that sociodemographic information about patients most often determines the women’s reconstructive choices

The researchers argue that anatomical concerns such as age and the type of mastectomy performed should determine what type of reconstructive surgery a woman undergoes rather than insurance and socioeconomic status. For example, younger women and their surgeons often prefer implants to the microsurgical procedure because implants look similar to real, younger breasts and the women may not have as much fat tissue around the abdomen when they are younger.

To ensure that patients are receiving the most appropriate type of reconstructive surgery, they should speak with both their oncologist and the surgeon who performed (or will perform) the mastectomy and the cosmetic surgeon who will perform the reconstruction. Women should ensure that their choices are driven by their needs and not sociodemographics.