Assessing the Shift: Increasing Rates of Immediate Breast Reconstruction by Non-Plastic Surgeons - Insights from a Nationwide Analysis.

Abstract

Background: Breast reconstruction techniques have advanced significantly over the last 50 years and are some of the most common services plastic surgeons provide in the United States. A growing perception exists that these procedures are increasingly performed by non-plastic surgeons, but the validity of this trend and its underlying drivers remain unknown.

Methods: A national insurance database was queried to identify patients who underwent partial and total mastectomy between 2010-2021. Immediate reconstructive procedures, including breast reduction, tissue expander/implant placement, and autologous tissue transfers, were then captured and stratified by physician specialty: General or Plastic Surgery. Demographics, annual trends, and distance to Comprehensive Cancer Centers and plastic surgery residency programs were compared.

Results: The rate of oncoplastic breast reductions increased over time, with more general surgeons performing oncoplastic breast reductions in 2021 compared to plastic surgeons (53.3% vs. 46.7%, p < 0.001). There was an increase in general surgeons performing implant-based breast reconstruction, which eclipsed that of plastic surgeons in 2021 (50.9% vs. 49.1%, p=0.028). Proximity to the closest NCI Cancer Center and plastic surgery residency programs was not significantly different amongst the groups (39.5 vs. 42.1 miles, p=0.66).

Conclusion: General surgeons are performing an increasing number of breast reconstruction procedures. This shift from specialized plastic surgery care to non-specialized care is highly variable across the United States but not significantly associated with distance to specialty centers. Efforts are needed to determine the factors driving this shift and to develop strategies to ensure patients have access to specialized breast reconstruction care.