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Background: With increasing rates of postmastectomy breast reconstruction, it has been suggested that there is an insufficient supply of services that meet patient demands. This study aimed to identify potential disparities in, and variables associated with, postmastectomy reconstruction in Japan., Methods: Using 20,257 Japanese breast cancer discharge data from 2010, the authors identified 1616 breast cancer patients, with tumor-node-metastasis classification of malignant tumors T1~4 and N0M0, between 20 and 59 years of age. Factors influencing the use of immediate breast reconstruction of either autogenous tissue or tissue expander placement were analyzed using multinomial logistic regression comparing no reconstruction to either autogenous tissue or tissue expander placement., Results: The immediate breast reconstruction rate was 11.2 percent among the study patients. The rate of autogenous method use was 49 percent and the rate of tissue expander use was 51 percent. Tissue expander placement was performed primarily in patients who resided in cities (OR, 2.4; 95 percent confidence interval, 1.5 to 4.1) and was performed at city hospitals. Patients who lived in rural areas primarily underwent autogenous tissue reconstruction, traveled to city hospitals to undergo surgery (OR, 2.0; 95 percent confidence interval, 1.0 to 4.0), and had normal body mass index (OR, 1.9; 95 percent confidence interval, 1.1 to 3.1)., Conclusions: The authors identified potential disparities associated with breast reconstruction. These disparities might be due to limited surgery methods and might have excluded some patients because of their age, physical, and economic status. Uneven distribution of plastic surgeons might have required patients to travel for breast reconstruction., Clinical Question/level of Evidence: Therapeutic, III.

Specimens of recipient vessels were obtained from the oral and maxillofacial regions when carrying out microsurgery and the condition of the vascular wall was analyzed histopathologically. This study was performed in both Japan and Germany and the results were compared. A higher percentage and a more advanced abnormality of the recipient vessel seemed to exist in the German patients as compared to the Japanese patients. This difference could be due to the preoperative multimodal chemo- and radiotherapy more often applied in Germany and the higher incidences of systemic diseases such as hypertension and diabetes in the German population. The success rate of the surgery is, however, the same in both countries. It could be concluded that the viability of the flaps was not affected by preoperative damage to the recipient vessel.