{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T10:37:39Z","timestamp":1774435059944,"version":"3.50.1"},"reference-count":49,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"name":"NIH\/NCI Cancer Center","award":["P30 CA008748"],"award-info":[{"award-number":["P30 CA008748"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Insurance type can serve as a surrogate marker for social determinants of health and can influence many aspects of the breast reconstruction experience. We aimed to examine the impact of insurance coverage on patients reported outcomes with the BREAST-Q (patient reported outcome measure for breast reconstruction patients, in patients receiving) in patients receiving deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.<\/jats:p><jats:p>\n          Methods\u2003We retrospectively examined patients who received DIEP flaps at our institution from 2010 to 2019. Patients were divided into categories by insurance: commercial, Medicaid, or Medicare. Demographic factors, surgical factors, and complication data were recorded. Descriptive statistics, Fisher's exact, Kruskal\u2013Wallis rank sum tests, and generalized estimating equations were performed to identify associations between insurance status and five domains of the BREAST-Q Reconstructive module.<\/jats:p><jats:p>\n          Results\u2003A total of 1,285 patients were included, of which 1,011 (78.7%) had commercial, 89 (6.9%) had Medicaid, and 185 (14.4%) had Medicare insurances. Total flap loss rates were significantly higher in the Medicare and Medicaid patients as compared to commercial patients; however, commercial patients had a higher rate of wound dehiscence as compared to Medicare patients. With all other factors controlled for, patients with Medicare had lower Physical Well-being of the Chest (PWBC) than patients with commercial insurance (\u03b2\u2009=\u2009\u2212\u20093.1, 95% confidence interval (CI): \u22125.0, \u22121.2, p\u2009=\u20090.002). There were no significant associations between insurance classification and other domains of the BREAST-Q.<\/jats:p><jats:p>\n          Conclusion\u2003Patients with government-issued insurance had lower success rates of autologous breast reconstruction. Further, patients with Medicare had lower PWBC than patients with commercial insurance regardless of other factors, while other BREAST-Q metrics did not differ. Further investigation as to the causes of such variation is warranted in larger, more diverse cohorts.<\/jats:p>","DOI":"10.1055\/a-2277-0236","type":"journal-article","created":{"date-parts":[[2024,2,28]],"date-time":"2024-02-28T00:54:56Z","timestamp":1709081696000},"page":"009-018","source":"Crossref","is-referenced-by-count":4,"title":["Social Determinants of Health and Patient-reported Outcomes Following Autologous Breast Reconstruction, Using Insurance as a Proxy"],"prefix":"10.1055","volume":"41","author":[{"given":"Ethan L.","family":"Plotsker","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis D.","family":"Graziano","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minji","family":"Kim","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian A.","family":"Boe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audree B.","family":"Tadros","sequence":"additional","affiliation":[{"name":"Breast Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan","family":"Matros","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Said C.","family":"Azoury","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"issue":"S 02","key":"ref1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/00333549141291S206","article-title":"The social determinants of health: it's time to consider the causes of the causes","volume":"129","author":"P Braveman","year":"2014","journal-title":"Public Health 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with more formal education have better health insurance opportunities?","volume":"17","author":"D M Dewar","year":"1998","journal-title":"Econ Educ Rev"},{"key":"ref10","volume-title":"Women's Health and Cancer Rights Act (WHCRA)","author":"Centers for Medicare & Medicaid Services","year":"2023"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/PRS.0000000000005905","article-title":"Discussion: The effect of the breast cancer provider discussion law on breast reconstruction rates in New York State","volume":"144","author":"E Matros","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/PRS.0000000000006453","article-title":"Impact of physician payments on microvascular breast reconstruction: an all-payer claim database analysis","volume":"145","author":"H Panchal","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"101661","DOI":"10.1016\/j.suronc.2021.101661","article-title":"Impact of insurance payer and socioeconomic status on type of autologous breast reconstruction","volume":"39","author":"J Dinis","year":"2021","journal-title":"Surg Oncol"},{"issue":"08","key":"ref14","doi-asserted-by":"crossref","first-page":"e2119141","DOI":"10.1001\/jamanetworkopen.2021.19141","article-title":"Factors associated with state-specific medicaid expansion and receipt of autologous breast reconstruction among patients undergoing mastectomy","volume":"4","author":"K A Huynh","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"e4410","DOI":"10.1097\/GOX.0000000000004410","article-title":"Breaking barriers to breast reconstruction among socioeconomically disadvantaged patients at a large safety-net hospital","volume":"10","author":"A E Meade","year":"2022","journal-title":"Plast 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Arthroplasty"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.bjps.2015.11.013","article-title":"The BREAST-Q in surgical research: a review of the literature 2009-2015","volume":"69","author":"W A Cohen","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"08","key":"ref23","doi-asserted-by":"crossref","first-page":"e1904","DOI":"10.1097\/GOX.0000000000001904","article-title":"BREAST-Q measurement of the patient perspective in oncoplastic breast surgery: a systematic review","volume":"6","author":"L Q Liu","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"08","key":"ref24","doi-asserted-by":"crossref","first-page":"5280","DOI":"10.1245\/s10434-022-11521-4","article-title":"BREAST-Q REACT: clinical reference values for the BREAST-Q in post-mastectomy breast reconstruction patients","volume":"29","author":"J A Nelson","year":"2022","journal-title":"Ann Surg Oncol"},{"issue":"03","key":"ref25","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/SLA.0000000000003467","article-title":"Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients","volume":"270","author":"J A Nelson","year":"2019","journal-title":"Ann Surg"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"e1313","DOI":"10.1097\/SLA.0000000000005478","article-title":"the impact of psychiatric diagnoses on patient-reported satisfaction and quality of life in post-mastectomy breast reconstruction","volume":"277","author":"M G Shamsunder","year":"2023","journal-title":"Ann Surg"},{"issue":"09","key":"ref27","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1111\/tbj.13849","article-title":"Impact of socioeconomic status on psychological functioning in survivorship following breast cancer and reconstruction","volume":"26","author":"N K Le","year":"2020","journal-title":"Breast 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complications and patient satisfaction: does payer status have an impact?","volume":"211","author":"J G Armstrong","year":"2016","journal-title":"Am J Surg"},{"key":"ref32","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/01.GOX.0000667792.74020.ac","article-title":"Abstract 184: The effect of insurance payer type on outcomes and readmission rates in patients undergoing breast reconstruction","volume":"8","author":"J Marquez","year":"2020","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"04","key":"ref33","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/2292550317749509","article-title":"Smoking and flap survival","volume":"26","author":"K Hwang","year":"2018","journal-title":"Plast Surg (Oakv)"},{"issue":"09","key":"ref34","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1055\/s-0040-1714426","article-title":"Impact of smoking status in free deep inferior epigastric artery perforator flap breast reconstruction: a multicenter study","volume":"36","author":"L Prantl","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"13902","DOI":"10.1038\/s41598-022-18216-6","article-title":"Smoking and microvascular free flap perfusion in head and neck reconstruction: radial free forearm flaps and anterolateral thigh flaps","volume":"12","author":"M Ooms","year":"2022","journal-title":"Sci Rep"},{"issue":"01","key":"ref36","doi-asserted-by":"crossref","first-page":"1e","DOI":"10.1097\/PRS.0000000000006315","article-title":"Impact of insurance payer on type of breast reconstruction performed","volume":"145","author":"F Chouairi","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"170","DOI":"10.17161\/kjm.vol1415147","article-title":"Intra-operative radiation therapy versus whole breast external beam radiotherapy: a comparison of patient-reported outcomes","volume":"14","author":"J Leatherman","year":"2021","journal-title":"Kans J Med"},{"issue":"02","key":"ref38","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1162\/qjec.2009.124.2.597","article-title":"Does Medicare save lives?","volume":"124","author":"D Card","year":"2009","journal-title":"Q J Econ"},{"issue":"03","key":"ref39","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1055\/s-0041-1731464","article-title":"Radiation-induced tissue damage: clinical consequences and current treatment options","volume":"35","author":"H Nepon","year":"2021","journal-title":"Semin Plast Surg"},{"issue":"01","key":"ref40","doi-asserted-by":"crossref","first-page":"32e","DOI":"10.1097\/PRS.0000000000009180","article-title":"Association of radiation timing with long-term satisfaction and health-related quality of life in prosthetic breast reconstruction","volume":"150","author":"J A Nelson","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.breast.2017.11.001","article-title":"Is chronic postsurgical pain surgery-induced? A study of persistent postoperative pain following breast reconstruction","volume":"37","author":"R S Roth","year":"2018","journal-title":"Breast"},{"issue":"02","key":"ref42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.bjpt.2020.05.010","article-title":"Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil","volume":"25","author":"B Mazuquin","year":"2021","journal-title":"Braz J Phys Ther"},{"issue":"03","key":"ref43","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1093\/fampra\/cmaa104","article-title":"Identifying patients who access musculoskeletal physical therapy: a retrospective cohort analysis","volume":"38","author":"J A Sharpe","year":"2021","journal-title":"Fam Pract"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.jpra.2021.09.002","article-title":"Patient perspective on post-breast reconstruction exercise and physical therapy","volume":"30","author":"M J Higgins","year":"2021","journal-title":"JPRAS Open"},{"issue":"06","key":"ref45","doi-asserted-by":"crossref","first-page":"e220631","DOI":"10.1001\/jamasurg.2022.0631","article-title":"Long-term quality of life in patients with breast cancer after breast conservation vs mastectomy and reconstruction","volume":"157","author":"S E Hanson","year":"2022","journal-title":"JAMA Surg"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/PRS.0000000000008633","article-title":"The impact of race on perioperative and patient-reported outcomes following autologous breast reconstruction","volume":"149","author":"S Oskar","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"ref47","volume-title":"Medicaid Expansion Has Helped Narrow Racial Disparities in Health Coverage and Access to Care","author":"J Cross-Call","year":"2020"},{"issue":"04","key":"ref48","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1177\/1077558704269664","article-title":"Low-income workers with employer-sponsored insurance: who's at risk when employer coverage is no longer an option?","volume":"61","author":"S K Long","year":"2004","journal-title":"Med Care Res Rev"},{"key":"ref49","volume-title":"Medicaid Buy-In Program for Working People with Disabilities","year":"2023"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2277-0236.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T23:39:17Z","timestamp":1735083557000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2277-0236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,27]]},"references-count":49,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,12,24]]},"published-print":{"date-parts":[[2025,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2277-0236","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2,27]]},"published":{"date-parts":[[2024,2,27]]}}}