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AAPS 85th Annual Meeting
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Ten Year Evaluation of 18,690 Patients Undergoing Mastectomy: The Impact of Community Factors on Access to Immediate Breast Reconstruction following Mastectomy in the State of Maryland
Gedge D. Rosson, MD, Navin K. Singh, MD, Nita Ahuja, MD, Lisa Jacobs, MD, David C. Chang, PhD, MPH, MBA.
Johns Hopkins University, Baltimore, MD, USA.

PURPOSE: Immediate breast reconstruction following mastectomy has been shown to positively impact the psychological well-being of patients. We sought to determine whether various individual patient characteristics and various characteristics of the neighborhood in which the patient lives would influence access to immediate breast reconstruction.
METHODS: A retrospective analysis of a prospectively collected observational database was performed, querying the Maryland hospital discharge database for all ICD-9 procedure codes which could describe mastectomy and immediate breast reconstruction within the same hospitalization for all patients in the state from January 1995 through December 2004. We analyzed patient and community factors and the likelihood of immediate breast reconstruction for those patients requiring mastectomy.
RESULTS: 18,690 patients required mastectomy in Maryland. 26% had immediate breast reconstruction. Increasing income and population density of the city in which the patient lives had a statistically significant positive impact. Black race, increasing age, increasing percentage of the patient’s neighborhood with a high school education or less, and increasing African-American composition of the patient’s neighborhood had a negative impact. The racial mix and educational level of the patient’s neighborhood were both independent of the race and income of the individual patient.
CONCLUSIONS: This type of analysis combining both individual patient factors and community factors has not been previously reported for a breast cancer cohort of this size. Prospective public health measures, including educational and informative programs, can be developed and implemented to address these disparities and increase the likelihood of patients with breast cancer and mastectomy obtaining immediate reconstruction.

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