March 2019 #PRSJournalClub Wrap-Up: Barriers of Access to Breast Reconstruction

by Andrew L. Weinstein, MD, MS
Plastic Surgery Resident
NewYork-Presbyterian Hospital


The March 2019 edition of #PRSJournalClub featured engaging discussions of an important topic: Barriers of Access to Breast Reconstruction. The main article can be accessed for free here.

In their article, authors Retrouvey et al. performed a systematic review with the purpose to identify and summarize barriers of access to breast reconstruction using the Penchansky and Thomas access-to-care framework, namely availability, accessibility, accommodation, affordability, acceptability, and awareness. Ninety-nine articles met search eligibility criteria and underwent qualitative synthesis. The following domains were found to be associated with lesser access to breast reconstruction:

  1. Availability: Nonteaching hospitals
  2. Accessibility: Rural geographic locations
  3. Accommodation: Reduced access to operating room time
  4. Affordability: High cost procedures and low insurance reimbursement
  5. Acceptability: Physicians with unfavorable attitudes toward breast reconstruction and certain patient and tumorcharacteristics
  6. Awareness:Patient lack of awarenes of breast reconstruction

The authors concluded that barriers to breast reconstruction are multifactorial and influenced by patient, physician, and institutional factors. As such, they recommend that a multiprong approach be taken to improve access through streamlining referral processes and educational initiatives for patients and physicians.

This article was first discussed on the #PRSJournalClub podcast by Resident Ambassadors to the PRS Editorial Board Raj Parikh, MD, Lily Mundy, MD, and Kyle Sanniec, MD and special guest Summer Hanson, MD, PhD, Assistant Professor of Plastic Surgery and Director of Translational Research at MD Anderson Cancer Center. You can listen to this discussion below:


It was also presented as a #PRSHotTopic video by Dr. Rod Rohrich:


Lastly, this article was the subject of a stimulating #PRSJournalClub Facebook Q&A discussion with the authors, which took place on Sunday, March 17th.


We hope you enjoyed this month’s #PRSJournalClub and will join us again next month for another great discussion!

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