Uptake and predictors of post-mastectomy reconstruction in women with breast malignancy – Systematic review
Abstract
Purpose There is enormous range in the reported rates of breast reconstruction. This study explored reasons for this variation by reviewing the published literature to examine rates of reconstruction, factors associated with uptake, and possible barriers.Methods A systematic review of the literature was performed. Eligible studies reported rates of breast reconstruction and variables associated with uptake in women undergoing mastectomy for early invasive or in situ breast malignancy.Results Twenty-eight eligible studies were included, reporting 159,305 cases of breast reconstruction in 940,678 women. In these studies 16·9% of women underwent immediate or delayed reconstruction (range 4·9-81·2%, median 23·3%). Variables associated with reconstruction were: patient/tumour factors (early stage, no adjuvant therapy, young age, white race, private insurance, higher education/income), surgeon/hospital factors and psychological/other factors (including patient choice).Conclusion Rates of breast reconstruction were highly variable. Reconstruction appeared to be offered to a minority of women; around half took up the offer. The main reasons reported for no reconstruction included patient-related and adjuvant therapy-related factors. Clinicians' beliefs about reconstruction may be an important factor. Rates of reconstruction could be increased with early discussion of the options when mastectomy is chosen or required.
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Breast reconstruction is not accepted by many women due to a multitude of factors.
“However, breast reconstruction is not accepted by many women due to a multitude of factors.”
From Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review. (2023) · cites this paper as [34]
Multiple barriers are associated with breast reconstruction, with prominent factors being age, ethnicity, income, educational status, and patient choice.
“There are multiple barriers associated with breast reconstruction with prominent factors being age, ethnicity, income, educational status, and patients choice. 34”
From Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review. (2023) · cites this paper as [34]
Reconstruction rates are highly variable in women.
“A systematic review conducted on the same observed the reconstruction rates are highly variable in women.”
From Coping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review. (2023) · cites this paper as [34]
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Kim, M., Ali, B., Zhang, K. M., Vingan, P. S., Boe, L. A., Ly, C. L., Allen, R. J., Stern, C. S., Matros, E., Cordeiro, P. G., et al. (2024) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000011554 · Cited by 16 · see citing works
Trends in Post-Mastectomy Reconstruction in an Asian Population: A 12-Year Institutional Review
Ng, Y. Y. R., Tan, V. K. M., Goh, T., Yong, W. S., Wong, C. Y., Ho, G. H., Madhukumar, P., Ong, K. W., Ong, Y. S., Sim, Y., et al. (2016) · The Breast Journal · doi:10.1111/tbj.12682 · Cited by 16 · see citing works
“Being retrospective in nature, we were unable to determine the influence of factors such as personal choice, socioeconomic status, and physician bias—common factors that have been reported to determine the uptake of post-mastectomy reconstruction in other studies (6,7,9,19,36).”
van Bommel, A. C. M., Schreuder, K., Veenstra, R. K., de Ligt, K. M., Peeters, M.-J. T. F. D. V., Maduro, J. H., Siesling, S., & Mureau, M. A. M. (2018) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000001572 · Cited by 16 · see citing works
Update on the management of early-stage breast cancer
Heilat, G. B., Brennan, M. E., & French, J. (2019) · Australian Journal of General Practice · doi:10.31128/ajgp-03-19-4891 · Cited by 16 · see citing works
Self-citationPerera, S. K., Jacob, S., Sullivan, R. J., & Barton, M. B. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(20)30589-1 · Cited by 16 · see citing works
Archer, S., Holland, F., & Montague, J. (2016) · Journal of Health Psychology · doi:10.1177/1359105316664135 · Cited by 16 · see citing works
“A recent systematic review showed that international BR rates range from 4.9 to 81.2 per cent (Brennan and Spillane, 2013).”
BackgroundInfluentialCoping in Post-Mastectomy Breast Cancer Survivors and Need for Intervention: Systematic Review.
Mishra, A., Nair, J., & Sharan, A. M. (2023) · Breast Cancer Basic and Clinical Research · doi:10.1177/11782234231209126 · Cited by 15 · see citing works
“34 Psychological intervention before surgery has been highlighted as a useful method in this review.”
MethodMethodological quality is underrated in systematic reviews and meta-analyses in health psychology
Oliveras, I., Losilla, J.-M., & Vives, J. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.05.002 · Cited by 15 · see citing works
Metcalfe, K. A., Semple, J. L., Quan, M., Holloway, C. M. B., Wright, F. C., Narod, S. A., Hofer, S. O. P., Bagher, S., & Zhong, T. (2017) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000002943 · Cited by 15 · see citing works
Improved immediate breast reconstruction as a result of oncoplastic multidisciplinary meeting
El-Gammal, M., Lim, M., Uppal, R. S., & Sainsbury, R. (2017) · Breast Cancer Targets and Therapy · doi:10.2147/bctt.s133800 · Cited by 13 · see citing works
“Rates of reconstruction could be increased with early discussion of the options when mastectomy is chosen or required.(4) Multidisciplinary team (MDT) working is considered as the “gold standard” in terms of cancer patient management.”
Soon, P. S. H., Karimi, N., Wu, V. S., & Girgis, A. (2019) · Ethnicity and Health · doi:10.1080/13557858.2019.1693513 · Cited by 13 · see citing works
“Decision-making about breast reconstruction is complex (Brennan and Spillane 2013) and mostly emotional (Crompvoets 2006) for women who have had or will have mastectomy for breast cancer.”
BackgroundOgrodnik, A., MacLennan, S. E., Weaver, D. L., & James, T. A. (2016) · Journal of Cancer Education · doi:10.1007/s13187-016-1046-x · Cited by 13 · see citing works
Cheng, T., Causarano, N., Platt, J., Jones, J. M., Hofer, S. O. P., O’Neill, A. C., & Zhong, T. (2018) · Cogent Social Sciences · doi:10.1080/23311886.2018.1479478 · Cited by 12 · see citing works
“…factors including age, education, ethnicity, socioeconomic status, access to plastic surgeons, risks and benefits associated with various surgical options, costs, distance to the hospital, and personal preferences and values (Brennan & Spillane, 2013; Manne et al., 2016; Sherman et al., 2016).”
BackgroundHeeg, E., Jensen, M., Mureau, M. A. M., Ejlertsen, B., Tollenaar, R. A. �. �., Christiansen, P., & Peeters, M.-J. T. F. D. V. (2020) · Breast Cancer Research and Treatment · doi:10.1007/s10549-020-05725-z · Cited by 12 · see citing works
“Nonetheless, previous research has shown substantial variation in postmastectomy IBR rates between hospitals in the Netherlands and other countries, unexplained by patient and tumor characteristics [15, 36, 37].”
ResultAljaaly, H. A., Mortada, H. H., & Trabulsi, N. H. (2021) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000003750 · Cited by 12 · see citing works
Couples’ Experience of the Decision-Making Process in Breast Reconstruction After Breast Cancer
Lamore, K., Vioulac, C., Fasse, L., Flahault, C., Quintard, B., & Untas, A. (2019) · Cancer Nursing · doi:10.1097/ncc.0000000000000708 · Cited by 12 · see citing works
“6% of women were offered BR after mastectomy.(42) In our study, the words used by women WBR highlight concerns about mastectomy and BR, the treatments and their side effects, and/or about the medical care.”
Angarita, F. A., Dossa, F., Zuckerman, J., McCready, D. R., & Cil, T. D. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05273-1 · Cited by 12 · see citing works
Li, X., Meng, M., Yang, D., Zhang, J., Zhang, X., Zhao, J., Yin, Y., Xue, P., & Hao, Y. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.108102 · Cited by 11 · see citing works
The International Awareness of Breast Reconstruction
Alsubhi, F., Alothman, M. A., & Alhadlaq, A. I. (2023) · Plastic & Reconstructive Surgery Global Open · doi:10.1097/gox.0000000000005417 · Cited by 9 · see citing works
Smeele, H. P., Dijkstra, R. C. H., Kimman, M., van der Hulst, R. R. W. J., & Tuinder, S. M. H. (2022) · Patient · doi:10.1007/s40271-021-00565-5 · Cited by 9 · see citing works
“In countries where breast reconstruction is relatively accessible—such as the Unites States, Australia, Japan, and several European countries—the non-weighted average uptake after therapeutic mastectomy is 17% [64].”
BackgroundStem cell and tissue engineering in breast reconstruction.
Techanukul, T., & Lohsiriwat, V. (2014) · PubMed Central · doi:10.3978/j.issn.2227-684x.2014.02.11 · Cited by 9 · see citing works
Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital
McCamley, C., Mills, C. D., Chow, Y., Ross, D. A., & Fox, J. G. (2020) · ANZ Journal of Surgery · doi:10.1111/ans.16335 · Cited by 8 · see citing works
“Breast cancer in Australia is a common disease, representing 28% of all cancers affecting women.1 Research suggests that 40% of women diagnosed with breast cancers are treated with mastectomy,2,3 a procedure that can cause a significant grief process for many women.4 It is well recognized that immediate breast reconst…”
BackgroundResultInfluentialAutologous tissue reconstruction after mastectomy–A cross-sectional survey of 110 hospitals in China
Wang, J., Xiu, B., Guo, R., Zhang, Q., Su, Y., Li, L., Chi, W., Shao, Z., & Wu, J. (2020) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2020.07.008 · Cited by 8 · see citing works
McKevitt, E. C., Kuusk, U., Dingee, C. K., Warburton, R., Pao, J., Laeken, N. V., & Bovill, E. S. (2019) · Annals of Surgical Oncology · doi:10.1245/s10434-019-07216-y · Cited by 7 · see citing works
What affects women’s decision-making on breast reconstruction after mastectomy for breast cancer?
van Bekkum, S., Clarijs, M. E., van der Veen, F. J. C., van Rosmalen, J., Koppert, L. B., & Menke‐Pluijmers, M. B. E. (2023) · Breast Cancer · doi:10.1007/s12282-023-01471-4 · Cited by 7 · see citing works
“Taking into account the available sample size, we selected these three variables as a consensus of known characteristics that often differed between reconstruction and non-reconstruction patients (based on existing literature [16, 21, 25, 26]) and significant differences found in our study population.”
MethodHeilat, G. B., Brennan, M. E., Kanesalingam, K., Sriram, N., Meybodi, F., & French, J. (2019) · ANZ Journal of Surgery · doi:10.1111/ans.15596 · Cited by 7 · see citing works
Self-citationBarriers to Post-Mastectomy Breast Reconstruction: A Comprehensive Retrospective Study
Vangsness, K. L., Cornely, R. M., Sam, A., Munabi, N. C. O., Chu, M., Agko, M., Chang, J., & Carré, A. L. (2025) · Cancers · doi:10.3390/cancers17122002 · Cited by 6 · see citing works
Bajonero-Canónico, P., Ferrigno, A. S., Saldaña-Rodríguez, J. A., Hinojosa-Gonzalez, D. E., de la O-Maldonado, C. G., Cruz, C., Moreno‐Jaime, B., Hernandez-Pavon, M., de la Rubia, J. M., Ávila, M. M., et al. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05784-4 · Cited by 6 · see citing works
Gong, F., Ding, L., Chen, X., Yao, D., Wu, Y., Xie, L., Ouyang, Q., Wang, P., & Niu, G. (2018) · Aesthetic Plastic Surgery · doi:10.1007/s00266-018-1171-5 · Cited by 6 · see citing works
Lamore, K., Quintard, B., Flahault, C., van Wersch, A., & Untas, A. (2016) · Bulletin du Cancer · doi:10.1016/j.bulcan.2016.03.011 · Cited by 6 · see citing works
Yin, Z., Wang, Y., Sun, J., Huang, Q., Liu, J., He, S., Han, C., Wang, S., Ding, B., & Yin, J. (2019) · Cancer Medicine · doi:10.1002/cam4.2133 · Cited by 6 · see citing works
Altinok, A., Beşe, N., Kara, H., Yazar, Ş., & Unal, C. (2018) · Współczesna Onkologia · doi:10.5114/wo.2018.74390 · Cited by 5 · see citing works
“For this reason, early implant utilization rates are still very low [24, 25].”
BackgroundMarouf, A., Mortada, H. H., & Fakiha, M. G. (2020) · Saudi Medical Journal · doi:10.15537/smj.2020.3.24946 · Cited by 4 · see citing works
James, J., Corrigan, B., & Saunders, C. M. (2017) · ANZ Journal of Surgery · doi:10.1111/ans.13857 · Cited by 4 · see citing works
“Reconstruction rates after mastectomy vary considerably between institutions, although worldwide access to all types of reconstruction can be a major limiting factor to its takeup.(2) Single- or two-stage breast reconstruction using an implant with or without tissue expander is a relatively simple, reliable and reprod…”
BackgroundTraining breast surgeons in Australia and New Zealand
Spillane, A. J. (2013) · ANZ Journal of Surgery · doi:10.1111/ans.12322 · Cited by 4 · see citing works
Self-citationArellano, C., Bouche, C., Weyl, A., Ung, M., Jouve, E., Selmes, G., Soule‐Tholy, M., Méresse, T., Massabeau, C., Cavillon, A., et al. (2024) · Innovative Practice in Breast Health · doi:10.1016/j.ibreh.2024.100005 · Cited by 3 · see citing works
Moore, T. M., Nees, D., Jacobsen, S. M., Peña, A. M., Anderson, R. M., Garrett, E. P., Staggs, J., Waters, P., Love, M., Dunford, B., et al. (2023) · Plastic Surgery · doi:10.1177/22925503231210878 · Cited by 2 · see citing works
“33 Patients with higher SES and income were associated with increased odds of undergoing reconstruction, 34,36,40,42,45,48,50,53,54,62,63,80,87 – 89 meanwhile lower income patients were more likely to undergo mastectomy.”
van Egdom, L. S. E., de Ligt, K. M., de Munck, L., Koppert, L. B., Mureau, M. A. M., Rakhorst, H. A., & Siesling, S. (2021) · Breast Cancer · doi:10.1007/s12282-021-01313-1 · Cited by 2 · see citing works
“In addition, IBR-rates in mastectomy patients have increased over the past years as well.”
BackgroundReconstrucción mamaria y calidad de vida
Masià, J., & Rodríguez‐Bauzà, E. (1970) · Psicooncología · doi:10.5209/psic.57087 · Cited by 2 · see citing works
Soon, P. S. H., Kamalmaz, K., Wu, V. S., Karimi, N., Gerges, M., Sherman, K. A., & Girgis, A. (2024) · Current Oncology · doi:10.3390/curroncol31070274 · Cited by 1 · see citing works
“Evidence suggests that Caucasian women are more likely to undergo reconstruction [13], and non-English speakers were half as likely to have discussions with their healthcare team about reconstruction prior to mastectomy [16].”
BackgroundJansson, S. M., Austin, C., Liu, M., & Craig, S. J. (2026) · The Breast Journal · doi:10.1155/tbj/1281318 · Cited by 1 · see citing works
“Globally, studies have found that approximately 50% of eligible women would elect for reconstruction if they were adequately informed and ofered the option [9–11].”
Julian‐Reynier, C., Bouhnik, A., Reynier, P., Bannier, M., Resseguier, N., Rey, D., & Viens, P. (2016) · Women s Health - Open Journal · doi:10.17140/whoj-1-111 · Cited by 1 · see citing works
“Satisfaction with breast reconstruction score Not specified 7(2) 1 6(2) 7(2) 1 8(1) 0.”
BackgroundBreast reconstruction in South Western Sydney
Karimi, N., Descallar, J., Girgis, A., & Soon, P. S. H. (2020) · ANZ Journal of Surgery · doi:10.1111/ans.16298 · Cited by 1 · see citing works
“health insurance) as well as other demographic factors such as age, family structure, education, income and race.(5,6) Our previous qualitative study of the perceived barriers and facili-”
BackgroundThe development of a rural breast reconstruction service: patient reported outcomes and benefits
Gunness, P., Hamilton, S., Capstick, R., Masters, J., & Toma, R. (2023) · ANZ Journal of Surgery · doi:10.1111/ans.18389 · Cited by 1 · see citing works
“that if given the choice, around 50% of women will elect to undergo a breast reconstruction.(8) To be able to make an informed decision about a breast reconstruction, the conversation between the surgeon and the patient needs”
BackgroundPatterns of breast reconstruction and the influence of a surgical multidisciplinary clinic
Tian, Y., Birks, S. E., Kemp, S., Lee, J. C., Weymouth, M. D., Serpell, J. W., & Walker, M. (2023) · ANZ Journal of Surgery · doi:10.1111/ans.18816 · Cited by 1 · see citing works
“6,7,12 This is despite evidence showing age does not signi fi cantly affect complication rates and older women also derive physical and psychosocial bene fi ts from reconstruction.”
BackgroundFihri, J. F., Lahkim, M., Baba, H., Khader, A. E., & Barni, R. E. (2024) · International Journal For Multidisciplinary Research · doi:10.36948/ijfmr.2024.v06i04.26301 · Cited by 1 · see citing works
“The number of patients who benefited from BR has increased worldwide over the last decade, but remains relatively low, ranging from 5% to 42% [5].”
BackgroundManchon‐Walsh, P., Clèries, R., Font, R., Solà, J., Casanovas-Guitart, C., Guarga, À., López-Ojeda, A., Pla, M., Espinàs, J. A., & Borràs, J. M. (2025) · JPRAS Open · doi:10.1016/j.jpra.2025.01.017 · Cited by 1 · see citing works
“Specifically, our data show that older age decreases the probability of undergoing BR, in consonance with the literature 8 , 12 , 20 : over 80% of women under 40 years received BR, and approximately 60% at 50-69 years; however, this proportion dropped dramatically in women over 70 years and was…”
InfluentialThe method of endoprosthesis deployment in breast cancer surgery
Saveliev, V. N., Валерьевич, Т. М., & Borisov, A. P. (2019) · Pirogov Russian Journal of Surgery · doi:10.17116/hirurgia201901150 · Cited by 1 · see citing works
“51 PIROGOV JOURNAL OF SURGERY, 1, 2019 Современная реконструктивная хирургия у больных с диагнозом рака молочной железы (РМЖ) продолжает совершенствоваться благодаря применению уникальных технологий оперативных вмешательств и вспомогательных устройств [1].”
MEDICAL AND STATISTICAL CHARACTERISTICS OF BREAST CANCER IN ST. PETERSBURG FEMALE RESIDENTS
Романенков, Н. С., Hizha, V. V., Мовчан, К. Н., Morozov, U. M., Мухаметович, Г. Р., & Slobodkina, A. S. (2019) · Research and Practical Medicine Journal · doi:10.17709/2409-2231-2019-6-2-3 · Cited by 1 · see citing works
“Что касается протезирования МЖ после мастэктомии, то частота таких хирургических вмешательств не превышает 15% даже в специализированных международных центрах по лечению РМЖ [13, 14].”
Gallagher, O. B. (2014) · The Sydney eScholarship Repository (The University of Sydney)
MODERN SITUATION IN BREAST RECONSTRUCTION AFTER MASTECTOMY
Masià, J., & Rodríguez‐Bauzà, E. (2017) · Issues of Reconstructive and Plastic Surgery · doi:10.17223/1814147/60/05
THE STATE OF BREAST RECONSTRUCTION IN AUSTRALIA
Dauway, E. L. (2018) · Mastology · doi:10.29289/259453942018edit284
Романенков, Н. С., & Мовчан, К. Н. (2019) · HERALD of North-Western State Medical University named after I I Mechnikov · doi:10.17816/mechnikov201810481-88
“Тем не менее частота проведения подобных реконструктивных хирургических вмешательств даже в специализированных медицинских центрах до сих пор не превышает 15 % от общего числа случаев выполнения мастэктомии [1].”
Timing and Type of Breast Reconstruction in Young Breast Cancer Patients
Micco, R. D., & Gentilini, O. (2020) · Springer eBooks · doi:10.1007/978-3-030-24762-1_9
Provision of breast reconstruction services in Australia: the case for change
Flitcroft, K. L., Mathieu, E., & Turner, L. (2020) · ANZ Journal of Surgery · doi:10.1111/ans.15864
“In Australia, the first case of COVID-19 was reported on 25 January.(1) Following this, entry of foreign nationals from China was banned on 1 February and the first COVID-19 death occurred on 1 March.”
BackgroundInfluentialFlitcroft, K. L., Brennan, M. E., & Spillane, A. J. (2020) · Archives of Breast Cancer · doi:10.32768/abc.202073168-177
Self-citationL’incertezza sui principi del processo amministrativo
Rossi, G. (2010) · Bollettino del CILEA (CILEA)
- Authors
- Brennan, M. E., & Spillane, A. J.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Brennan, M.E.
- Venue
- European Journal of Surgical Oncology (EJSO)
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 39
- Issue
- 6
- Pages
- 527-541
- ISSN
- 0748-7983 (ISSN-L)
- OpenAlex
- W1966100055
- Cited by
- 109
- References
- 40
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 11 · 2022: 4 · 2021: 5 · 2020: 12 · 2019: 13 · 2018: 8 · 2017: 13 · 2016: 14 · 2015: 9 · 2014: 6 · 2013: 1
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Surgical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Breast Implant and Reconstruction
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- breast reconstruction, mastectomy, breast cancer, adjuvant therapy, early breast cancer, breast-conserving surgery, patient factors, patient choice
- MeSH terms
- Age Factors, Australia, Breast Neoplasms, Carcinoma in Situ, Decision Making, Educational Status, Europe, Female, United Kingdom, Humans, Income, Japan, Neoplasm Staging, Prospective Studies, Retrospective Studies, South Africa, United States, Mastectomy, Modified Radical, Mammaplasty, Carcinoma, Ductal, Breast
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