title: National and Regional Differences in 32,248 Postmastectomy Autologous Breast Reconstruction Using the Updated National Inpatient Survey.
abstract: BACKGROUND
  The incidence of breast cancer (BC) cases has increased significantly. The number of breast reconstruction (BR) procedures performed has mirrored this trend. Although implant-only procedures remain the most commonly used type of immediate BR, autologous techniques involving donor sites account for approximately 20%. The aim of this study was to assess national and regional trends in different types of autologous BR.
  
  
  METHODS
  Using the Nationwide Inpatient Sample database (2008 to 2012), data on BC and mastectomy rates, type of autologous BR, and sociodemographics were obtained and analyzed. Furthermore, national and regional trends over time for autologous BR were plotted and analyzed.
  
  
  RESULTS
  A total of 427,272 patients diagnosed with BC or at increased risk of BC were included in the study. A total of 343,163 (80.3%) patients underwent mastectomy and, within this group, 148,700 (43.3%) patients underwent immediate BR. Of these, 32,249 (21.7%) patients underwent an autologous BR (not solely implant based) and 118,258 (78.3%) implant-based BR. Most autologous BRs were performed in the Southern region (37.4%). When stratified into flap types, most pedicled transverse rectus abdominis muscle (TRAM), free TRAM, and other flaps were performed in the Northeast region, whereas most deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps were performed in the Southern region. Subgroup analysis demonstrated a significant increasing trend for both LD and DIEP flaps, both nationally (P < 0.001) and regionally (P < 0.001). Pedicled TRAM and free TRAM reconstructions decreased significantly both on national and regional level.
  
  
  CONCLUSIONS
  Autologous BR demonstrated a significant positive trend over time in the Southern region (P < 0.001). The DIEP and LD flaps increased significantly over time, both nationally and regionally.
authors.affiliation: From the *Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; †T. Marciniak Lower Silesian Specialist Hospital, Wroclaw, Poland; ‡Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA; §Department of Plastic and Reconstructive Surgery, VU Medical Center, Amsterdam, the Netherlands; and ∥Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Parisa
authors.initials: P
authors.lastname: Kamali
authors.forename: Marek A
authors.initials: MA
authors.lastname: Paul
authors.forename: Ahmed M S
authors.initials: AMS
authors.lastname: Ibrahim
authors.forename: Pieter G L
authors.initials: PGL
authors.lastname: Koolen
authors.forename: Winona
authors.initials: W
authors.lastname: Wu
authors.forename: Marc L
authors.initials: ML
authors.lastname: Schermerhorn
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014182:Transplantation, Autologous; D014481:United States