Abstract
BACKGROUND: Breast reconstruction after mastectomy is crucial for physical and psychological recovery. While reconstruction rates have risen globally under supportive policies, utilization in China remains low, and nationwide data on patterns, costs, and access are scarce. This study aims to provide the first comprehensive analysis of the current status, costs, and regional disparities of breast reconstruction in Chinese plastic surgery department based on national quality control databases. METHODS: We analyzed three national databases [the National Clinical Improvement System (NCIS), the National Medical Quality Control Platform of Plastic and Aesthetic Medicine (QCP-PAM), and the Hospital Quality Monitoring System (HQMS)]. Variables included surgical volume, reconstruction type, perioperative antibiotic usage, surgical site infection rate, hospitalization cost, and self-pay ratio. Descriptive statistics, cross-database comparisons, and Pearson's correlations with socioeconomic indicators [per capita gross domestic product (GDP), urbanization rate] were performed. RESULTS: In 2022, NCIS recorded 30,530 breast cancer surgeries, with a phase I reconstruction rate of 6.4%. HQMS identified 490 reconstructions across 15 China's provincial-level administrative divisions (PLADs) in 2023, with mean hospitalization cost of CNY 53,695 and self-pay of 61.7%. Regional disparities were striking, with self-pay ranging from <10% to 100%. GDP correlated positively with cost (r=0.45) and negatively with self-pay (r=-0.60); urbanization was also negatively correlated with self-pay (r=-0.50). CONCLUSIONS: This first nationwide analysis highlights low reconstruction rates, heavy financial burden, and marked geographic inequities. Expanded insurance, stronger infrastructure, and quality monitoring are needed to improve access. Limitations include incomplete provincial coverage, lack of detailed outcomes, and potential underreporting.