Plastic surgery market share of breast reconstructive procedures: An analysis of two nationwide databases Journal Article

   


Authors: Rochlin, D. H.; Matros, E.; Shamsunder, M. G.; Rubenstein, R.; Nelson, J. A.; Sheckter, C. C.
Article Title: Plastic surgery market share of breast reconstructive procedures: An analysis of two nationwide databases
Abstract: Background and Objectives: Given advances that streamline breast reconstruction (e.g., prepectoral placement, acellular dermal matrix [ADM], oncoplastic surgery), there is concern that nonplastic surgeons are performing a growing proportion of breast reconstructive procedures. The purpose of this study was to evaluate US trends in the market share of breast reconstruction performed by plastic compared to general surgeons. Methods: IBM® MarketScan® Commercial Claims 2006–2017 and NSQIP 2005–2020 were queried to identify women who underwent mastectomy with alloplastic (tissue expander or implant-based) or free flap reconstruction, or lumpectomy with oncoplastic reconstruction (breast reduction, mastopexy, or local/regional flap). MarketScan included immediate and delayed reconstructions, while all NSQIP reconstructions were immediate. Poisson regression with incident rate ratios (IRRs) modeled trends in surgeon type over time. Results: The cohort included 65 168 encounters from MarketScan and 73 351 from NSQIP. Plastic surgeons performed 95.8% of free flap, 93.8% of alloplastic, and 64.9% of oncoplastic reconstructions. Plastic surgeons performed an increasing proportion of immediate oncoplastic reduction and mastopexy (MarketScan IRR: 1.077, 95% confidence interval [CI]: 1.060–1.094, p < 0.001; NSQIP IRR: 1.041, 95% CI: 1.030–1.052, p < 0.001). There were no clinically significant trends for delayed oncoplastic, alloplastic, or free flap reconstructions. Plastic surgeons were more likely to use ADM compared to general surgeons in NSQIP (p < 0.001). Conclusions: Plastic surgeons gained market share in immediate oncoplastic breast reduction and mastopexy over the past two decades without any loss in alloplastic or free flap breast reconstruction. Plastic surgeons should continue collaboration with breast surgical oncologists to reinforce the shared surgeon model for management of breast cancer. © 2023 Wiley Periodicals LLC.
Keywords: adult; controlled study; human tissue; major clinical study; plastic surgery; comparative study; mastectomy; incidence; cohort analysis; breast reconstruction; data base; total quality management; surgeon; free tissue graft; breast reduction; lumpectomy; trends; collaboration; implant reconstruction; plastic surgeon; human; female; article; poisson regression; oncoplasty; free flap reconstruction; oncoplastic reconstruction; oncoplastic reduction; plastic surgery market share
Journal Title: Journal of Surgical Oncology
Volume: 128
Issue: 7
ISSN: 0022-4790
Publisher: Wiley Blackwell  
Date Published: 2023-12-01
Start Page: 1064
End Page: 1071
Language: English
DOI: 10.1002/jso.27398
PUBMED: 37439094
PROVIDER: scopus
PMCID: PMC10592339
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165128916&doi=10.1002%2fjso.27398&partnerID=40&md5=31414e41b5ec574bb219e73db1ebcdc6
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Danielle H. Rochlin -- Source: Scopus
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MSK Authors
  1. Evan Matros
    202 Matros
  2. Jonas Allan Nelson
    209 Nelson
  3. Meghana G Shamsunder
    43 Shamsunder
  4. Robyn Rubenstein
    26 Rubenstein
  5. Danielle Helena Rochlin
    18 Rochlin
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