Immediate breast reconstruction among patients with Medicare and private insurance: A matched cohort analysis

Parisa Kamali, Joseph A. Ricci, Daniel A. Curiel, Justin B. Cohen, Anmol Chattha, Hinne A. Rakhorst, Bernard T. Lee, Samuel J. Lin

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: By eliminating economic hurdles, the Women's Health and Cancer Rights Act of 1998 represented a paradigm shift in the availability of breast reconstruction. Yet, studies report disparities among Medicare-insured women. These studies do not account for the inherent differences in age and comorbidities between a younger privately insured and an older Medicare population. We examined immediate breast reconstruction (IBR) utilization between a matched pre- and post-Medicare population. Methods: Using the Nationwide Inpatient Sample database (1992-2013), breast cancer patients undergoing IBR were identified. To minimize confounding medical variables, 64-year-old privately insured women were compared with 66-year-old Medicare-insured women. Demographic data, IBR rates, and complication rates were compared. Trend over time was plotted for both cohorts. Result: A total of 21,402 64-year-old women and 25,568 66-year-old women were included. Both groups were well matched in terms of demographic type of reconstruction and complication rates. 72.3% of 64-year-old and 71.2 of % 66-year-old women opted for mastectomy. Of these, 25.5% (n = 3,941) of 64-year-old privately insured and 17.7% (n = 3,213) of 66-year-old Medicare-insured women underwent IBR (P < 0.01). During the study period, IBR rates increased significantly in both cohorts in a similar cohort. Conclusion: This study demonstrates significant increasing IBR rates in both cohorts. Moreover, after an initial slower upward trend, after a decade, IBR in 66-year-old Medicare-insured women approached similar rates of breast reconstruction among those with private insurance. Trends in unilateral versus bilateral mastectomy are also seen.

Original languageEnglish (US)
Article numbere1552
JournalPlastic and Reconstructive Surgery - Global Open
Issue number1
StatePublished - 2018

ASJC Scopus subject areas

  • Surgery

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