To report on the use and variation in the use of immediate (IBR) and delayed breast reconstruction (DBR) among women in NSW following mastectomy for primary invasive breast cancer.
This is a population-based retrospective cohort study that used de-identified linked public and private hospital administrative data. The study cohort included all women resident in NSW, diagnosed with primary invasive breast cancer who underwent a mastectomy as their first breast resection between 2008 and 2011. IBR included procedures performed at the time of mastectomy and DBR included procedures in the 3 years following mastectomy.
Three years after a mastectomy 17% ( 969/5698) of women had a breast reconstruction. Use of IBR increased from 7.1% of women in 2008 to 11.0% in 2011. Use of DBR remained stable. Over half of women aged 18 to 39 years had BR compared with a third of 40-49 year olds. BR was rare among women aged over 70 years.
The proportion of women who underwent BR varied from 7.6 to 34.9% by Local Health District (LHD) of residence. These differences remained after adjusting for differences in age and comorbidity status. IBR was more common among residents of metropolitan (11.6%) compared with regional/rural LHDs (4.5%). Women who underwent mastectomy in a private hospital were more likely to have IBR and DBR compared with those treated in public hospitals (IBR 11.9 and 7.1%, DBR 8.7 and 6.3% respectively).
Despite BR being recognised as an important component of care following mastectomy, the proportion of women having BR remains low. Women experience age-related, geographical and financial barriers to accessing BR following mastectomy. Variation in use of IBR is the biggest contributor to variation in BR by geography and the public/private sectors. Greater engagement of specialist plastic surgeons in multidisciplinary care is warranted.