title: Disparities associated with breast reconstruction in Japan.
abstract: BACKGROUND
  With increasing rates of postmastectomy breast reconstruction, it has been suggested that there is an insufficient supply of services that meet patient demands. This study aimed to identify potential disparities in, and variables associated with, postmastectomy reconstruction in Japan.
  
  
  METHODS
  Using 20,257 Japanese breast cancer discharge data from 2010, the authors identified 1616 breast cancer patients, with tumor-node-metastasis classification of malignant tumors T1~4 and N0M0, between 20 and 59 years of age. Factors influencing the use of immediate breast reconstruction of either autogenous tissue or tissue expander placement were analyzed using multinomial logistic regression comparing no reconstruction to either autogenous tissue or tissue expander placement.
  
  
  RESULTS
  The immediate breast reconstruction rate was 11.2 percent among the study patients. The rate of autogenous method use was 49 percent and the rate of tissue expander use was 51 percent. Tissue expander placement was performed primarily in patients who resided in cities (OR, 2.4; 95 percent confidence interval, 1.5 to 4.1) and was performed at city hospitals. Patients who lived in rural areas primarily underwent autogenous tissue reconstruction, traveled to city hospitals to undergo surgery (OR, 2.0; 95 percent confidence interval, 1.0 to 4.0), and had normal body mass index (OR, 1.9; 95 percent confidence interval, 1.1 to 3.1).
  
  
  CONCLUSIONS
  The authors identified potential disparities associated with breast reconstruction. These disparities might be due to limited surgery methods and might have excluded some patients because of their age, physical, and economic status. Uneven distribution of plastic surgeons might have required patients to travel for breast reconstruction.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Tokyo, Japan From the Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School.
authors.forename: Ayako
authors.initials: A
authors.lastname: Oda
authors.forename: Hiroyo
authors.initials: H
authors.lastname: Kuwabara
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000556:secondary / Q000601:surgery*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D016462:Mammaplasty / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data; D008875:Middle Aged; D018579:Patient Selection; D012424:Rural Population / Q000706:statistics & numerical data; D013524:Surgical Flaps / Q000706:statistics & numerical data*; D015625:Tissue Expansion Devices / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult