title: Diminishing relative contraindications for immediate breast reconstruction: a multicenter study.
abstract: BACKGROUND
  During the past decade, there has been a rise in US breast reconstruction rates, with a greater expansion in prosthetic-based techniques relative to autologous transfer. Immediate reconstruction in high-risk oncologic and surgical patients might be a contributing factor to these trends.
  
  
  METHODS
  The National Cancer Data Base from the American College of Surgeons and the American Cancer Society was used to identify a breast cancer cohort (1998 to 2011) treated with mastectomy. The patients were divided into high risk and low risk based on presence or absence of historic surgical or oncologic relative contraindications. Reconstructions were categorized as either autologous or implants. To understand trends for each high-risk characteristic, rates were adjusted by 1,000 total mastectomies performed for patients within each specific group and analyzed with Poisson regression.
  
  
  RESULTS
  Information from 1,040,088 patients with mastectomy was included. Rates of high-risk features did not change from 1998 to 2011. The increase in immediate reconstruction rates was greater for high-risk than low-risk patients (incidence rate ratio = 1.09 vs 1.06; p < 0.05 for both). There was a greater rate increase in implant than autologous reconstructions for both high-risk and low-risk groups. For high-risk patients, implant use increased for all features, but with the greatest change for elderly, comorbidities, and post-mastectomy radiotherapy (p < 0.01). For high-risk patients, autologous tissue use increased significantly for all features except pre-mastectomy radiotherapy.
  
  
  CONCLUSIONS
  Breast reconstruction increased in high-risk surgical and oncologic patients, suggestive of a diminishing set of relative contraindications. Increased implant use in high-risk patients might be a contributing factor toward the preferential national expansion of prosthetic techniques.
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Albornoz
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Cordeiro
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Pusic
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCarthy
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Babak J
authors.initials: BJ
authors.lastname: Mehrara
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Disa
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. Electronic address: matrose@mskcc.org.
authors.forename: Evan
authors.initials: E
authors.lastname: Matros
mesh_terms: D018427:Breast Implants / Q000639:trends*; D001943:Breast Neoplasms / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000639:trends*; D008408:Mastectomy; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology