Temporal Trends in Autologous Breast Reconstruction Among Patients With Psychiatric Diagnoses: From Disparity to Equity

Background: During the last decades, advances in microsurgical techniques and equipment, alongside improvements in the perioperative care, have contributed to a steady rise in the use of autologous breast reconstruction (ABR). However, access to advanced reconstruction procedures has not been uniform across the patient population, exhibiting significant disparities related to race, ethnicity, comorbidity burden, insurance status, and socioeconomic status. Prior studies examining the relationship between psychiatric diagnoses and breast reconstruction have largely focused on short-term outcomes. The present study addresses this gap by leveraging the TriNetX Global Collaborative Network to examine 25-year temporal trends in the incidence of ABR among women with documented psychiatric diagnoses. Methods: This retrospective cohort study used TriNetX data (2000-2024) to evaluate temporal trends in ABR among women with and without preexisting psychiatric diagnoses. Incidence rates were analyzed across predefined periods using Poisson and negative binomial regression, reporting incidence rate ratios with 95% confidence intervals. Results: Among 6412 ABRs, 1877 occurred in women with psychiatric diagnoses, and 4535 in those without. Incidence rates rose from 33.5 to 895.1 per 100,000 person-years in psychiatric cohorts and from 108.1 to 700.9 in nonpsychiatric cohorts. Early incidence rate ratios favored nonpsychiatric patients, attenuating to near unity over time, with persistent lower rates observed in schizophrenia. Conclusions: Women with psychiatric diagnoses historically underwent ABR at significantly lower rates. These disparities progressively attenuated over the years, until reaching a near-equitable access to ABR irrespective of psychiatric status.