Assessing the Shift: General Surgeons’ Increasing Involvement in Breast Reconstructive Procedures - Insights from a Nationwide Analysis

Background: Breast reconstruction techniques have advanced significantly over the years becoming some of the most common services plastic surgeons provide in the United States. However, there is a perceived rise in general surgeons performing breast reconstruction which this study hypothesized to be due to geospatial barriers to plastic surgeons. Methods: A national insurance database was utilized for data collection. Patients who underwent mastectomy and same-day implant-based reconstruction between 2010-2021 were identified using CPT codes. Those who underwent other reconstructive breast procedures such as local or free flaps and oncoplastic breast reduction were also extracted from the database. Patients were stratified by physician specialty performing the reconstruction: plastic surgery or general surgery. Demographics, yearly trends, and distance to academic and national cancer institutions were compared. Results: General surgeons are increasingly performing breast reconstruction procedures, especially implant-based breast reconstruction and oncoplastic breast reductions, surpassing plastic surgeons in recent years. Direct-to-implant procedures were more common in the general surgery group (17.4% vs. 15.5%, p<0.01), while pedicled and free flaps were rarely performed by general surgeons. Plastic surgeons appear to perform a larger proportion of breast reconstruction in the Northeast and Midwest. Proximity to the closest academic or national cancer center was not significantly different among the groups (39.5 vs. 42.1 miles, p=0.66). Conclusion: This study reveals that general surgeons are performing a rapidly increasing rate of implant-based reconstruction and oncoplastic reduction procedures, recently exceeding plastic surgeons. Institutional dynamics and referral patterns most likely play a part in these trends.