"Adapting Perspectives: Analyzing Dynamic Shifts in Breast Surgical Trends and Reconstructive Choices Over 16 Years".

Introduction: Over the last 16 years, there have been novel approaches in breast cancer surgical care. This study aims to provide a contemporary surgical trend analysis for breast cancer patients and secondarily, further investigate trends across all aspects of breast reconstruction including Oncoplastic Surgery (OPS).

Methods: A retrospective cohort analysis was conducted using the ACS-NSQIP database from 2008 to 2023. Patients were categorized into surgical groups for partial mastectomy (PM), mastectomy without reconstruction (M), mastectomy with Autologous reconstruction (M+AR), mastectomy with implant reconstruction (M+IR), and OPS. A subgroup analysis was conducted to elaborate further within each reconstructive surgical groups.

Results: The primary cohort consisted of 360,731 patients and of those patients, 119,096 had reconstructive surgery. Annual surgical trends increased for PM by 129% and OPS by 408%, declined for the M group by 38% and M+AR by 20% (all p<0.01); M+IR had no significant trend shift (p=0.30). In the reconstructive subgroup analysis mastectomy procedures declined: M+IR by 11%, mastectomy with latissimus dorsi flap by 65%, mastectomy with TRAM flap by 95%, however mastectomy with free flap increased by 212%. The OPS groups had the most significant increase across all sub-categories: Level 1 OPS by 587%, Level 2 OPS by 194% and OPS volume replacement by 151% (all p<0.01).

Conclusion: This study provides a comprehensive analysis of demographic profiles and surgical trends across common breast interventions and reconstructive surgeries. Our findings suggest that the shift towards oncoplastic surgery and advanced reconstructive techniques is becoming more prevalent and mastectomy without reconstruction is decreasing.