August 2016 #PRSJournalClub Wrap-Up: Distance to a Plastic Surgeon and Type of Insurance Plan Are Independently Predictive of Postmastectomy Breast Reconstruction

by Mark Fisher, MD (@DrMarkFisher)

August brought with it another excellent #PRSJournalClub, this time focused on access to care. Roughton et al. used a linked data set combining a state cancer registry with insurance claims to study the variables that predict likelihood of reconstruction after mastectomy. They focused on geographical distance to a plastic surgeon in addition to other variables such as demographics, insurance, and timing of reconstruction.

Overall, they looked at 5381 patients who met their inclusion criteria. Of those, only 20% underwent postmastectomy reconstruction. Interestingly, the authors found that distance to a breast reconstructive surgeon was significantly and independently associated with receipt of reconstruction. Specifically, woman living 10-20 miles from a plastic surgeon has 22 percent lower odds of undergoing and reconstruction, and women living 20+ miles from a plastic surgeon had 27% lower odds when compared to women living less than 10 miles away.

In addition, Roughton et al.  discovered that women with federally funded health care also had significantly lower odds of undergoing reconstruction compared to women with private insurance. Their study also reinforced prior data that showed that minority women were less likely to undergo breast reconstruction compared to non-Hispanic whites.


An expert discussion by Dr. Amy Alderman provided an interesting and in-depth discussion touching on some of the political factors as well as questioning what changes may have occurred since 2006 (the endpoint of the study data).

The article was also supplemented by a video discussion by Dr. Rod Rohrich (@DrRodRohrich), which helped to launch the discussion on Twitter.


Some outstanding tweets:



And a great Q&A:

Jordan Frey: @mroughtonmd Excellent&important paper! How can we better reach out to breast surgeons in community?

Michelle Roughton:@JordanFreyMD Partner with nearby surgeons. Encourage patients to stay local for what they can: chemo, XRT, mastectomy. Stage recon 1-2weeks

Amanda K Silva:@mroughtonmd any tips to ensure good communication w/ outside physicians?

Michelle Roughton:@AmandaKSilvaMD Keep it simple. 3As: Available, Affable, Able…& I give them my cell #.

Raj Sawh-Martinez:@PaulDiegidio Do you think part of the solution is to bring plastic surgeons to rural areas?

Dr.PD: :@docrfsm Until there are more of us, I think Telemedicine consults may be more efficacious

Nima Khavanin: Is there a role 4 new fed/state policy in overcoming obstacles (distance or otherwise) to recon?

Michelle Roughton: @NimaKhavanin Patient education will drive change in access to #BreastReconstruction

Sammy Sinno: @PaulDiegidio do you think disparities will worsen or improve over time?

Dr.PD: @sammysinnoMD Gradually improve. Recon rates have doubled in NC last 10yrs. Education and outreach for the win!

Pallab Chatterjee: @mroughtonmd Did you feel that distance as a factor was counter intuitive given that reputation of centres drive surgeries?

Michelle Roughton:@pallabc Not at all, many folks don’t want to/can’t afford travel to “big city”.

All past Journal Club podcasts are available here.

The next Journal Club podcast will be September 18th and 19th.


Make sure your crew is geared up for #PSTM16 with PRS, PRS Global Open, and PRS Journal Club Apparel!!

Get yours today at:


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