Post-mastectomy immediate breast reconstruction trends in Ireland between 2005 and 2014.

Problem

Numerous published studies have proved the safety of undertaking breast reconstruction on the same day as mastectomy. This research proposed to examine various time trends of accessibility to undergo immediate breast reconstruction across Ireland compared to other countries.

Approach

National level datasets were retrieved from the Hospital In-Patient Enquiry database from 2005 to 2014. Estimated unadjusted and adjusted immediate reconstruction rates were explored in four defined Irish hospital regions considering patient age, year of breast surgery and the region where patients lived. Multivariable logistic regression analyses were used to assess the chances of undergoing tissue expander or flap reconstructions adjusted for year of surgery and the hospital region.

Findings

A total number of 8,849 women underwent breast surgery in Ireland throughout the study period. The overall immediate reconstruction rate was rising gradually from 10.6% in 2005 to 23.4% in 2014. Younger patients (< 40 years old – 40.9%; 40-49 years – 30.7%; 50-59 years – 22.5%) had a higher chance of undergoing immediate reconstruction than older patients (>60 years old – 9.9%) (p<0.001). Furthermore, both Dublin hospital regions (North East and Mid Leinster) have become major medical centres with the rates of undertaken mastectomies together with reconstruction of 28 and 37% in 2014, respectively, compared to the South (17%) and West (14%) regions (p<0.001). Additionally, tissue expander (27 – 49%) and myocutaneous flap (51 – 72%) reconstructive technique rates were prevailing over omental flap type (less 1%) during the whole study period (p<0.001).

Consequences

Despite the growing immediate reconstruction rates in Ireland, they still varied between the hospital regions. Joint work across hospitals is needed, to achieve equal access for all breast cancer patients, in the state, to mastectomies with immediate reconstruction.