Trends in Breast Reconstruction by Ethnicity: An Institutional Review Centered on the Treatment of an Urban Population

• Published in: The American surgeon 2016-06, Vol.82 (6), p.497-504
• Main Authors: Rodby, Katherine A., Danielson, Kirstie K., Shay, Elizabeth, Robinson, Emilie, Benjamin, Martin, Antony, Anuja K.
• Format: Article
• Language: English
• Subjects: African Americans; Body mass index; Breast cancer; Breast Implants; Breast Neoplasms - ethnology; Breast Neoplasms - surgery; Cancer therapies; Chemotherapy; Colleges & universities; Cultural differences; Ethnic Groups - statistics & numerical data; Ethnicity; European Continental Ancestry Group - statistics & numerical data; Female; Hispanic Americans; Hospitals; Humans; Mammaplasty - statistics & numerical data; Mastectomy; Mastectomy - statistics & numerical data; Middle Aged; Minority Groups - statistics & numerical data; Mortality; Patient Preference - ethnology; Patient satisfaction; Population; Quality of life; Software; Transplants & implants; Trends; Urban Population - statistics & numerical data; White people; Womens health
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/000313481608200609

Previous studies have investigated reconstructive decisions after mastectomy and such studies document a preference among African American women for autologous tissue-based procedures and among Latin American women for implant-based reconstructions, however, there is a paucity of studies evaluating the current relationship between ethnicity and reconstructive preferences. This institutional review provides a unique, up-to-date evaluation of an understudied urban population composed of majority ethnic minority patients and explores reconstructive trends. Consecutive breast reconstruction patients were entered into a prospectively maintained database at the University of Illinois at Chicago and affiliate hospitals between July 2010 and October 2013. Demographics and oncologic characteristics including tumor stage, pathology, BRCA status, and adjuvant treatment were reviewed, and reconstructive trends were assessed by racial group with a focus on reconstructive procedure, mastectomy volume, and implant characteristics. Statistical analysis was performed using SAS (version 9.2). One-hundred and sixty breast reconstructions were performed in 105 women; of which 50 per cent were African American, 26 per cent Hispanic, 22 per cent Caucasian, and 2 per cent Asian. Age, tumor stage, prevalence of triple negative disease, chemotherapy, and radiation treatment was comparable between groups. Rates of obesity, hypertension, and diabetes mellitus were slightly higher in African American and Hispanic cohorts, with more African American patients having one or more of these comorbidities as compared with the Caucasian and Hispanic cohorts (P = 0.047). Despite comparable positive BRCA testing rates, significant differences were seen in the percentage of bilateral mastectomy; 68 per cent African American, 48 per cent Caucasian, and 30 per cent Hispanic (P = 0.004). Hispanics predominantly underwent flap-based reconstruction (56%), while African American (74%) and Caucasian (60%) patients had a preference toward tissue expander reconstruction (P = 0.04 across all groups). African American and Hispanic presented with increased mastectomy weights and thus required higher implant volumes as compared with Caucasians that approached significance (P = 0.06 and P = 0.06). Implant size utilization followed a unimodal distribution for Caucasians, peaking at 500 cc; while African American and Hispanic demonstrated a bimodal distribution, peaking once at 550 cc and again at the max impl