Reconstruction trends in New York City: A multi-decade, multi-institutional experience before and after the implementation of the Breast Cancer Provider Discussion Law

Abstract

Introduction

The potential benefits of breast reconstruction for achieving greater patient satisfaction, wellbeing, and functional outcomes after mastectomy have been widely acknowledged. However, sociodemographic and economic disparities exist in accessing reconstruction. This study aimed to characterize the influence of various factors on access to reconstruction and investigate the impact of the Breast Cancer Provider Discussion Law (BCPDL), legislation that mandates patient education and referral to plastic surgery at the time of breast cancer diagnosis, on utilization of reconstructive services.

Methods

Retrospective chart review was performed to collect data on patients who underwent mastectomy at two institutions within the New York-Presbyterian system from 1998–2019. Sociodemographic, past medical history, and treatment approach information were recorded. Interrupted time series analysis and logistic regression were used for statistical analysis.

Results

The cohort included 6122 patients, of which 3737 (61.04%) underwent reconstruction and 2385 (38.96%) did not. Older age, Medicaid/Medicare insurance, higher tumor staging, and Asian American/Pacific Islander identity were negative predictors of undergoing reconstruction. The interrupted time series analysis of the years before and the years after implementation of the 2010 BCPDL revealed that while there was an immediate increase in the proportion of patients who received reconstruction, the effects were not sustained.

Conclusion

Our data indicates that patient-physician communication alone may not be sufficient to bridge the gap in reconstructive care. This study highlights the need for consistent plastic surgery referral for sustained equal access to reconstructive services.