{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:55:00Z","timestamp":1790207700211,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T00:00:00Z","timestamp":1719532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Little is known about disparities in oncoplastic breast surgery delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Massachusetts All\u2010Payer Claims Database was queried for patients who received lumpectomy for a diagnosis of breast cancer. Oncoplastic surgery was defined as adjacent tissue transfer, complex trunk repair, reduction mammoplasty, mastopexy, flap\u2010based reconstruction, prosthesis insertion, or unspecified breast reconstruction after lumpectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 18\u2009748 patients who underwent lumpectomy between 2016 and 2020. Among those, 3140 patients underwent immediate oncoplastic surgery and 436 patients underwent delayed oncoplastic surgery. Eighty\u2010one percent of patients who underwent oncoplastic surgery did so in the same county as they underwent a lumpectomy. However, the relative frequency of oncoplastic surgery varied significantly among counties. In multivariable regression, public insurance status (odds ratio: 0.87, 95% confidence interval: 0.80\u20130.95, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) was associated with lower odds of undergoing oncoplastic surgery, even after adjusting for macromastia, other comorbidities, and county of lumpectomy. Average payments for lumpectomy with oncoplastic surgery were more than twice as high from private insurers ($840 vs. $1942, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Disparities in the receipt of oncoplastic surgery were related to differences in local practice patterns and the type of insurance patients held. Expanding services across counties and considering billing reform may help reduce these disparities.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.27755","type":"journal-article","created":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T14:15:22Z","timestamp":1719584122000},"page":"210-221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Local practice variations and payer differences underlie state\u2010wide disparities in oncoplastic breast surgery"],"prefix":"10.1002","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8721-6394","authenticated-orcid":false,"given":"Alan Z.","family":"Yang","sequence":"first","affiliation":[{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colby J.","family":"Hyland","sequence":"additional","affiliation":[{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amitai S.","family":"Miller","sequence":"additional","affiliation":[{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid K.","family":"Killelea","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce F.","family":"Starr","sequence":"additional","affiliation":[{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Broyles","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003273"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07345-4"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-018-5018-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-019-07592-5"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007478"},{"issue":"11","key":"e_1_2_8_7_1","first-page":"2572","article-title":"Oncoplastic breast surgery: comprehensive review","volume":"21","author":"Bertozzi N","year":"2017","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"10","key":"e_1_2_8_8_1","article-title":"Oncoplastic breast\u2010conserving surgery for women with primary breast cancer","volume":"2021","author":"Nanda A","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2021.02.013"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e3182605598"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181c82d3e"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/tbj.14186"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.02795"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30084-X"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004336"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-020-05544-2"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15078"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2023.03.006"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5407-9"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27173"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000004180"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001904"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001228"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000006453"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-018-6760-7"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2022.11.067"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001419"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1099125"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15309"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000009616"},{"key":"e_1_2_8_31_1","unstructured":"Mass General Cancer Center. 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