title: Analyzing Regional Differences over a 15-Year Trend of One-Stage versus Two-Stage Breast Reconstruction in 941,191 Postmastectomy Patients.
abstract: BACKGROUND
  Implant-based reconstruction is the predominant form of breast reconstruction, with the two-stage tissue expander/implant approach being the most popular. Recently, the direct-to-implant, one-stage breast reconstruction procedure has gained momentum. In this study, national and regional trends across the United States for the two different types of implant-based reconstructions were evaluated.
  
  
  METHODS
  The Nationwide Inpatient Sample database was used to extrapolate data on type of mastectomy, implant-based reconstructive technique (one-stage or two-stage), and sociodemographic and hospital variables. Differences were assessed using the chi-square test, impact of variables on reconstructive method was analyzed using logistic regression, and trends were analyzed using the Cochrane-Armitage test.
  
  
  RESULTS
  Between 1998 and 2012, a total of 1,444,587 patients treated for breast cancer or at increased risk of breast cancer met the defined selection criteria. Of these, 194,377 patients underwent implant-based breast reconstruction (13.6 percent one-stage and 86.4 percent two-stage). In both, there was a significant increase in procedures performed over time (p < 0.001). The highest increase in both was seen in the Northeast region of the United States, and the lowest increase was seen in the South. When stratified into regions, analysis showed differences in socioeconomic and hospital characteristics within the different regions.
  
  
  CONCLUSIONS
  There is an observed increase in the number of one-stage and two-stage breast reconstructions being performed. Sociodemographic and hospital factors of influence vary in the different regions of the United States. This study provides important information for clinicians and policy makers who seek to ensure equitable and appropriate access for patient to the different types of implant-based procedures.
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Parisa
authors.initials: P
authors.lastname: Kamali
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Pieter G L
authors.initials: PGL
authors.lastname: Koolen
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Ahmed M S
authors.initials: AMS
authors.lastname: Ibrahim
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Marek A
authors.initials: MA
authors.lastname: Paul
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Rieky E
authors.initials: RE
authors.lastname: Dikmans
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.affiliation: Boston, Mass.; Amsterdam, The Netherlands; and New Orleans, La.|From the Divisions of Plastic and Reconstructive Surgery and Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; the Division of Plastic Reconstructive and Hand Surgery, VU Medical Center; and the Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants; D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013524:Surgical Flaps; D015625:Tissue Expansion Devices