Insurance type influences timeliness and outcomes of post mastectomy breast reconstruction

Background: Patients with government-based insurance often face barriers to care, including delayed access to specialists. This study investigates the impact of insurance type on post mastectomy breast reconstruction (PMBR) timeliness and outcomes. Methods: Data was collected on PMBR patients between 2017 and 2023. Insurance types were categorized as Private, Medicaid or Medicare. Outcomes included the mean length of time from diagnostic biopsy to plastic and reconstructive surgery (PRS) consultation, initiation and completion of reconstruction, operative times for index and final reconstructive procedures, complication rates, and hospital length of stay (LOS). Regression analyses assessed associations between insurance type and outcomes. Results: 1584 breast reconstruction patients were identified, of which 948 patients (60%) had Private-insurance, 287 patients (18%) had Medicaid, and 349 patients (22%) had Medicare. Demographics, comorbidities and reconstruction modality were significantly different between cohorts. On regression analysis, Medicare patients showed significant delays with respect to initiation (β = 0.110, p = < 0.001) and completion (β = 0.116, p = < 0.001) of reconstruction. Furthermore, both Medicare (aOR 1.34, p =.04) and Medicaid (aOR 1.40, p =.02) patients had higher odds of having a complication compared to Private-insurance counterparts, while only Medicare patients showed longer hospital length of stay (β = 0.065, p =.004). Conclusions: Compared to private-insurance patients, Medicare patients had longer waits for initiation and completion of reconstructive care while both Medicaid and Medicare patients had significantly elevated complication rates, underscoring the role of insurance in healthcare access and delivery across breast cancer patients. Level of Evidence: Level III, risk / prognostic study.