Documenting patterns of breast reconstruction in Australia: The national picture

• Innovative mapping highlights gaps in services by showing where BR is and is not available.
• Uses best available hospital-level data on national BR prevalence and distribution.
• Demonstrated statistically significant differences in BR uptake between jurisdictions.
• BR is more likely in younger women and in private hospitals, and less likely in remote areas.
• Provides baseline data to explore the role of limited access in BR uptake variation.

IntroductionDifferences in national health data collection systems preclude accurate assessments of how much breast reconstruction (BR) is performed in Australia. This paper aims to quantitatively document and visually map the national prevalence and distribution of BR, using the best available evidence.Materials and methodsQuantitative analysis and spatial mapping of hospital-level data on BR prevalence in all six Australian states and two mainland territories. Data was extracted on 3786 women, under the care of members of Breast Surgeons of Australia and New Zealand Incorporated, who had mastectomy for breast malignancy with or without post-mastectomy BR in 2013.ResultsAnalysis revealed a national BR rate of 18.3%. Statistically significant differences in BR uptake (p < .0001) were found between jurisdictions [χ2 (df = 7) = 284.29], with BR more likely in younger women [χ2 (df = 14) = 395.62] and in private hospitals (χ2 = 63.99) and less likely in remote areas [χ2 (df = 4) = 66.49].ConclusionAnalysis of this substantial subset of Australian women requiring mastectomy for breast cancer has demonstrated significant variation in provision or uptake of BR across four important variables. As BR has been shown to provide long-term survivorship benefits for the growing number of women living longer following mastectomy for breast cancer, there is an urgent need to ensure BR is accessible and affordable for all women who choose this option.