Current status of and trends in post-mastectomy breast reconstruction in Korea

Abstract

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

Keywords: Big data; Breast neoplasms; Insurance; Mammaplasty; Statistics.

Fig. 1.. Annual changes in mastectomy numbers in Korea

Fig. 2.. Annual changes in breast reconstruction

The rate of post-mastectomy breast reconstruction in Korea.

Fig. 3.. Breast reconstruction rate in Korea

(A) Trends in the breast reconstruction rate in Korea (numbers). (B) Trends in the breast reconstruction rate in Korea (percentages).

Fig. 4.. Annual changes in autologous breast reconstruction

The number of autologous breast reconstruction procedures in Korea. LD, latissimus dorsi muscle flap, muscle-sparing latissimus dorsi myocutaneous flap (thoracodorsal artery perforator flap), and extended latissimus dorsi myocutaneous flap; PTRAM, single-pedicled transverse rectus abdominis musculocutaneous flap and bipedicled transverse rectus abdominis musculocutaneous flap; FTRAM, free transverse rectus abdominis musculocutaneous flap, muscle-sparing transverse rectus abdominis musculocutaneous flap, and deep inferior epigastric artery perforator free flap.

Fig. 5.. Annual changes in implant breast reconstruction

The number of implant breast reconstruction procedures in Korea. TE, tissue expander; DTI, direct-to-implant.

Fig. 6.. Breast reconstruction procedures performed in 2018

LD, latissimus dorsi muscle flap, muscle-sparing latissimus dorsi myocutaneous flap (thoracodorsal artery perforator flap), and extended latissimus dorsi myocutaneous flap; DIEP+TRAM, single-pedicled transverse rectus abdominis musculocutaneous flap, bipedicled transverse rectus abdominis musculocutaneous flap, free transverse rectus abdominis musculocutaneous flap, muscle-sparing transverse rectus abdominis musculocutaneous flap, and deep inferior epigastric artery perforator (DIEP) free flap; TE, tissue expander; DTI, direct-to-implant.