Assessment of disparities in breast reconstruction following breast cancer surgery at a Central Illinois Breast Cancer Program

Introduction: Despite increases in reconstruction rates and legislative efforts to improve access, disparities in post-mastectomy breast reconstruction persist. Prior studies have shown lower reconstruction rates among racial and ethnic minorities, patients with lower socioeconomic status, those insured with Medicare/Medicaid, older patients, and individuals living in rural areas. Methods: We performed a retrospective cohort study of 99 patients (>18 years) who underwent total/simple, skin-sparing, nipple-sparing, or modified radical mastectomy for breast cancer between January 2020 and December 2022 at our institution. Patients who underwent partial mastectomy/lumpectomy were excluded. Clinical, demographic, socioeconomic, and operative data were extracted from the electronic medical record and managed in REDCap. Rural vs. urban residence was determined using RUCC codes (1-3 urban; 4-9 non-urban).The primary outcome was receipt of post-mastectomy breast reconstruction. Results: The majority of patients in the cohort were Caucasian (87%), with racial and ethnic minority groups representing a smaller proportion. Race was not significantly associated with receipt of breast reconstruction. Patients who underwent reconstruction were significantly younger than those who did not (50.4 ± 11.7 vs. 61.6 ± 12.3 years, p < 0.0001). Geographic residence(urban vs. non-urban), smoking status, and comorbidities, including type 2 diabetes, congestive heart failure, and COPD were not associated with reconstruction. Cancer stage and receipt of adjuvant chemotherapy or radiation therapy also did not significantly influence reconstruction rates. Patients who underwent contralateral prophylactic mastectomy were significantly more likely to receive reconstruction (p = 0.00005); of these, only 3 patients had a BRCA mutation, while the remainder opted for the procedure by personal choice. Conclusion: In our cohort, younger age and undergoing contralateral prophylactic mastectomy were the strongest predictors of post-mastectomy reconstruction. Other demographic and clinical factors, including race, geographic residence, and adjuvant treatment, did not affect reconstruction. Standardizing patient education and early referral to plastic surgery may help reduce variation and support more equitable care.