Influencers of Immediate Postmastectomy Reconstruction: A National Cancer Database Analysis.

BACKGROUND: The literature examining decision-making related to treatment and reconstruction for women with breast cancer has established that patient, clinical, and facility factors all play a role. OBJECTIVES: The aim of this study was to use the National Cancer Database to determine how patient, clinical, and facility factors influence: (1) the receipt of immediate breast reconstruction; and (2) the type of immediate breast reconstruction received (implant-based, autologous, or a combination). METHODS: A total of 638,772 female patients with breast cancers (Tis-T3, N0-N1, or M0) who between 2004 and 2017 received immediate reconstruction following mastectomy were identified in the National Cancer Database. Univariate and multivariate logistic regression models were applied to identify characteristics associated with immediate breast reconstruction and type of reconstruction. RESULTS: Immediate breast reconstruction was more frequently associated with patients of White race, younger age, with private insurance, with lesser comorbidities, who resided in zip codes with higher median incomes or higher rates of high-school graduation, in urban areas, with Tis to T2 disease, or with involvement of <4 lymph nodes (all odds ratios [ORs] > 1.1). Negative predictors of immediate breast reconstruction were insurance status with Medicaid, Medicare, other government insurance, and none or unknown insurance (all ORs < 0.79). Implant-based reconstruction was associated with non-Black race, uninsured status, completion of higher education, undifferentiated disease, and stage T0 disease (all ORs > 1.10). CONCLUSIONS: These findings confirm some previous studies on what patient, clinical, and facility factors affect decision-making, but also raise new questions that relate to the impact of third-party payer on receipt and type of reconstruction postmastectomy for breast cancer.