title: Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons.
abstract: BACKGROUND
  Concern exists that plastic surgeons are performing fewer autologous and microsurgical breast reconstructions, despite superior long-term outcomes. The authors describe the proportion of U.S. plastic surgeons performing these procedures and evaluate motivating factors and perceived barriers.
  
  
  METHODS
  A random national sample of American Society of Plastic Surgeons members was surveyed (n = 325; response rate, 76 percent). Surgeon and practice characteristics were assessed, and two multiple logistic regression models were created to evaluate factors associated with (1) high-volume autologous providers and (2) microsurgical providers. Qualitative assessments of motivating factors and barriers to microsurgery were also performed.
  
  
  RESULTS
  Fewer than one-fifth of plastic surgeons perform autologous procedures for more than 50 percent of their breast cancer patients, and only one-quarter perform any microsurgical breast reconstruction. Independent predictors of a high-volume autologous practice include involvement with resident education (odds ratio, 2.57; 95 percent CI, 1.26 to 5.24) and a microsurgical fellowship (odds ratio, 2.09; 95 percent CI, 1.04 to 4.27). Predictors of microsurgical breast reconstruction include involvement with resident education (odds ratio, 6.8; 95 percent CI, 3.32 to 13.91), microsurgical fellowship (odds ratio, 2.4; 95 percent CI, 1.16 to 4.95), and high breast reconstruction volume (odds ratio, 6.68; 95 percent CI, 1.76 to 25.27). The primary motivator for microsurgery is superior outcomes, and the primary deterrents are time and reimbursement.
  
  
  CONCLUSIONS
  The proportion of U.S. plastic surgeons with a high-volume autologous or microsurgical breast reconstruction practice is low. Involvement with resident education appears to facilitate both, whereas time constraints and reimbursement are primary deterrents. Future efforts should focus on improving the feasibility and accessibility of all types of breast reconstruction.
authors.affiliation: Ann Arbor, Mich.; Raleigh-Durham, N.C.; and Atlanta, Ga. From the Section of Plastic Surgery, University of Michigan; the Section of Plastic Surgery, Duke University; and private practice.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Kulkarni
authors.forename: Erika Davis
authors.initials: ED
authors.lastname: Sears
authors.forename: Dunya M
authors.initials: DM
authors.lastname: Atisha
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D016462:Mammaplasty / Q000191:economics / Q000193:education / Q000379:methods*; D008408:Mastectomy; D008866:Microsurgery / Q000191:economics / Q000193:education / Q000706:statistics & numerical data*; D008875:Middle Aged; D009042:Motivation; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms; D013524:Surgical Flaps / Q000191:economics / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States