title: Breast reconstruction in Nova Scotia: Rate, trends and influencing factors.
abstract: BACKGROUND
  During their lifetime, approximately 10% of Canadian women will develop breast cancer. An increased awareness of breast reconstruction in patients undergoing mastectomy appears to have increased the demand for breast reconstructive surgery.
  
  
  OBJECTIVE
  To study the rate of breast reconstructive surgeries performed in the province of Nova Scotia to determine whether the breast reconstructive services now offered are adequate to meet the needs of the population of this area.
  
  
  METHODS
  The number of breast reconstruction procedures and mastectomies completed in the province of Nova Scotia during the time period of 1992 to 2001 was reviewed. The data were obtained from Maritime Medical Care Incorporated, the provincial medical plan. Information available on patients coded as undergoing breast surgeries was reviewed (n=10,056). The data on the trends and demographics of the Nova Scotia population were obtained from Statistics Canada. The data on incidence, prevalence and trends of breast cancer were obtained from the Canadian Cancer Society and the National Cancer Institute of Canada.
  
  
  CONCLUSIONS
  There is strong evidence of an increasing trend in the number of reconstructive surgeries among the women who underwent mastectomy. The number of breast reconstruction procedures increased 15 fold during the study period. This is mainly attributed to the increased awareness of women undergoing mastectomy and improved education by surgeons, family physicians and breast cancer support groups. Health sector employees must evaluate these trends to determine if the breast reconstructive services currently offered in this region are adequate. Reconstructive surgery was negatively associated with increasing age. Place of residency (urban versus rural) seems to play a role in women's decisions to proceed with breast reconstruction.
authors.affiliation: Departments of Internal Medicine, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Edvin B
authors.initials: EB
authors.lastname: Koshi
authors.forename: Pantelis
authors.initials: P
authors.lastname: Andreou
authors.forename: Steven F
authors.initials: SF
authors.lastname: Morris
keywords: Breast cancer; Breast reconstruction; Mastectomy