A study published in the May issue of Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons (ASPS) and part of the Lippincott portfolio by Wolters Kluwer, reveals that while there have been increases in immediate breast reconstruction (IBR) rates after mastectomy following the implementation of the Affordable Care Act (ACA), racial disparities in IBR still persist.
Lead author Rachel E. Schafer, MPH, a medical student at Cleveland Clinic Lerner College of Medicine, commented, “Our study demonstrates that Hispanic women are more likely to undergo post-mastectomy breast reconstruction compared to their non-Hispanic counterparts in the post-ACA era. However, our analysis shows persistent racial disparities in breast reconstruction care. To better understand these trends, future studies are needed for targeted interventions to ensure equitable reconstructive care for all patients with breast cancer.”
The researchers utilized data from the American College of Surgeons’ National Surgical Quality Improvement Project to analyze trends in IBR. The ACA, with provisions like expanded protections for pre-existing conditions and a reduction in the number of uninsured Americans, was expected to improve healthcare access for historically marginalized groups. The analysis included 224,506 patients who underwent mastectomy either in 2005-08, before the ACA was passed, or in 2016-22, after its full implementation.
Before the ACA, there were significant racial disparities in IBR. Reconstruction rates varied from 35.1% among White patients to 28.8% in Asian patients, 22.3% in Black/African American patients, and a mere 3.8% in American Indian/Alaska Native patients. Hispanic ethnicity patients were also less likely to undergo IBR, with a rate of 28.0% compared to 33.4% in non-Hispanic patients.
After the ACA’s implementation, IBR rates increased across all racial groups. American Indian/Alaska Native and Black/African American patients saw the largest increases, by 27.6% and 24.2% respectively, compared to a 16.9% increase among White patients. Asian patients and those classified as “other” race also experienced smaller but significant increases. Hispanic patients had a 25.8% increase in IBR, while non-Hispanic patients had a 14.5% increase.
Despite these improvements, racial minority groups still had lower IBR rates in the years following the ACA rollout. In 2016-22, the IBR rate was 52.0% among White patients, compared to 46.5% for Black/African American, 38.7% for Asian, and 31.4% for American Indian/Alaska Native patients. However, Hispanic patients were more likely to have IBR than non-Hispanic patients, with rates of 56.6% and 45.7% respectively.
The researchers acknowledge the limitations of their study, noting that it cannot account for the numerous factors affecting access to reconstructive surgery or the complex interplay of cultural, social, and individual factors influencing breast reconstruction decisions.
For patients who have undergone mastectomy, breast reconstruction can restore both form and enhance patient satisfaction. The new analysis shows a steady increase in immediate breast reconstruction rates among all minority groups when compared to White patients since the ACA.
“However, despite this advancement, disparities persist among different racial groups, indicating a complex landscape of reconstructive surgery rates despite legislative efforts,” the researchers wrote. “These findings underscore the need for continued efforts to address disparities and promote equitable reconstructive care.”
Plastic and Reconstructive Surgery is published by Wolters Kluwer. The American Society of Plastic Surgeons, with over 11,000 physician members worldwide, is the largest organization of board-certified plastic surgeons globally and a leading authority on cosmetic and reconstructive plastic surgery. Wolters Kluwer, reporting 2022 annual revenues of €5.5 billion, serves customers in over 180 countries and has operations in more than 40 countries with approximately 20,000 employees worldwide, headquartered in Alphen aan den Rijn, the Netherlands.
Click here to read “Legislative Impact and Persistent Disparities: Postmastectomy Breast Reconstruction Rates in the United States among 224,506 Patients”
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