Nationwide trends in breast reconstruction in Korea during the reimbursement era (2015-2023).

Abstract

Background: This nationwide retrospective study was used to characterize temporal trends in postmastectomy breast reconstruction in Korea during the National Health Insurance reimbursement era from 2015 to 2023.

Methods: Using Health Insurance Review and Assessment Service claims data, total mastectomy (TM) and index breast reconstruction (BR) procedure episodes among female patients with breast cancer were identified from April 2015 through December 2023. Reconstruction was classified as implant-based or autologous, and the timing was operationally defined according to claim linkage with the mastectomy hospitalization episode. Second-stage expander-to-implant exchanges (N7150) were excluded from the primary reconstruction-volume and timing analyses.

Results: A total of 114,141 TM and 44,374 BR procedure episodes were identified. The BR-to-TM procedure-volume ratio increased from 23.8% in 2015 to 56.9% in 2023 (p for trend < 0.001). Interpretation of the apparent increase between 2017 and 2018 is limited by a revision in the Korean mastectomy procedure coding system in July 2017. The proportion of implant-based reconstruction among all BR procedures increased from 56.8% to 82.0%, whereas the proportional share of autologous reconstruction decreased. The proportion of BR procedure episodes operationally classified as immediate reconstruction increased from 65.1% to 82.2%. Implant-based reconstruction was more frequent in the operationally defined immediate and delayed reconstruction groups, whereas autologous reconstruction accounted for a larger proportion of delayed reconstruction. Furthermore, BR procedures remained concentrated in tertiary hospitals.

Conclusions: These findings describe substantial temporal changes in BR procedure patterns during the reimbursement era, including a sustained shift toward implant-based reconstruction and an increasing proportion of claims operationally classified as immediate reconstruction. As nationwide pre-reimbursement data were unavailable, we could not evaluate whether reimbursement expansion caused the observed changes.