Racial Differences in Immediate Breast Reconstruction Complication Rates

SDCC 

Introduction: Breast reconstruction after mastectomy is an important step in the management and treatment of breast cancer. Though reconstruction has been deemed beneficial for postmastectomy patients, the literature on racial disparities in breast reconstruction outcomes is mixed. One study found that IBR surgical complication rates did not differ by race/ethnicity (1) whereas another reported that Black patients were significantly more likely to experience all-cause complications compared to White patients (2). To date, no study has examined potential mediators of the racial/ethnic differences in immediate breast reconstruction complication rates (IBR). The authors sought to examine mediators of the racial differences (Black vs White) in IBR complication rates using the American College of Surgeons–National Surgery Quality Improvement Program (ACS-NSQIP) data sets.

Methods: A cross-sectional study design was used to assess racial differences in IBR complication rates and explore to what extent these differences are explained by the following covariates: age, menopausal status, BMI, diabetes status, smoking status, and socioeconomic status (SES). Self-identified Black or White women, ages 45 years and above from the NSQIP during the years 2012 to 2022. Women were excluded if they have no values available for the covariates IBR is defined as two different outcomes: implant-based (E/I) reconstruction (mastectomy only vs E/I reconstruction) and autologous reconstruction (mastectomy only vs autologous reconstruction). A logistic regress was used to estimate differences in IBR outcomes for Black versus White women. A mediation analyses was used to determine the extent to which the covariates mediate the association between race and our outcome.

Results: Overall, 60,003 post-mastectomy patients were included; of these, 20,001 (33%) underwent IBR. Of these patients undergoing reconstruction, the vast majority received implant-based reconstruction (76%) compared with autologous (24%). Overall, 24,789 Black women and 35,214 White women were included in our analysis. Black women were 12% more likely to have IBR complications (95% CI: 1.12 [1.02, 1.30]), adjusted for age, menopausal status, BMI, diabetes status, smoking and SES. Mediation analyses suggested that 43% of the treatment delay among Black women could be removed if an intervention equalized their age, menopausal status, BMI, diabetes status, smoking status, and socioeconomic status (SES) to that of White patients. The largest mediating factor was BMI, accounting for 48% of the racial disparity in IBR complication rates.

Conclusion: Black women are 12% more likely to experience IBR complications. Equalization of the mediators used in this study could reduce the disparities by 48% for Black women. Future research should identify other causes of racial disparities in complication rates and intervene accordingly.

1. Butler PD, Nelson JA, Fischer JP, et al. Racial and age disparities persist in immediate breast reconstruction: an updated analysis of 48,564 patients from the 2005 to 2011 American College of Surgeons National Surgery Quality Improvement Program data sets. Am J Surg. 2016;212(1):96-101. doi:10.1016/j.amjsurg.2015.08.025
2. Johnstone T, Thawanyarat K, Rowley M, et al. Racial Disparities in Postoperative Breast Reconstruction Outcomes: A National Analysis. J Racial Ethn Health Disparities. Published online April 19, 2023. doi:10.1007/s40615-023-01599-1

Breast

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