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How Do We Perform Breast Reconstruction? Current National Trends Based on the Latest Timeframe of the Nationwide Inpatient Sample Database (NIS 2008- 2012) in 201,195 Patients
Marek A. Paul, MD, Pieter G. Koolen, MD, Ahmed M. Ibrahim, MD, Jinesh Shah, Medical Student, Bernard T. Lee, MD, MBA, Samuel J. Lin, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

Purpose
The incidence of breast cancer cases increased from 182,460 cases in 2008 to 226,870 new cases in 2012. Hence, breast reconstructive procedures follow this trend constituted both by autologous and implant based reconstructions. This study aims to assess the incidence of specific reconstructive procedures in order to identify the most up-to-date nationwide trends in breast reconstruction.
Methods
A retrospective review of all patients undergoing autologous, implant based or combined procedures was performed using the HCUP Nationwide Inpatient Sample database (2008-2012). Additionally, subgroup analysis was done to assess trends in the incidence of pedicled LD flaps, pedicled TRAM flaps, free TRAM flaps, DIEP flaps, SIEA flaps and GAP flaps (2008-2012). Furthermore, reconstruction trends were plotted and regional trends, patient comorbidities, and complications determined.
Results
Among 201,195 patients included in our study, implant based breast reconstruction remains the most frequently performed procedure. The most prevalent autologous breast reconstructive procedure nationwide is based on the use of the LD flap (n=18,957), followed by DIEP flap reconstruction (n=17,854) (Figure 1). Interestingly, subset analysis showed a 5% decrease in the overall incidence of reconstructive procedures performed in 2012.
Conclusion
Epidemiologic analysis of autologous breast reconstructions identifies the most important procedural, geographical and patient characteristics. Latissumus dorsi based autologous breast reconstruction still predominates. Approximately a third of all reconstructions were performed in Southern United States.


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