title: A 35-Year Evolution of Free Flap-Based Breast Reconstruction at a Large Urban Academic Center.
abstract: BACKGROUND
  This study aims to characterize the evolution and trends in free flap breast reconstruction at our institution.
  
  
  METHODS
  The authors reviewed and analyzed a registry of free flap breast reconstructions performed at a large urban academic center.
  
  
  RESULTS
  Between 1979 and mid-2014, a total of 920 patients underwent breast reconstruction with 1,254 flaps. The mean age was 47.7 years (range, 16-79 years). Over the past 10 years, patients were older than all patients seen in the prior decade (average age 48.9 vs. 46.1 years, p = 0.002). Overall, 82% of flaps were performed at our university hospital, 17% at a major urban county hospital, and < 1% at other sites. A total of 99% patients received postmastectomy reconstruction for an existing cancer diagnosis or prophylaxis. There has been a significant increase in reconstructions, with 579 flaps performed over the past 5 years alone. There has been a fundamental shift in the predominant flap of choice over time. Perforator flaps have increased in popularity at our institution, with 74% of all reconstructions over this past 5 years being perforator based. Perforator flaps were more likely to be chosen over nonperforator flaps in older versus younger patients (p = 0.0008). There has been a steady increase in bilateral reconstructions since the first one was performed in 1987 (p = 0.002).
  
  
  CONCLUSIONS
  Over the past 35 years, our institution has seen a significant evolution in free flap-based breast reconstruction. Besides a massive increase in flap numbers we have seen a significant trend toward bilateral reconstructions and perforator-based flaps.
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Rohini
authors.initials: R
authors.lastname: Kadle
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Joshua
authors.initials: J
authors.lastname: Cohen
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Hambley
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gomez-Viso
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Rifkin
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Allen
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Nolan
authors.initials: N
authors.lastname: Karp
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Pierre
authors.initials: P
authors.lastname: Saadeh
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ceradini
authors.affiliation: New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, New York.
authors.forename: Jamie
authors.initials: J
authors.lastname: Levine
authors.affiliation: Department of Surgery, Division of Plastic and Reconstructive Surgery, Mount Sinai Health System and Icahn School of Medicine, New York, New York.
authors.forename: Tomer
authors.initials: T
authors.lastname: Avraham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D016462:Mammaplasty / Q000706:statistics & numerical data* / Q000639:trends; D008408:Mastectomy / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D061525:Perforator Flap; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D013524:Surgical Flaps; D019037:Urban Health Services / Q000639:trends*; D014505:Urban Population; D055815:Young Adult