Breast Reconstruction Rates Stabilize, With Disparities Narrowing

The rate of immediate breast reconstruction following mastectomy has plateaued over the past decade, according to a new study published in Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons (ASPS). While overall reconstruction rates have leveled off, the study also highlights a slow but notable reduction in racial and insurance-based disparities in breast reconstruction access.

What’s New: Trends and Disparities in Breast Reconstruction

Researchers analyzed data from over 1.5 million mastectomy patients between 2005 and 2017, drawn from three U.S. national databases. The study found that 32.7% of patients underwent immediate breast reconstruction during this period. While reconstruction rates increased annually from 2005 to 2012, they stabilized from 2013 to 2017.

Importantly, the study revealed changes in demographic trends. Historically, the majority of women undergoing reconstruction were White. However, over time, the proportion of White women choosing reconstruction decreased, while it increased for Black, Asian/Pacific Islander, and Native American women. Adjusted data showed that Black and White women now have similar reconstruction rates.

Insurance coverage trends also shifted. While private insurance remains the most common payer for breast reconstruction, its share dropped from 85.0% to 75.1%. Conversely, reconstruction rates rose among publicly insured patients, with Medicaid coverage increasing from 3.3% to 6.6% and Medicare coverage rising from 9.9% to 15.6%.

Why It Matters: Patient Choices and Equity in Care

The stabilization of breast reconstruction rates suggests a shift in patient decision-making and healthcare dynamics. Factors such as population aging, concerns over implant safety, and increased popularity of less-intensive treatments like breast conservation may influence these trends. Additionally, the growing visibility of “go flat” campaigns advocating for aesthetic flat closures has likely contributed to a broader acceptance of alternative post-mastectomy options.

While disparities have narrowed, the findings underscore the need to address lingering inequities in access to care. The preference-sensitive nature of breast reconstruction—where decisions are shaped by personal choice, access, and systemic barriers—necessitates further investigation. As the study authors note, ongoing efforts are essential to ensure that all patients, particularly those from underrepresented groups, receive equal access to timely and informed care options.

This research not only sheds light on evolving trends in breast reconstruction but also emphasizes the importance of patient-centered care in oncology and reconstructive surgery.