Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care.

Background and Objectives: Breast cancer-related lymphedema (BCRL) is a complication of axillary lymph node dissection (ALND). Immediate lymphatic reconstruction (ILR) may help to decrease lymphedema after ALND by creating lymphatic bypasses. This retrospective single-institution study aimed to compare lymphedema in patients undergoing ALND with and without ILR. Materials and Methods: Bioimpedance and limb measurements determined the presence of BCRL. The categorical data that were collected and analyzed included BMI, comorbidities, BCRL onset, and number of lymphatic bypasses. Pearson’s chi-square test and multivariable logistic regression were performed to identify factors associated with the onset of lymphedema. An odds ratio compared the incidence of BCRL with and without ILR. Results: In total, 186 patients underwent ALND, 44 (24%) with ILR and 142 (76%) without. The mean number of bypasses during ILRs created was 3.54. The odds of developing lymphedema with ILR were 64% lower than for ALND alone. ILR patients who developed BCRL had a mean onset of 543 days post-operatively versus 389 days in the control group. Age, ethnicity, BMI, and bypass amount had no significant influence on lymphedema development. Conclusions: ILR was associated with lower rates of BCRL after ALND. Patients who developed lymphedema despite undergoing ILR did so 8 months later than the controls.

Background: Large-volume ptotic breasts are associated with incision complication rates in single-stage direct-to-implant pre-pectoral breast reconstruction. The aim is to propose an updated surgical approach for this patient population. Methods: A small retrospective case series of patients who underwent direct-to-implant breast reconstruction without a wise-pattern incision from 2019 to 2024 at a single academic institution. Results: Eight breasts from five patients fulfilled the inclusion criteria. One patient had minimal superior nipple–areolar complex ischemia with no additional postoperative complications identified. Conclusions: Refinement to a popular direct-to-implant breast reconstruction technique has the potential to decrease complication rates and improve aesthetic outcomes in large-volume ptotic breasts.

Objective: The aim of this study is to investigate how demographic factors influence medical students' attitudes toward COVID-19 vaccines and their perceptions of vaccine education in medical school curricula. Methods: A 28-question anonymous online survey was distributed to 640 medical students at one academic medical institution. Individual attitudes toward vaccines were evaluated using a 5-point Likert scale. Responses were tested for association with various demographic factors using the Chi-square test or Fisher's exact test. Results: Two-hundred and forty-four responses out of 640 total surveyed revealed that 97.9% of the students had received at least one COVID-19 vaccine, 68.44% supported mandatory vaccinations, 16.81% did not believe vaccination protects others from getting sick, and 66.4% supported vaccine personal choice, with men showing a statistically stronger belief than women (p=0.0046). Approximately 25.1% of the students reported not receiving sufficient vaccine education in medical school and only 12.4% of all students considered medical school curricula as their most trusted source of vaccine information. Moreover, 8.6% of the students would not encourage patients to receive the COVID-19 vaccine and 8.2% were uncomfortable discussing patients' concerns. Unvaccinated students were more likely to not encourage patients to receive the vaccine (p<0.0001) and were more inclined to believe that acquiring natural immunity was preferable to vaccination (p<0.0001). One hundred percent of very conservative students, 97.8% of slightly conservative students, and students associated with any religion displayed statistical significance in endorsing vaccine personal choice (p=<0.0001), particularly among Christians (p=<0.0001). In contrast, 28% of very liberal and 48.3% of slightly liberal students agreed (p<0.0001). Additionally, the majority of liberal students agreed vaccines prevent the spread of disease while only 75% of conservative, independent, and neutral students agreed (p<0.001). Conclusion: Despite high compliance, this cohort significantly demonstrated concern toward the COVID-19 vaccine, particularly those who were unvaccinated, had conservative political associations, and belonged to certain religious groups. These findings suggest identifying factors that impede medical education and an understanding of vaccines in order to improve physician training. We recommend an expanded medical curriculum to address these issues.