Skip to main content

Advertisement

SpringerLink
Log in

Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

For many women, breast reconstruction is an essential component of the breast cancer care continuum after mastectomy. Despite postmastectomy breast reconstruction now being a standard of care, numerous studies over the past decade have documented persistent racial disparities in breast reconstruction rates, physician referral patterns, and patient knowledge of their reconstructive options. These disparities have disproportionately impacted women of color—most specifically, African American women. Recent data have revealed racial differences in patient comorbidities, informed decision-making satisfaction, and clinical outcomes after breast reconstruction. Explicitly, African American women have significantly more risk factors for complications and less baseline knowledge regarding reconstructive options than white women. With a recent heightened attention focused on social determinants of health, studies designed to improve these racial differences have demonstrated promising results through educational outreach to underserved communities, implementation of tailored legislation promoting inclusion, diversity, and equity, and encouragement of additional recruitment of ethnically underrepresented-in-medicine surgeons. This study uses a targeted review of the literature to provide a summary of racial disparities in breast reconstruction for African American women, with our perspective on opportunities for improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Women’s Health and Cancer Rights Act (WHCRA)|CMS. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet. Accessed 5 May 2021.

  2. Plastic Surgery Statistics|American Society of Plastic Surgeons. https://www.plasticsurgery.org/news/plastic-surgery-statistics. Accessed 5 May 2021.

  3. Sharma K, Grant D, Parikh R, Myckatyn T. Race and breast cancer reconstruction: is there a health care disparity? In: Plastic and Reconstructive Surgery. Vol 138. Baltimore: Lippincott Williams & Wilkins; 2016:354-61. https://doi.org/10.1097/PRS.0000000000002344

  4. Berlin NL, Momoh AO, Qi J, et al. Racial and ethnic variations in one-year clinical and patient-reported outcomes following breast reconstruction. Am J Surg. 2017;214(2):312–7. https://doi.org/10.1016/j.amjsurg.2017.02.009.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Wu RT, Peck CJ, Shultz BN, Travieso R, Steinbacher DM. Racial disparities in cleft palate repair. Plast Reconstr Surg. 2019;143(6):1738–45. https://doi.org/10.1097/PRS.0000000000005650.

    Article  CAS  PubMed  Google Scholar 

  6. Billig JI, Sterbenz JM, Zhong L, Chung KC. Gender disparities in preoperative resource use for wrist arthroscopy. Plast Reconstr Surg. 2018;142(5):1267–74. https://doi.org/10.1097/PRS.0000000000004840.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Sergesketter AR, Thomas SM, Lane WO, et al. Decline in racial disparities in postmastectomy breast reconstruction: a Surveillance, Epidemiology, and End Results analysis from 1998 to 2014. Plast Reconstr Surg. 2019;143(6):1560–70. https://doi.org/10.1097/PRS.0000000000005611.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Mets EJ, Chouairi FK, Gabrick KS, Avraham T, Alperovich M. Persistent disparities in breast cancer surgical outcomes among hispanic and African American patients. Eur J Surg Oncol. 2019;45(4):584–90. https://doi.org/10.1016/j.ejso.2019.01.016.

    Article  PubMed  Google Scholar 

  9. Smith BT, Egro FM, Murphy CP, Stavros AG, Nguyen VT. An evaluation of race disparities in academic plastic surgery. Plast Reconstr Surg. 2020;145(1):268–77. https://doi.org/10.1097/PRS.0000000000006376.

    Article  CAS  PubMed  Google Scholar 

  10. Aboagye JK, Kaiser HE, Hayanga AJ. Rural-urban differences in access to specialist providers of colorectal cancer care in the United States: a physician workforce issue. JAMA Surg. 2014. https://doi.org/10.1001/jamasurg.2013.5062.

    Article  PubMed  Google Scholar 

  11. Fiscella K, Franks P, Meldrum S, Barnett S. Racial disparity in surgical complications in New York State. Ann Surg. 2005. https://doi.org/10.1097/01.sla.0000171031.08435.b9.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Atisha D, Alderman AK, Lowery JC, Kuhn LE, Davis J, Wilkins EG. Prospective analysis of long-term psychosocial outcomes in breast reconstruction: Two-year postoperative results from the Michigan breast reconstruction outcomes study. Ann Surg. 2008;247(6):1019–28. https://doi.org/10.1097/SLA.0b013e3181728a5c.

    Article  PubMed  Google Scholar 

  13. Stevens LA, Mc Grath M, Druss RG, Kister SJ, Gump FE, Forde KA. The psychological impact of immediate breast reconstruction for women with early breast cancer. Plast Reconstr Surg. 1984;73(4):619–26. https://doi.org/10.1097/00006534-198404000-00018.

    Article  CAS  PubMed  Google Scholar 

  14. Wilkins EG, Cederna PS, Lowery JC, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan breast reconstruction outcome study. Plast Reconstr Surg. 2000;106(5):1014–25. https://doi.org/10.1097/00006534-200010000-00010.

    Article  CAS  PubMed  Google Scholar 

  15. Nkana ZH, Wood KL, Karczewski AM, et al. Evaluation of racial disparities in postoperative outcomes following breast reconstruction at a single institution in Wisconsin. WMJ. 2021;120(S1):S42–7.

    PubMed  Google Scholar 

  16. Retrouvey H, Solaja O, Gagliardi AR, Webster F, Zhong T. Barriers of access to breast reconstruction. Plast Reconstr Surg. 2019;143(3):465e-e476. https://doi.org/10.1097/PRS.0000000000005313.

    Article  CAS  PubMed  Google Scholar 

  17. Daar DA, Abdou SA, Robinson IS, Levine JP, Thanik V. Disparities in postmastectomy breast reconstruction: a systematic review of the literature and modified framework for advancing research toward intervention. Ann Plast Surg. 2018;81(4):503–7. https://doi.org/10.1097/SAP.0000000000001503.

    Article  CAS  Google Scholar 

  18. August DA, Wilkins E, Rea T. Breast reconstruction in older women. Surgery. 1994;115(6):663–8.

    CAS  PubMed  Google Scholar 

  19. In H, Jiang W, Lipsitz SR, Neville BA, Weeks JC, Greenberg CC. Variation in the utilization of reconstruction following mastectomy in elderly women. Ann Surg Oncol. 2013;20(6):1872–9. https://doi.org/10.1245/s10434-012-2821-5.

    Article  PubMed  Google Scholar 

  20. Panayi AC, Agha RA, Sieber BA, Orgill DP. Impact of obesity on outcomes in breast reconstruction: a systematic review and meta-analysis. J Reconstr Microsurg. 2018;34(5):363–75. https://doi.org/10.1055/s-0038-1627449.

    Article  PubMed  Google Scholar 

  21. Soni SE, Lee MC, Gwede CK. Disparities in use and access to postmastectomy breast reconstruction among African American women: a targeted review of the literature. Cancer Control. 2017. https://doi.org/10.1177/1073274817729053.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Wirth LS, Hinyard L, Keller J, Bucholz E, Schwartz T. Geographic variations in racial disparities in postmastectomy breast reconstruction: a SEER database analysis. Breast J. 2019;25(1):112–6. https://doi.org/10.1111/tbj.13166.

    Article  PubMed  Google Scholar 

  23. Shippee TP, Kozhimannil KB, Rowan K, Virnig BA. Health insurance coverage and racial disparities in breast reconstruction after mastectomy. Women’s Heal Issues. 2014. https://doi.org/10.1016/j.whi.2014.03.001.

    Article  Google Scholar 

  24. Offodile AC, Wenger J, Guo L. Relationship between comorbid conditions and utilization patterns of immediate breast reconstruction subtypes post-mastectomy. Breast J. 2016;22(3):310–5. https://doi.org/10.1111/tbj.12574.

    Article  PubMed  Google Scholar 

  25. Kwok AC, Goodwin IA, Ying J, Agarwal JP. National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012 Presented at the 2014 Surgical Forum at the American College of Surgeons Clinical Congress. Am J Surg. 2015;210(3):512–6. https://doi.org/10.1016/j.amjsurg.2015.03.019.

    Article  PubMed  Google Scholar 

  26. Tseng JF, Kronowitz SJ, Sun CC, et al. The effect of ethnicity on immediate reconstruction rates after mastectomy for breast cancer. Cancer. 2004;101(7):1514–23. https://doi.org/10.1002/cncr.20529.

    Article  PubMed  Google Scholar 

  27. Preminger BA, Trencheva K, Chang CS, et al. Improving access to care: breast surgeons, the gatekeepers to breast reconstruction. J Am Coll Surg. 2012;214(3):270–6. https://doi.org/10.1016/j.jamcollsurg.2011.11.014.

    Article  PubMed  Google Scholar 

  28. Greenberg CC, Schneider EC, Lipsitz SR, et al. Do variations in provider discussions explain socioeconomic disparities in postmastectomy breast reconstruction? J Am Coll Surg. 2008;206(4):605–15. https://doi.org/10.1016/j.jamcollsurg.2007.11.017.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Fu RH, Baser O, Li L, Kurlansky P, Means J, Rohde CH. The effect of the breast cancer provider discussion law on breast reconstruction rates in New York State. Plast Reconstr Surg. 2019;144(3):560–8. https://doi.org/10.1097/PRS.0000000000005904.

    Article  CAS  PubMed  Google Scholar 

  30. Bauder AR, Gross CP, Killelea BK, Butler PD, Kovach SJ, Fox JP. The relationship between geographic access to plastic surgeons and breast reconstruction rates among women undergoing mastectomy for cancer. In: Annals of Plastic Surgery. Vol 78. Baltimore: Lippincott Williams & Wilkins; 2017:324-329. https://doi.org/10.1097/SAP.0000000000000849

  31. Butler PD, Familusi O, Serletti JM, Fox JP. Influence of race, insurance status, and geographic access to plastic surgeons on immediate breast reconstruction rates. Am J Surg. 2018;215(6):987–94. https://doi.org/10.1016/j.amjsurg.2017.09.037.

    Article  PubMed  Google Scholar 

  32. McGee SA, Durham DD, Tse CK, Millikan RC. Determinants of breast cancer treatment delay differ for African American and white women. Cancer Epidemiol Biomarkers Prev. 2013;22(7):1227–38. https://doi.org/10.1158/1055-9965.EPI-12-1432.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Butler PD, Nelson JA, Fischer JP, et al. African-American women have equivalent outcomes following autologous free flap breast reconstruction despite greater preoperative risk factors. Am J Surg. 2015;209(4):589–96. https://doi.org/10.1016/j.amjsurg.2014.11.002.

    Article  PubMed  Google Scholar 

  34. Blankensteijn LL, Sparenberg S, Crystal DT, Ibrahim AMS, Lee BT, Lin SJ. Racial disparities in outcomes of reconstructive breast surgery: an analysis of 51,362 patients from the ACS-NSQIP. J Reconstr Microsurg. 2020;36(8):592–9. https://doi.org/10.1055/s-0040-1713174.

    Article  PubMed  Google Scholar 

  35. Sanati-Mehrizy P, Massenburg BB, Rozehnal JM, et al. A comparison of postoperative outcomes in immediate versus delayed reconstruction after mastectomy. Eplasty. 2015;15:e44. http://www.ncbi.nlm.nih.gov/pubmed/26483861. Accessed January 7, 2021.

  36. Wu TY, Lin C, Chen SL, Jung Y. A community-based intervention to promote breast cancer awareness and screening among Asian American women. Int Q Community Health Educ. 2013;34(2):171–85. https://doi.org/10.2190/IQ.34.2.e.

    Article  PubMed  Google Scholar 

  37. Rodby KA, Danielson KK, Shay E, Robinson E, Benjamin M, Antony AK. Trends in breast reconstruction by ethnicity: an institutional review centered on the treatment of an urban population. Am Surg. 2016;82(6):497–504. https://doi.org/10.1177/000313481608200609.

    Article  PubMed  Google Scholar 

  38. Newman LA, Kaljee LM. Health disparities and triple-negative breast cancer in African AMERICAN women a review. JAMA Surg. 2017;152(5):485–93. https://doi.org/10.1001/jamasurg.2017.0005.

    Article  PubMed  Google Scholar 

  39. Lloyd-Jones D, Adams RJ, Brown TM, et al. Executive summary: heart disease and stroke statistics-2010 update: a report from the american heart association. Circulation. 2010. https://doi.org/10.1161/CIRCULATIONAHA.109.192667.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Boersma P, Black LI, Ward BW. Prevalence of multiple chronic conditions among US adults, 2018. Prev Chronic Dis. 2020;17:200130. https://doi.org/10.5888/pcd17.200130.

    Article  Google Scholar 

  41. Raghupathi W, Raghupathi V. An empirical study of chronic diseases in the united states: a visual analytics approach. Int J Environ Res Public Health. 2018;15:3. https://doi.org/10.3390/ijerph15030431.

    Article  Google Scholar 

  42. Wu C, Clayton JL, Halvorson EG. Racial differences in ischemic complications of pedicled versus free abdominal flaps for breast reconstruction. In: Annals of Plastic Surgery. Vol 72. Baltimore: Lippincott Williams & Wilkins; 2014. doi:https://doi.org/10.1097/SAP.0000000000000102

  43. Morrow M, Li Y, Alderman AK, et al. Access to breast reconstruction after mastectomy and patient perspectives on reconstruction decision making. JAMA Surg. 2014;149(10):1015–21. https://doi.org/10.1001/jamasurg.2014.548.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Barr DA. Race/ethnicity and patient satisfaction using the appropriate method to test for perceived differences in care. vol 19, London: Blackwell Publishing; 2004.

    Google Scholar 

  45. Schwitzer JA, Albino FP, Mathis RK, Scott AM, Gamble L, Baker SB. Assessing demographic differences in patient-perceived improvement in facial appearance and quality of life following rhinoplasty. Aesthetic Surg J. 2015. https://doi.org/10.1093/asj/sjv066.

    Article  Google Scholar 

  46. Shaterian A, Gandy J, Lalezari S, Smith S, Paydar K. Patient race and provider predict patient satisfaction following post-mastectomy breast reconstruction. World J Plast Surg. 2016;5(2):114–23.

    PubMed Central  PubMed  Google Scholar 

  47. Mouslim MC, Johnson RM, Dean LT. Healthcare system distrust and the breast cancer continuum of care. Breast Cancer Res Treat. 2020;180(1):33–44. https://doi.org/10.1007/s10549-020-05538-0.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Jaiswal J, Halkitis PN. Towards a more inclusive and dynamic understanding of medical mistrust informed by science. Behav Med. 2019;45(2):79–85. https://doi.org/10.1080/08964289.2019.1619511.

    Article  PubMed  Google Scholar 

  49. Meyer HS. Bad Blood: The Tuskegee syphilis experiment. JAMA J Am Med Assoc. 1981;246(22):2633. https://doi.org/10.1001/jama.1981.03320220077036.

    Article  Google Scholar 

  50. Wolinetz CD, Collins FS. Recognition of research participants’ need for autonomy: remembering the legacy of Henrietta Lacks. JAMA - J Am Med Assoc. 2020. https://doi.org/10.1001/jama.2020.15936.

    Article  Google Scholar 

  51. Rubin LR, Chavez J, Alderman A, Pusic AL. “Use what God has given me”: difference and disparity in breast reconstruction. Psychol Heal. 2013;28(10):1099–120. https://doi.org/10.1080/08870446.2013.782404.

    Article  Google Scholar 

  52. Mahmoudi E, Giladi AM, Wu L, Chung KC. Effect of Federal and State policy changes on racial/ethnic variation in immediate postmastectomy breast reconstruction. Plast Reconstr Surg. 2015;135(5):1285–94. https://doi.org/10.1097/PRS.0000000000001149.

    Article  CAS  PubMed  Google Scholar 

  53. Mahmoudi E, Lu Y, Metz AK, Momoh AO, Chung KC. Association of a policy mandating physician-patient communication with racial/ethnic disparities in postmastectomy breast reconstruction. JAMA Surg. 2017;152(8):775–83. https://doi.org/10.1001/jamasurg.2017.0921.

    Article  PubMed Central  PubMed  Google Scholar 

  54. How ACA Narrowed Racial Ethnic Disparities Access to Health Care|Commonwealth Fund. https://www.commonwealthfund.org/publications/2020/jan/how-ACA-narrowed-racial-ethnic-disparities-access. Accessed 14 May 2021.

  55. Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the national Cancer data base. J Am Coll Surg. 2012;215(5):658–66. https://doi.org/10.1016/j.jamcollsurg.2012.07.008.

    Article  PubMed  Google Scholar 

  56. The Patient Protection and Affordable Care Act. 2010;111(2):111-48.

  57. Changes in Health Coverage by Race and Ethnicity since the ACA, 2010-2018|FF. https://www.kff.org/racial-equity-and-health-policy/issue-brief/changes-in-health-coverage-by-race-and-ethnicity-since-the-aca-2010-2018/. Accessed 17 May 2021.

  58. Buchmueller TC, Levy HG. The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care. Health Aff. 2020;39(3):395–402. https://doi.org/10.1377/hlthaff.2019.01394.

    Article  Google Scholar 

  59. Wexelman B, Schwartz JA, Lee D, Estabrook A, Ma AMT. Socioeconomic and geographic differences in immediate reconstruction after mastectomy in the United States. Breast J. 2014;20(4):339–46. https://doi.org/10.1111/tbj.12274.

    Article  PubMed  Google Scholar 

  60. Text - H.R.2540 - 114th Congress (2015-2016): Breast Cancer Patient Education Act of 2015|Congress.gov|Library of Congress. https://www.congress.gov/bill/114th-congress/house-bill/2540/text. Accessed 14 May 2021.

  61. Mullens CL, Hernandez JA, Conn ME, Kennedy-Rea S, Ueno CM. Closing the breast cancer loop: barriers and perceptions of breast reconstruction among rural women. Plast Reconstr Surg - Glob Open. 2020. https://doi.org/10.1097/GOX.0000000000002638.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Familusi O, Rios-Diaz AJ, Tilahun ED, Cunning JR, Broach RB, Brooks AD, Guerra CE, Butler PD. Post-mastectomy breast reconstruction: reducing the disparity through educational outreach to the underserved. Support Care Cancer. 2021;29(2):1055–63.

    Article  PubMed  Google Scholar 

  63. Hurd TC, Muti P, Erwin DO, Womack S. An evaluation of the integration of non-traditional learning tools into a community based breast and cervical cancer education program: the witness project of Buffalo. BMC Cancer. 2003. https://doi.org/10.1186/1471-2407-3-18.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Hoffman RL, Bryant B, Allen SR, Lee MK, Aarons CB, Kelz RR. Using community outreach to explore health-related beliefs and improve surgeon-patient engagement. J Surg Res. 2016;206(2):411–7. https://doi.org/10.1016/j.jss.2016.08.058.

    Article  PubMed  Google Scholar 

  65. Campbell MK, Hudson MA, Resnicow K, Blakeney N, Paxton A, Baskin M. Church-based health promotion interventions: evidence and lessons learned. In: Annual Review of Public Health. Vol 28. Annu Rev Public Health; 2007:213-34. https://doi.org/10.1146/annurev.publhealth.28.021406.144016

  66. Chatters LM, Levin JS, Ellison CG. Public health and health education in faith communities. Heal Educ Behav. 1998;25(6):689–99. https://doi.org/10.1177/109019819802500602.

    Article  CAS  Google Scholar 

  67. Lee CNH, Ubel PA, Deal AM, et al. How informed is the decision about breast reconstruction after mastectomy? A prospective, cross-sectional study. Ann Surg. 2016;264(6):1103–9. https://doi.org/10.1097/SLA.0000000000001561.

    Article  PubMed  Google Scholar 

  68. Hasak JM, Myckatyn TM, Grabinski VF, Philpott SE, Parikh RP, Politi MC. Stakeholders’ perspectives on postmastectomy breast reconstruction: recognizing ways to improve shared decision making. Plast Reconstr Surg - Glob Open. 2017. https://doi.org/10.1097/GOX.0000000000001569.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Bradford PS, Degeorge BR, Williams SH, Butler PD. How to embrace antiracism as a US plastic surgeon: definitions, principles, and practice. Plast Reconstr Surg - Glob Open. 2020. https://doi.org/10.1097/GOX.0000000000003185.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Komaromy M, Grumbach K, Drake M, et al. The role of black and hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334(20):1305–10. https://doi.org/10.1056/nejm199605163342006.

    Article  CAS  PubMed  Google Scholar 

  71. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999;159(9):997–1004. https://doi.org/10.1001/archinte.159.9.997.

    Article  CAS  PubMed  Google Scholar 

  72. Silver JK, Bean AC, Slocum C, et al. Physician workforce disparities and patient care: a narrative review. Heal Equity. 2019;3(1):360–77. https://doi.org/10.1089/heq.2019.0040.

    Article  Google Scholar 

  73. Traylor AH, Schmittdiel JA, Uratsu CS, Mangione CM, Subramanian U. The predictors of patient-physician race and ethnic concordance: a medical facility fixed-effects approach. Health Serv Res. 2010;45(3):792–805. https://doi.org/10.1111/j.1475-6773.2010.01086.x.

    Article  PubMed Central  PubMed  Google Scholar 

  74. Holistic Review|AAMC. https://www.aamc.org/services/member-capacity-building/holistic-review. Accessed 14 May 2021.

  75. Grbic D, Morrison E, Sondheimer HM, Conrad SS, Milem JF. The association between a holistic review in admissions workshop and the diversity of accepted applicants and students matriculating to medical school. In: Academic Medicine. Vol 94. Baltimore: Lippincott Williams & Wilkins; 2019:396-403. https://doi.org/10.1097/ACM.0000000000002446

  76. Llado-Farrulla M, Fosnot J, Couto J, et al. In Search of workforce diversity? A Program’s successful approach. Plast Reconstr Surg. 2021;147(5):1229–33. https://doi.org/10.1097/PRS.0000000000007881.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

    Paris D. Butler MD, MPH & Martin P. Morris MBE

  2. Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Adeyiza O. Momoh MD

Authors
  1. Paris D. Butler MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin P. Morris MBE
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Adeyiza O. Momoh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paris D. Butler MD, MPH.

Ethics declarations

Disclosure

The author declares that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Butler, P.D., Morris, M.P. & Momoh, A.O. Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation. Ann Surg Oncol 28, 6099–6108 (2021). https://doi.org/10.1245/s10434-021-10487-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-10487-z

Search

Navigation