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Implementation of Service Line System Optimizes Comprehensive Breast Cancer Care and Increases Rates of Breast Reconstruction: An 11-Year Review
Eric I. Chang, M.D.1, Stephanos Boukovalas, MD1, Richard J. Bleicher, MD1, David W. Chang, MD2.
1Fox Chase Cancer Center, Philadelphia, PA, USA, 2University of Chicago, Chicago, IL, USA.

PURPOSE: Comprehensive breast cancer treatment includes restoring the patient to her former self in addition to undergoing mastectomy surgery, chemotherapy, and radiation. We evaluate the system employed at a tertiary cancer center to provide reconstruction to all patients undergoing mastectomy.
METHODS: Retrospective review of all patients undergoing mastectomy surgery between January 2002 and December 2012 was performed. Patient demographics and rates of plastic surgery consultations were evaluated to assess frequency of breast reconstruction.
RESULTS: Overall, 554 out of 1314 patients (39.9%) underwent reconstruction after mastectomy with 305 (55.1%) undergoing autologous tissue reconstruction and 249 (44.9%) having implant reconstruction. The rates of breast reconstruction and plastic surgery referrals increased dramatically from 53.1% to 75.4% and from 53.8% to 93.8% respectively. Advanced age and stage of disease were significant predictors for not undergoing evaluation or reconstruction. Ethnicity was also a negative predictor for reconstruction during the study period. There were significant racial disparities during the first half of the study period with Caucasian (11.0%) and Asian (23.1%) women being more likely to undergo autologous tissue reconstruction compared to African-American (2.7%) or Hispanic (0%) women. These differences were no longer evident during the second half of the study after implementation of the Breast Surgery Service Line.
CONCLUSION: The Breast Surgery Service Line has increased rates of plastic surgery referrals and breast reconstruction above the national average. Implementation of similar programs at community hospitals and academic institutions provides additional avenues for improvement in order to increase rates of breast reconstruction to all patients.


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